Anger, Anxiety, and Depression as Risk Factors for Cardiovascular Disease: The Problems and Implications of Overlapping Affective Dispositions

The effects of aerobic training on subclinical negative affect: A randomized controlled trial

OBJECTIVE

The antidepressant and anxiolytic effects of aerobic exercise are well known, but less is known about its effects on subclinical levels of trait negative affect in healthy but sedentary adults. In the present study, we test the effects of a 3-month randomized controlled trial of aerobic exercise training in young to midlife adults on trait measures of depression, anxiety, hostility, and anger.

METHOD

One-hundred and 19 men (n = 56) and women (n = 63) aged 20-45 were randomized to 1 of 2 conditions: (a) 12 weeks of aerobic exercise after which they were asked to halt exercising and decondition for 4 weeks, or (b) a 16-week waitlist control group. Assessments of depression, anxiety, hostility and anger were completed at study entry, Week 12 and Week 16.

RESULTS

At study entry, participants scored low on measures of depression, anxiety, hostility and anger. Analyses among the intent-to-treat and per protocol samples found significant treatment effects of aerobic training for hostility and depression, but not for anxiety and anger. Within-group analyses demonstrated that depression and hostility scores decreased in the exercise group over the course of the intervention, while remaining stable in the control group. These effects persisted for the exercise group at nonsignificant levels after 4 weeks of deconditioning.

CONCLUSIONS

Aerobic exercise training has significant psychological effects even in sedentary yet euthymic adults, adding experimental data on the known benefits of exercise in this population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Understanding the influence of high novelty-seeking on academic burnout: Moderating effect of physical activity

A large number of studies have shown a positive correlation between high novelty-seeking (HNS), substance/medication use (S/MU), high physical activity (HPA), and academic burnout (AB); however, the outcome of individuals with HNS in the terms of catching AB is doubtful. The present study was conducted to find out whether the personality traits such as HNS in medical students predisposes the AB or decreases its severity by increased physical activity (PA). This cross-sectional study, 227 medical students with HNS were selected from three major cities of Iran during February, 2019 to July, 2019 using convenience sampling and were assessed using demographic information form, Baecke’s physical activity questionnaire, and Breso’s academic burnout questionnaire. In this study, 126 male and 151 female participants were divided into four groups namely HNS + low physical activity (LPA) (n = 68); HNS + HPA (n = 73); HNS + S/MU + LPA (n = 72); and HNS + S/MU + HPA (n = 64). The study results indicated that the maximum and minimum mean scores of AB and its subscales were in the HNS + S/MU + LPA and HNS + HPA groups, respectively. In addition, the hierarchical multiple regression analysis results for the two groups of students with and without S/MU indicated that PA plays a moderating role in the relationship between AB and HNS. Given that the AB can be considered as an antecedent of depressive disorders, its lowered level could be effective in preventing major depressive disorder. Regarding the moderating role of PA in the relationship between HNS and AB, PA, as a relatively simple and inexpensive alternative to pharmacotherapy and psychotherapy, can be raised in the treatment and prevention of the AB.

Real Men Don't Cry: Skill Expressing Discrete Emotions Differentially Predicts Cardiovascular Disease Risk in Men and Women

BACKGROUND

Expressing emotions effectively is central to social functioning and has links to health and cardiovascular disease (CVD) risk. Previous work has linked the ability to smile to lower CVD risk in men but has not studied other expressions or considered the context of these skills.

PURPOSE

To test whether the ability to express fear, anger, sadness, happiness, and disgust cross-sectionally predict CVD risk in both genders and whether links are moderated by the ability to decode others' emotional signals.

METHODS

A community sample of 125 men and women (30-75 years) provided trait emotion data before a laboratory visit where blood was drawn and performance-based assessments of the ability to signal and decode emotions were administered. Expressive accuracy was scored using FaceReader software. Projected CVD risk was calculated using Framingham, a New Zealand (NZ) specific, and Atherosclerosis CVD (ASCVD) risk algorithms.

RESULTS

Accuracy expressing happiness predicted lower projected risk, whereas greater accuracy expressing fear and sadness predicted higher risk. Gender frequently moderated these links; greater accuracy expressing happiness predicted lower risk in men but not women. Conversely, greater accuracy expressing fear predicted higher risk in men, whereas greater accuracy expressing sadness predicted lower risk in women but, again, higher risk in men. The ability to accurately decode others' emotions moderated some links.

CONCLUSIONS

The ability to signal emotion has complex links to health parameters. The ability to flexibly regulate expressions in accordance with gender norms may be one useful way of thinking about adaptive expressive regulation.

Linking Daily-Life Interpersonal Stressors and Health Problems Via Affective Reactivity in Borderline Personality and Depressive Disorders

OBJECTIVE

Borderline personality disorder (BPD) is associated with unstable interpersonal relationships, affective instability, and physical health problems. In individuals with BPD, intense affective reactions to interpersonal stressors may contribute to the increased prevalence of health problems.

METHODS

BPD (n = 81) and depressed participants (DD; n = 50) completed six daily ambulatory assessment prompts for 28 days. At each prompt, participants reported interpersonal stressors (disagreements, rejections, feeling let down), negative affect, and health problems in four domains (gastrointestinal, respiratory, aches, depressive symptoms). In multilevel moderated mediation models, we examined the indirect effects of interpersonal stressors on health problems via negative affect, by group.

RESULTS

Interpersonal stressors were positively associated with negative affect in both groups (β values > 0.12, p values < .001), but more so for participants with BPD (βDay = 0.05, p < .001). Negative affect was positively associated with health problems across all domains (βMoment/Day values > 0.01, p values < .046), but associations were larger at the day level for respiratory symptoms in BPD (β = 0.02, p = .025) and for depressive symptoms in DD (β = 0.04, p < .001). Negative affect mediated the association of interpersonal stressors and health problems in both groups, with larger effects for the DD group for depressive problems (β = 0.02, p = .092) and for the BPD group for the other three domains (β values > 0.02, p values < .090).

CONCLUSIONS

Interpersonal stressors may contribute to increased physical health problems via an inability to regulate affective responses to such events. This pathway may be stronger in several health domains for those with BPD and may contribute to an elevated risk of morbidity and mortality in this disorder, suggesting a target for intervention to reduce these risks.

Psychological Distress and Heart Disease Mortality in the United States: Results from the 1997-2014 NHIS-NDI Record Linkage Study

OBJECTIVE

Despite the long-term decline, heart disease has remained the leading cause of death in the United States (US) over the past eight decades, accounting for 23% of all deaths in 2017. Although psychological distress has been associated with cardiovascular disease mortality, the relationship between different psychological distress levels and heart disease mortality in the US has not been analyzed in detail. Using a national longitudinal dataset, we examined the association between levels of psychological distress and US heart disease mortality.

METHODS

We analyzed the Kessler 6-item psychological distress scale as a risk factor for heart disease mortality using the pooled 1997-2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N=513,081). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates.

RESULTS

In Cox models with 18 years of mortality follow-up, the heart disease mortality risk was 121% higher (hazard ratio [HR]=2.21; 95% CI=1.99,2.45) in adults with serious psychological distress (SPD) (p<0.001), controlling for age, and 96% higher (HR=1.96; 95% CI=1.77,2.18) in adults with SPD (p<0.001), controlling for age, gender, race/ethnicity, immigrant status, education, marital status, poverty status, housing tenure, and geographic region when compared with adults without psychological distress. The relative risk of heart disease mortality associated with SPD decreased but remained significant (HR=1.14, 95% CI=1.02,1.28) after controlling for additional covariates of smoking, alcohol consumption, self-assessed health, activity limitation, and body mass index. There was a dose-response relationship, with relative risks of heart disease mortality increasing consistently at higher levels of psychological distress. Moreover, the association varied significantly by gender and race/ethnicity. The relative risk of heart disease mortality for those who experienced SPD was 2.42 for non-Hispanic Whites and 1.76 for non-Hispanic Blacks, compared with their counterparts who did not experience psychological distress.

CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS

US adults with serious psychological distress had statistically significantly higher heart disease mortality risks than those without psychological distress. These findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing heart disease mortality.

Neighborhood crime is differentially associated with cardiovascular risk factors as a function of race and sex

Background: Neighborhood crime may be an important factor contributing to cardiovascular health disparities, and these relations may vary by race and sex. The present investigation evaluated (a) potential differential associations between neighborhood crime and cardiovascular disease (CVD) risk factors within subgroups of African American (AA) and White men and women, and (b) potential mediation by negative affect. Design and Methods: Participants were 1,718 AAs and Whites (58% AA; 54% female; 59% above poverty; ages 30-64 years) living Baltimore, Maryland who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span study from 2004-2009. CVD risk factors included body mass index, total serum cholesterol, glucose, and systolic and diastolic blood pressure. A negative affect composite was comprised of self-reported depression, anxiety, anger, vigilance, and perceived stress. Hierarchical multiple regression analyses were used to examine associations between per capita overall and violent crime rates, negative affect, and CVD risk factors. Results: There were significant associations of greater overall crime rate with higher fasting glucose (b=.192, P<0.05), and greater violent crime rate with higher systolic (b=86.50, P<0.05) and diastolic (b=60.12, P<0.05) blood pressure in AA women, but not men. These associations were not explained by negative affect. In Whites, there were no significant associations of overall or violent crime rates with cardiovascular risk factors. Conclusions: AA women may be particularly vulnerable to the negative impact of crime on cardiovascular risk. Preventative efforts aimed toward this group may help to deter the detrimental effects that living in a high crime area may have on one's cardiovascular health.

A Systematic Review and Meta-analysis of Depression, Anxiety, and Sleep Disorders in US Adults with Food Insecurity

INTRODUCTION

A large number of peer-reviewed studies, with various methodologies and populations, have addressed the effects of food insecurity (FIS) on mental health conditions such as depression, anxiety, and sleep disorders. There are currently, however, no published systematic assessments or meta-analyses of this literature.

METHODS

A systematic search of the literature was conducted in PubMed, PsycInfo, Embase, Scopus, and Web of Science. Cross-sectional studies assessing the association between food insecurity and depression, anxiety, or sleep disorders were identified. For each of the three health outcomes, we extracted (or calculated when possible) the following effect sizes: odds ratio (OR), Hedges' g, Pearson correlation coefficients r, or bivariate coefficients. Then, for each mental health-outcome/effect-size pair, the available studies were combined using the random effect model. Heterogeneity, publication bias, and subgroup dependence, for each meta-analysis, were also assessed.

RESULTS

Fifty-seven studies provided cross-sectional data on the relationship between FIS and depression (n = 169,433), 13 on anxiety and psychological distress (n = 91,957), and 8 studies provided data on sleep disorders (n = 85,788). Meta-analysis showed that FIS is associated with an increased risk of testing positive for depression OR = 2.74 [95% CI 2.52-2.97, n = 135,500, Q(df = 41) = 69, I² = 40%], anxiety OR = 2.41 [95% CI 1.81-3.22, n = 51,541, Q(df = 3) = 8, I² = 63%], and sleep disorders OR = 1.80 [95% CI 1.51-2.15, n = 84,800, Q(df = 5) = 13, I² = 62%]. The highest risks were found for depression and anxiety which had statistically similar values. The results were robust to covariates and population groups.

DISCUSSION

This systematic review and meta-analysis demonstrates a strong association between FIS and depression, anxiety, and sleep disorders, for which more longitudinal studies addressing effect sizes are warranted to further study causation.

Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities

Evidence of popular interest in the interrelationships between mind, body, and heart disease dates to Ancient Grecian times and paved the way for modern-day scientific inquiry into the relationships between psychological comorbidities in coronary heart disease. Although the systematic evidence has suggested an association of poor medical prognosis and lower quality of life among patients with coronary heart disease with comorbid psychological conditions, the mechanisms are less well understood. In this selective review article, the epidemiology, mechanisms, screening, and treatment recommendations for 4 common psychological conditions (depression, anxiety, stress, and insomnia) comorbid with coronary heart disease are presented. We focus on the grand challenges and unprecedented opportunities for research in this area considering the methodological and technological innovations of the 21st century. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The association between psychological distress and angina pectoris: A population-based study

BACKGROUND

Psychological distress is an undifferentiated combination of symptoms that may be related to the occurrence of angina pectoris (AP). However, few studies have investigated the relationship between psychological distress and AP, particularly in Asian populations. The purpose of this study was to examine the relationship between psychological distress and AP in Taiwanese adults.

METHODS

We adopted a cross-sectional design to explore the data of the 2005-2008 Nutrition and Health Survey in Taiwan. In total, 2080 subjects (aged ≥ 19 years) responded to questionnaire interviews and underwent physical examinations. Each of the five dimensions of psychological distress (sleep disturbance, anxiety, hostility, depression, and feelings of inferiority) were scored (from 0-20) according to the Five-Item Brief Symptom Rating Scale (BSRS-5). A score ≥ 6 points indicated psychological distress. AP was evaluated using a modified Rose questionnaire.

FINDINGS

In total, 102 subjects (3.6%) had AP, and 231 subjects (8.8%) had symptoms of psychological distress. After adjusting for the basic data, metabolism, and lifestyle covariates, the BSRS-5 total score was associated with AP (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.13-1.26, p < 0.001). Subjects with psychological distress had a higher risk of AP (OR = 2.97, 95% CI = 1.76-4.99, p < 0.001).

CONCLUSIONS

The presence of AP is associated with psychological distress. Health care providers should therefore be aware of the impact of psychological distress on AP. Our study findings can serve as a reference for AP assessments. Large scale longitudinal studies are needed to confirm a causal relationship between psychological distress and AP.

Factor structure and validity of Type D personality scale among Indian (Tamil-speaking) patients with acute myocardial infarction

BACKGROUND

Type D personality has been linked to negative outcomes following acute myocardial infarction (AMI). Our objective was to determine the factor structure, reliability, and validity of the Type D personality construct among people with AMI in the Indian clinical setting.

MATERIALS AND METHODS

In a cross-sectional study conducted between August 2016 and July 2017, 200 consecutive patients with AMI admitted to a tertiary care center completed the Tamil version of the Type D scale-14 (DS-14). The Eysenck Personality Questionnaire Revised-Short Form (EPQR-S) was also administered to check the convergent/divergent validity.

RESULTS

The prevalence of Type D personality was 24%. Results of the principal components analysis revealed a four-factor solution for the Tamil version of the DS-14 which explained more than 75% of the variability. Strong convergent validity with the neuroticism subscale of EPQR-S (r = 0.84, P < 0.001) and divergent validity with the extraversion subscale (r = -0.75, P < 0.001) was noted. The two subscales of the Type D scale, negative affectivity and social inhibition (SI), demonstrated good reliability (Cronbach's alpha of 0.85 and 0.76, respectively). Dropping item no 14 from the DS-14 led to significant increase in internal consistency (Cronbach's alpha 0.81) for the SI subconstruct.

CONCLUSION

Among an Indian Tamil-speaking clinical sample of patients with AMI, Type D is a valid construct and can be assessed using the regional version of the DS-14 which showed a four-factor structure and good psychometric properties. Item no. 14 of the DS-14 scale may need modification for the Indian setting.

The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study

BACKGROUND

Co-morbid depression and anxiety symptoms are frequently under-recognised and under-treated in heart disease and this negatively impacts self-management.

AIMS

The purpose of this study was to determine the prevalence, correlates and predictors of depression and anxiety in cardiac rehabilitation programmes, the impact of cardiac rehabilitation on moderate depression, anxiety and stress symptoms, and the relationship between moderate depression, anxiety and stress symptoms and cardiac rehabilitation adherence.

METHODS

This was a retrospective cohort study of 5908 patients entering cardiac rehabilitation programmes from 2006-2017, across two Sydney metropolitan teaching hospitals. Variables included demographics, diagnoses, cardiovascular risk factors, medication use, participation rates, health status (Medical Outcomes Study Short Form-36) and psychological health (Depression Anxiety Stress Scales) subscale scores.

RESULTS

Moderate depression, anxiety or stress symptoms were prevalent in 18%, 28% and 13% of adults entering cardiac rehabilitation programmes, respectively. Adults with moderate depression (24% vs 13%), anxiety (32% vs 23%) or stress (18% vs 10%) symptoms were significantly less likely to adhere to cardiac rehabilitation compared with those with normal-mild symptoms (p < 0.001). Anxiety (odds ratio 4.395, 95% confidence interval 3.363-5.744, p < 0.001) and stress (odds ratio 4.527, 95% confidence interval 3.315-6.181, p < 0.001) were the strongest predictors of depression. Depression (odds ratio 3.167, 95% confidence interval 2.411-4.161) and stress (odds ratio 5.577, 95% confidence interval 4.006-7.765, p < 0.001) increased the risk of anxiety on entry by more than three times, above socio-demographic factors, cardiovascular risk factors, diagnoses and quality of life.

CONCLUSION

Monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation can assist to improve adherence and may identify the need for additional psychological health support. Exploring the relevance and use of adjunct psychological support strategies within cardiac rehabilitation programmes is warranted.

Emotions in Social Relationships and Their Implications for Health and Disease: Introduction to the Special Issue of Psychosomatic Medicine

Social relationships and emotions are important to health and disease, but research in this area has largely progressed along parallel and distinct historical paths. These areas are critically linked because relationships are among the most powerful elicitors of health-relevant emotions and emotions can in turn influence relationships for better or worse. Conceptually, relationships and emotions can have mediational, reciprocal, and interactive influences on health outcomes, associations that seem dependent on the broader sociocultural context. The articles in this issue of Psychosomatic Medicine are based on a joint meeting of the American Psychosomatic Society and the Society for Affective Science titled "Emotions in social relationships: implications for health and disease." Recent research and conceptual models that fall at the interface of relationships, emotions, and health are highlighted in this special issue. Future work that capitalizes on these links will be critical if this area is to fulfill its potential in terms of new scientific insights and intervention opportunities.

Trait dominance and cardiovascular functioning during social stress

Cardiovascular reactivity (CVR) to stress has been found to be an important indicator of future ill health, and individual differences in personality have been posited to explain disparities in outcomes. Dominance is associated with forceful persons who desire hierarchy in social interactions. This study investigated dominance and CVR during social or asocial stressors. Sixty-one women, categorized as low, moderate, or high in dominance using the Jackson Personality Research Form, completed a social or asocial stressor while undergoing cardiovascular measurement during baseline, stressor, and recovery phases. A 3 × 2 × 3 analysis of covariance revealed a significant Phase × Stressor × Dominance interaction for systolic blood pressure (SBP). Women with lower and moderate dominance-but not women with higher dominance-exhibited greater SBP responses to stress in the social condition compared with the asocial condition. No significant difference was found for women with higher dominance, indicative of blunted SBP during the social stressor. During recovery, women with lower dominance had marginally elevated SBP in the social condition compared with the asocial condition. The current study extends prior knowledge of the association between dominance and CVR, such that greater dominance was associated with blunted SBP and lower dominance was associated with attenuated recovery to social stress.

Prospective associations of happiness and optimism with lifestyle over up to two decades

Greater levels of psychological well-being are associated with reduced disease and mortality risk, and lifestyle habits may be potential mechanisms underlying these relationships. Prospective studies show that positive psychological factors enhance the likelihood of adopting specific health behaviors; yet, whether they promote the adoption of multiple healthy behaviors, which can have a multiplicative effect on disease and mortality risk compared to individual behaviors, is unknown. We investigated whether happiness and optimism were related to a healthy lifestyle (characterized by multiple health behaviors) over 10-22 years of follow-up; we also explored bidirectional associations, assessing if a healthy lifestyle at baseline was related to greater likelihood of experiencing higher happiness and optimism over time. Women reported levels of happiness in 1992 (N = 52,133) and optimism in 2004 (N = 36,802). Health-related behaviors (physical activity, body mass index, diet, alcohol and tobacco consumption) were self-reported and combined into a lifestyle score, every four years from baseline until 2014. Multivariable generalized estimating equations with a Poisson distribution were used. Women with moderate and higher (versus lower) happiness levels were more likely to report sustaining healthy lifestyles (RR = 1.18, CI = 1.11-1.25; RR = 1.39, CI = 1.32-1.46, respectively). In secondary analyses, the magnitude of the inverse association was somewhat smaller (likelihood of sustaining higher happiness levels for baseline healthy versus unhealthy lifestyle, RR = 1.11, CI = 1.10-1.12). Results were similar when considering optimism as the exposure and in other secondary analyses (e.g., across individual habits). While bidirectional associations are apparent, these findings suggest pursuing happiness and optimism as modifiable determinants of lifestyle deserves further consideration.

Cardiovascular Disease and Homelessness

Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.

Understanding of and perceptions towards cardiovascular diseases and their risk factors: a qualitative study among residents of urban informal settings in Nairobi

OBJECTIVES

The study explored the understanding of and perception towards cardiovascular disease (CVD) and risk factors, and how they influence prevention and development of the conditions, care-seeking and adhering to treatment.

SETTING

Informal settlements of Nairobi.

PARTICIPANTS

Nine focus group discussions consisting of between six and eight purposively sampled participants were conducted among healthy individuals aged 20 years or older. A total of 65 participants (41 female) were involved.

RESULTS

Poverty, ignorance and illiteracy promoted behaviours like smoking, (harmful) alcohol consumption, physical inactivity and unhealthy diet, implicated in the development of obesity, diabetes and hypertension. Some respondents could not see the link between behavioural risk factors with diabetes, hypertension and stroke and heart attacks. Contaminated food items consumed by the residents and familial inheritance were factors that caused CVD, whereas emotional stress from constant worry was linked to hypertension, stroke and heart attacks. Few and inadequately equipped public health facilities were hindrances to treatment seeking and adherence to treatment for CVD conditions. Lack of medication in public health facilities was considered to be the single most important barrier to adherence to treatment next to lack of family support among older patients.

CONCLUSION

Interventions to prevent and manage CVD in low-resource and urban poor settings should consider perceptions and understanding of risk factors for CVD, and the interrelationships among them while accounting for cultural and contextual issues for example, stigma and disregard for conventional medicine. Programmes should be informed by locally generated evidence on awareness and opportunities for CVD care, coupled with effective risk communication through healthcare providers. Screening for and treatment of CVD must address perceptions such as prohibitive cost of healthcare. Finally, social determinants of disease and health, mainly poverty and illiteracy, which are implicated in addressing CVD in low-resource settings, should be addressed.

Persistent emotional distress after a first-time myocardial infarction and its association to late cardiovascular and non-cardiovascular mortality

BACKGROUND

Patients with symptoms of depression and/or anxiety - emotional distress - after a myocardial infarction (MI) have been shown to have worse prognosis and increased healthcare costs. However, whether specific subgroups of patients with emotional distress are more vulnerable is less well established. The purpose of this study was to identify the association between different patterns of emotional distress over time with late cardiovascular and non-cardiovascular mortality among first-MI patients aged <75 years in Sweden.

METHODS

We utilized data on 57,602 consecutive patients with a first-time MI from the national SWEDEHEART registers. Emotional distress was assessed using the anxiety/depression dimension of the European Quality of Life Five Dimensions questionnaire two and 12 months after the MI, combined into persistent (emotional distress at both time-points), remittent (emotional distress at the first follow-up only), new (emotional distress at the second-follow up only) or no distress. Data on cardiovascular and non-cardiovascular mortality were obtained until the study end-time. We used multiple imputation to create complete datasets and adjusted Cox proportional hazards models to estimate hazard ratios.

RESULTS

Patients with persistent emotional distress were more likely to die from cardiovascular (hazard ratio: 1.46, 95% confidence interval: 1.16, 1.84) and non-cardiovascular causes (hazard ratio: 1.54, 95% confidence interval: 1.30, 1.82) than those with no distress. Those with remittent emotional distress were not statistically significantly more likely to die from any cause than those without emotional distress.

DISCUSSION

Among patients who survive 12 months, persistent, but not remittent, emotional distress was associated with increased cardiovascular and non-cardiovascular mortality. This indicates a need to identify subgroups of individuals with emotional distress who may benefit from further assessment and specific treatment.

Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure

Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.

The Relation of Psychosocial Distress With Myocardial Perfusion and Stress-Induced Myocardial Ischemia

OBJECTIVE

Mental stress-induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease (CAD). The link between an integrated measure of chronic psychosocial distress and mental stress-induced myocardial ischemia, and whether it differs by sex, has not been examined before.

METHODS

We used latent class analysis to derive a composite measure of psychosocial distress integrating scales of depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress in 665 individuals with stable CAD. Participants underwent myocardial perfusion imaging with mental stress and perfusion defects were quantified at rest (summed rest score), with mental stress (summed stress score), and their difference (summed difference score), the latter being an index of inducible ischemia.

RESULTS

The M (SD) age was 63 (9) years, and 185 (28%) were women. Latent class analysis characterized the study sample into four distinct classes of incremental psychosocial distress. In women, class 4 (highest distress) had an adjusted 4.0-point higher summed rest score (95% confidence interval = 0.2-7.7) as compared with class 1 (lowest distress), whereas no difference was observed in men (-0.87 points, 95% confidence interval = -3.74 to 1.99, p = .04 for interaction). There was no association between the psychosocial distress latent variable and summed difference score in either women or men.

CONCLUSIONS

Among patients with CAD, a higher level of psychosocial distress is not associated with mental stress ischemia, but it is associated with more resting (fixed) perfusion abnormalities in women only, as well as with blunted hemodynamic response to mental stress in both men and women.

The Association Between Symptoms of Anxiety, Depression, and Cardiovascular Risk Factors: Results From an Italian Cross-Sectional Study

Cardiovascular diseases, anxiety, and depression are among the most frequent clinical conditions in the Western world, often in comorbidity. Evidence regarding a shared pathophysiology suggests a mediating role by chronic systemic inflammation. The aims of this study were to measure the association between anxiety and depressive symptoms, cardiovascular risk factors, and inflammatory markers. Outpatients aged 40 years or more undergoing colonoscopy after positive fecal occult blood test were enrolled; the following data were collected: body mass index, blood pressure, blood glucose, lipid profile, C-reactive protein (CRP) level, carotid thickness, Hospital Anxiety and Depression Scale, Temperament and Character Inventory, INTERdisciplinary MEDicine Self-Assessment, and 36-Item Short-Form Health Survey scores. Fifty-four patients were enrolled; 30.2% had anxiety symptoms, 18.9% depressive symptoms, and 9.4% concomitant anxiety-depressive symptoms. Anxiety symptoms were associated with low high-density lipoprotein levels. Depressive symptoms were associated with CRP levels, providing supporting evidence for the role of inflammation in the pathophysiology of depression.

Emotional Dysregulation as a Factor of Psychosomatic Disturbances in Depression and Cardiovascular Pathology (Analytical Review of Foreign Literature)

The review presents data on cognitive processes of emotional regulation, which are the result of the interaction of the activity of the prefrontal cortex and emotional centers, as the most important pathogenetic link in the psychosomatic relations of depressive and cardiovascular diseases. The neuroanatomical substrate of emotional regulation is the connection between emotional and cognitive processes, which are carried out through bidirectional neuronal interactions between the neocortex and emotional centers. This connection allows emotional centers to modulate cortical activity, and cognitive centers, through descending cortical influences, to modulate the processing of emotions. At present, direct and indirect connections of the frontal cortex with the centers of the autonomic nervous system and its stimulating sympathetic and inhibitory parasympathetic influences have been confirmed. Pathogenetic links of emotional dysregulation include neurobiological and cognitive (rumination, fixation on negative information) processes. The pathophysiological mechanisms of depression and cardiovascular diseases have common links - the dysregulation of the metabolic, immunological and hypothalamus-pituitary-adrenal systems. The tendency to negative emotional response, the prevalence of negative emotions and alexithymia (low awareness of emotions) stand out as predictors of the development of both cardiovascular diseases and depression. Studies aimed at studying the typology and meaning of emotional dysregulation in various forms of psychopathological disorders in the aspect of comorbidity and psychosomatic relationships with somatic diseases can be fruitful in terms of finding new approaches to diagnosis and therapy.

Associations of mindfulness with depressive symptoms and well-being in older adults: the moderating role of neuroticism

OBJECTIVE

To investigate whether observed interactions of mindfulness with the personality trait neuroticism extend to older adults and to aspects of psychological functioning other than depressive symptoms, and whether effects of mindfulness training in this population depend on levels of neuroticism.

METHOD

We performed a secondary analysis of data from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) for community-dwelling older adults. We investigated whether neuroticism moderates associations of dispositional mindfulness with various aspects of psychological and physical functioning at baseline, as well as effects of MBSR on these outcomes.

RESULTS

Significant two-way interactions showed that greater mindfulness was associated with fewer depressive symptoms and less negative affect at baseline in individuals with average or higher levels of neuroticism. In contrast, mindfulness was associated with greater positive affect and vitality and fewer physical symptoms regardless of the level of neuroticism. There were no effects of MBSR on these outcomes at any level of neuroticism.

CONCLUSION

Mindfulness may be more protective against psychological ill-being in older adults with higher levels of neuroticism, but conducive to positive psychological and physical well-being regardless of this personality trait. The potential moderating role of neuroticism should be further evaluated in studies of mindfulness-based interventions in older adults.

The Role of Positive and Negative Affectivity in Healthy and Unhealthy Work-Related Behavior and Experiences

Abstract. Positive affectivity (PA) and negative affectivity (NA) are basic traits that affect work-related perceptions and behaviors and should be considered in any assessment of these variables. A quite common method to assess healthy or unhealthy types of work-related perceptions and behaviors is the questionnaire on Work-Related Coping Behavior and Experience Patterns (WCEP). However, the association of PA and NA with WCEP remained unclear. In a sample of teachers, physiotherapists, and teacher students ( N = 745; Mage = 35.07, SD = 12.49; 78% females), we aimed to identify the relevance of these basic traits. After controlling for age, gender, and type of occupation, we found main effects of PA and NA, with the specific combination of PA and NA being decisive for predicting the assignment to a WCEP type. The results highlight the need to include PA and NA in future assessments with the WCEP questionnaire.

Psychiatric Illness Is Common in Elderly Fracture Patients

OBJECTIVES

To (1) describe the prevalence of psychiatric illness in fracture patients ≥70 years of age and (2) investigate the association between psychiatric illness and complications requiring unplanned readmission in elderly patients.

DESIGN

Retrospective cohort study.

PATIENTS/PARTICIPANTS

One thousand one hundred eighty-six patients ≥70 years of age with surgically treated fractures and ≥1-month follow-up treated from 2012 to 2017.

INTERVENTION

None.

MAIN OUTCOME MEASURE

Complication requiring unplanned readmission.

RESULTS

Forty-four percent of patients ≥70 years of age have psychiatric comorbidities, and of those, 34% had >1 diagnosis. There was a higher rate of readmission among patients with psychiatric diagnosis compared with those without psychiatric diagnosis (35% vs. 21%, P < 0.001). There was a higher prevalence of psychiatric illness among patients 70 years of age or older compared with patients less than 70 years of age (44% vs. 39%, P = 0.007). Multivariate regression analysis controlling for age, sex, Charlson Comorbidity Index, dementia, delirium during admission, tobacco use, substance abuse, Injury Severity Score, fracture location, number of procedures, and number of fractures demonstrated an independent association between psychiatric illness and unplanned readmission (adjusted OR 1.54, 95% confidence interval, 1.15-2.07, P = 0.003).

CONCLUSIONS

Almost half of the elderly patients in the present cohort have psychiatric comorbidities. Furthermore, psychiatric illness is an independent predictor of unplanned readmission, which may have substantial consequences for recovery and cost of care. This emphasizes the need for more attention to these issues in geriatric patient populations and the need to identify means to influence the downstream consequences of these comorbidities.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Leveraging digital technology to intervene on personality processes to promote healthy aging

The scientific evidence is clear that personality processes (particularly conscientiousness and neuroticism) play an important role in healthy aging. Assuming it would be desirable to assist individuals to change their personality in directions that would promote healthy aging, the next step is designing interventions for the task. During the past decade, technological advances have made it possible to develop and evaluate interventions delivered via web and mobile digital technologies. The purpose of this article is to discuss the possibilities for leveraging technology to intervene on personality processes to promote healthy aging, with a specific emphasis on applications for older adults. We begin by reviewing interventions that target personality change to treat mental health problems and physical health, followed by the scant research leveraging digital technologies in targeting personality processes. We present a rationale for adopting a transdiagnostic model to guide intervention development and review the brief literature supporting transdiagnostic interventions when adapted for digital delivery (transdiagnostic Internet-based cognitive-behavioral therapy). We then summarize the literature on designing technology interventions to meet the specific needs of older adults and some of the impressive results from digital technology (Internet-based cognitive-behavioral therapy) intervention studies. We conclude with suggestions for addressing gaps in this important but understudied area of research, with a focus on research targeted to older adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Role of Affect on Physical Health Over Time: A Cross-Lagged Panel Analysis Over 20 Years

BACKGROUND

While previous studies have investigated the interplay between affect and health (1) over an extended period of time, (2) in a representative population, and (3) while modelling positive and negative affect simultaneously, no single study has done all three at once.

METHODS

The present study accomplishes this by sampling adults from the Midlife Development in the US study who completed affect (Mroczek & Kolarz, 1998) and health measures (chronic conditions, Charlson, Szatrowski, Peterson, & Gold, 1994; functional limitations, McHorney, Ware, Lu, & Sherbourne, 1994; self-reported health) measured three times over 20 years. We ran three (one per health metric) random-intercept cross-lagged panel models, where positive and negative affect were modelled simultaneously.

RESULTS

Results indicated that positive and negative affect significantly predicted future heath (functional limitations/self-reported health) and that this relationship was reciprocal (i.e. health measures predicted future affect). However, there were no significant cross-lagged relations between affect and chronic conditions.

CONCLUSION

Our results suggest that both positive and negative affect play an equal role in predicting future health for functional limitations and self-reported health as well as highlight the bi-directionality of this relationship. Additionally, the degree to which affect predicts future health may be moderated by the type of health outcome.

Moving Beyond a One-Size-Fits-All View of Positive Affect in Health Research

Although the literature that connects positive affect (PA) to health has exploded over the last 20 years, the approach to studying this topic has remained simplistic. Specifically, researchers overwhelmingly rely on the principle that all PA is healthful, all of the time. Here, we review recent studies indicating that a more nuanced approach is valuable. In particular, we demonstrate that a more thoughtful approach to factors such as arousal, culture, timing, and measurement type results in a more complex picture of when PA is helpful and when it is not. Taking these issues into account also has implications for the types of mechanisms underlying these associations, as well as how other moderators might operate. Thus, we argue that considering these gradations will allow researchers to develop successful and theoretically based health interventions, untangle mixed findings, and enable a deeper understanding of the connection between PA and health.

A computer-based avatar task designed to assess behavioral inhibition extends to behavioral avoidance but not cognitive avoidance

Avoidance is a common feature of post-traumatic stress disorder (PTSD) as well as anxiety and depressive disorders. Avoidance can be expressed behaviorally as well as cognitively. Most personality assessments for avoidance involve self-report inventories which are susceptible to biased responding. The avatar task (Myers et al., 2016a) was developed as an objective measure of behavioral inhibition (BI) which is defined as a tendency for avoidance of unfamiliar people and situations. The avatar task has been demonstrated to screen avoidant behaviors related to BI, PTSD, as well as harm avoidance (HA) as measured by the Tridimensional Personality Questionnaire (TPQ). In the current work, the avatar task was tested with cognitive as well as behavioral avoidance as measured by the cognitive-behavioral avoidance scale (CBAS; Ottenbreit & Dobson, 2004). The CBAS includes four subscales which measure behavioral social (BS) avoidance, behavioral non-social (BN) avoidance, cognitive social (CS) avoidance, and cognitive non-social (CN) avoidance. It was hypothesized that avatar scores would be significantly positively related to behavioral, but not cognitive, avoidance. In addition, it was also hypothesized that performance on the avatar task would be more related to social than non-social behavioral avoidance. Participants completed the avatar task, the HA scale of the TPQ and the CBAS. Pearson's product moment correlations revealed that avatar scores were significantly related to CBAS total scores as well as BS and BN scores, but not CS and CN scores. In addition, BS has a stronger relationship with avatar scores than BN avoidance which fits with the social aspects of the scenarios in the avatar task. A median split of the avatar scores produced a significant difference in scores on the behavioral but not the cognitive subscales. Overall, the current results supported the idea that the avatar task is measuring behavioral avoidance, specifically in social situations, rather than cognitive avoidance. Future work could adapt the avatar task to include scenarios similar to the cognitive items on the CBAS to create an objective measure of cognitive avoidance which may be relevant in measuring avoidance in depression and behavioral avoidance associated with PTSD as well as anxiety disorders.

The case of the middle class: Social determinants of health in Mumbai

In India, a growing middle class and rising lifestyle diseases put prevention in the spotlight. This study assesses the impact of health behaviors (tobacco use and exercise) as well as psychological states (positive emotional style, hope, and perceived stress) on the health of 314 middle class participants from Mumbai. Logistic regression predicting objective health revealed that positive emotional style was a protective factor. Linear regression predicting perceived health indicated perceived stress and positive emotional style as the significant factors. An intersectional approach focusing on psychological factors and health behaviors, nested within class and gender, will lead to effective preventive strategies.

Self-regulation of emotional responses to Zika: Spiral of fear

Fear of infectious disease can create a variety of problems not the least of which is fear itself. An important question is how individuals attempt to manage their fear. The appearance of Zika in the U.S. presented an opportunity to examine this issue in a consequential natural context. Beginning nine days after the W.H.O. declared Zika a world health crisis, two-waves of survey data were collected from women ages 18–35 who were living in the Southern U.S. (N = 561). Most respondents (71%) used one or more emotion regulation strategies and a plurality (41%) utilized multiple strategies. Fear of Zika showed no demonstrable effect on avoidance, reappraisal, or contesting and none of these three strategies were effective at down-regulating fear. Fear and suppression, however, showed a self-reinforcing cycle in which fear increased use of suppression and suppression increased intensity of the fear response. Although the observed associations were small, even modest effects can be consequential when cumulated over time or across large numbers of individuals.

Childhood Misfortune, Personality, and Heart Attack: Does Personality Mediate Risk of Myocardial Infarction?

Objective

Previous research has revealed a link between childhood experiences and adult health, but the mechanisms underlying this relationship are less clear. To elucidate this relationship, we investigated the pathway from childhood misfortune to nonfatal myocardial infarction (MI) via individual differences in personality.

Method

Longitudinal data were drawn from the National Survey of Midlife Development in the United States, which sampled 3,032 men and women aged 25-74 years at baseline. Big 5 personality traits and multiple measures of childhood misfortune were used to assess whether personality mediated the effect of childhood misfortune on MI risk.

Results

A series of proportional hazards models revealed that neuroticism mediated the effect of additive childhood misfortune on adult MI risk.

Discussion

Childhood misfortune may be formative in the development of personality, which, subsequently, can be consequential to health. These findings highlight the salient roles of early-life experiences and personality to shape health and aging.

Behavioral Adjustment Moderates the Link Between Neuroticism and Biological Health Risk: A U.S.-Japan Comparison Study

Neuroticism, a broad personality trait linked to negative emotions, is consistently linked to ill health when self-report is used to assess health. However, when health risk is assessed with biomarkers, the evidence is inconsistent. Here, we tested the hypothesis that the association between neuroticism and biological health risk is moderated by behavioral adjustment, a propensity to flexibly adjust behaviors to environmental contingencies. Using a U.S.-Japan cross-cultural survey, we found that neuroticism was linked to lower biological health risk for those who are high, but not low, in behavioral adjustment. Importantly, Japanese were higher in behavioral adjustment than European Americans, and as predicted by this cultural difference, neuroticism was linked to lower biological health risk for Japanese but not for European Americans. Finally, consistent with prior evidence, neuroticism was associated with worse self-reported health regardless of behavioral adjustment or culture. Discussion focused on the significance of identifying sociocultural correlates of biological health.

Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry

Background

Emotional distress, symptoms of depression and anxiety, is common among patients after a myocardial infarction (MI), and is associated with an increased risk of cardiovascular morbidity. Real world population data on factors associated with emotional distress in MI patients are scarce. The aim was to determine factors associated with incident emotional distress two and 12 months post MI respectively, and with persistent emotional distress, versus remittent, in patients <75 years old.

Design

This was a registry-based observational study.

Methods

Data from the national SWEDEHEART registry on 27,267 consecutive patients with a first-time MI, followed up at two and 12 months post MI (n = 22,911), were included in the analyses. Emotional distress was assessed with the EuroQol-5D questionnaire. Several candidate sociodemographic and clinical factors were analysed for their association with emotional distress in multivariate models.

Results

Symptoms of emotional distress were prevalent in 38% and 33% at two and 12 months post MI respectively. At both time-points, previous depression and/or anxiety, readmission for new cardiovascular event, female gender, younger age, born outside the neighbouring Nordic countries, smoking and being neither employed nor retired showed the strongest associations with emotional distress. Other factors related to medical history, the MI and its care or were only modestly associated with emotional distress. Persistent emotional distress was associated with younger age, female gender, smoking and being born outside of the Nordic countries.

Conclusion

Previous depression/anxiety, female gender, younger age, smoking, born outside of the Nordic countries, neither employed nor retired and readmission due to cardiovascular events were strongly associated with emotional distress post MI. These factors may be of relevance in tailoring rehabilitation programmes.

Psychosocial perspectives in cardiovascular disease

Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out of cardiac rehabilitation, impacting on patients' quality of life, risk of hospitalisation and mortality. Hence it is paramount to identify this subset of high-risk patients in clinical practice. This review provides a general overview of the prevalence of selected psychosocial risk factors, their impact on patient-reported and clinical outcomes, and biological and behavioural mechanisms that may explain the association between psychosocial factors and health outcomes. The review also provides recommendations on which self-report screening measures to use to identify patients at high risk due to their psychosocial profile, and the effectiveness of available trials that target these risk factors. Despite challenges and barriers associated with screening of patients combined with appropriate treatment, it is paramount that we treat not only the heart but also the mind in order to improve the quality of care and patient and clinical outcomes.

Relationship Between Changes in Workplace Bullying Status and the Reporting of Personality Characteristics

OBJECTIVE

To examine whether a shift in work-related bullying status, from being non-bullied to being bullied or vice versa, was associated with changes in reporting of personality characteristics.

METHODS

Data on bullying and personality (neuroticism, extraversion, and sense of coherence) were collected in three waves approximately 2 years apart (N = 4947). Using a within-subjects design, personality change scores that followed altered bullying status were evaluated with one-sample t tests. Sensitivity analyses targeted depressive symptoms.

RESULTS

Shifts from non-bullied to frequently bullied were associated with increased neuroticism or decreased sense of coherence manageability scores. Shifts from bullied to non-bullied were associated with decreasing neuroticism and increasing extraversion scores, or increasing sense of coherence meaningfulness and comprehensibility scores. Excluding depressive cases had minor effects.

CONCLUSIONS

Bullying seems to some extent to affect personality scale scores, which thus seem sensitive to environmental and social circumstances.

Mental health disorders mediate association of sexual minority identity with cardiovascular disease

BACKGROUND

Little is known about cardiovascular health disparities for lesbian, gay, or bisexual (LGB) persons and whether these disparities are mediated by mental health disorders due to sexual minority stress. We hypothesize LGB identity is associated with an increased risk of cardiovascular disease (CVD) and that major depressive disorder (MDD) and generalized anxiety disorders (GAD) may mediate this association.

METHODS

The National Epidemiologic Survey on Alcohol and Related Conditions is a longitudinal, nationally-representative study of non-institutionalized U.S. adults. We cross-sectionally analyzed the second wave data (2004-2005) comparing 577 self-identified LGB persons to 33,598 heterosexuals. Multiple logistic regression modeling and mediation analysis (the product of coefficients approach) were performed.

RESULTS

LGB persons had significantly higher CVD prevalence [adjusted odds ratio (AOR): 1.5, 95% CI: 1.2-1.9], and were more likely to be diagnosed with MDD (AOR: 1.9, 1.8-2.1), GAD (AOR: 2.2, 1.9-2.4), or co-occurring MDD and GAD (AOR: 2.2, 2.0-2.5). MDD, GAD, and co-occurrence of MDD and GAD significantly mediated 14.3%, 22.2%, and 33.3% of the association of LGB status with increased CVD prevalence, respectively.

CONCLUSIONS

Our findings identified a 50% increased CVD prevalence among LGB persons and this increased risk was mediated in part by MDD and GAD, both being more prevalent in sexual minority adults.

The Myth of Optimality in Clinical Neuroscience

Clear evidence supports a dimensional view of psychiatric illness. Within this framework the expression of disorder-relevant phenotypes is often interpreted as a breakdown or departure from normal brain function. Conversely, health is reified, conceptualized as possessing a single ideal state. We challenge this concept here, arguing that there is no universally optimal profile of brain functioning. The evolutionary forces that shape our species select for a staggering diversity of human behaviors. To support our position we highlight pervasive population-level variability within large-scale functional networks and discrete circuits. We propose that, instead of examining behaviors in isolation, psychiatric illnesses can be best understood through the study of domains of functioning and associated multivariate patterns of variation across distributed brain systems.

Qualitative study of challenges of caring for a person with heart failure

Heart failure (HF) is a chronic health condition that causes significant morbidity among older adults, many of whom receive support and care from an informal caregiver. Caregiving is a difficult role with many responsibilities and challenges. An in-depth understanding of these challenges is necessary to develop services, resources, and interventions for HF caregivers. The goal of this study was to qualitatively ascertain the most significant challenges facing HF caregivers. We conducted semi-structured interviews with 16 caregivers of a person with HF (PHF). Content analysis revealed challenges rooted within the PHF (negative affect, resistant behavior, independence, and illness) Caregiver (balancing employment, lack of support, time, and caregiver health) and Relational level (PHF/caregiver dyadic relationship and other relationships). These findings can be used to inform interventions and support services for HF caregivers.

Motivation, health-related lifestyles and depression among university students: A longitudinal analysis

Positive motivational attitudes protect against depressive symptoms in young adults. This study examined the longitudinal relationship between motivation to achieve important life goals and depression in a sample of young adult university students, who are at higher risk of developing psychiatric disorders and adopting unhealthy behaviours than their age peers who are not attending university. The participants were 228 Italian undergraduates who completed an online self-report questionnaire twice during a one-year period. Measures included positive motivational attitudes, depressive feelings, body mass index, smoking, alcohol consumption, cannabis use, subjective family income and satisfaction with academic choice. A cross-lagged longitudinal model demonstrated that higher motivation predicted lower depression after one year. No other covariate effects were observed. The results confirm that motivation protects against mental health problems during higher education and is a better predictor of mental health than health-related risk factors. Encouraging undergraduates to invest effort in achieving important goals may prevent the onset of depressive disorders.

Effects of a psychological intervention programme on mental stress, coping style and immune function in percutaneous coronary intervention patients

PURPOSE

This study aimed to assess the effects of a psychological intervention programme on the mental stress, coping style and cortisol and IL-2 levels of patients undergoing percutaneous coronary intervention (PCI).

METHODS

A total of sixty cardiovascular patients scheduled for PCI with clear anxiety and depression screened by the Hospital Anxiety and Depression Scale were randomly divided into an experimental (n = 30) and control (n = 30) group. The participants in the experimental group received cognitive therapy, relaxation therapy and emotional support. Self-reported questionnaires, including the Self-Report Symptom Checklist (SCL-90) and the Medical Coping Mode Questionnaire (MCMQ), and levels of IL-2 and cortisol were collected at baseline and the day before discharge.

RESULTS

Compared with the controls, patients in the intervention group had a better mental state and coping style (confrontation), higher levels of IL-2 and lower levels of cortisol (all P<0.05).

CONCLUSIONS

The psychological intervention programme effectively improved mental state, reduced negative coping styles, increased levels of IL-2, and decreased cortisol levels in patients undergoing PCI. This programme may be an effective preoperative nursing intervention for PCI patients.

TRIAL REGISTRATION

Chinese Clinical Trail Registry ChiCTR-IOR-16007864.

When is affect variability bad for health? The association between affect variability and immune response to the influenza vaccination

OBJECTIVES

This study addresses methodological and theoretical questions about the association between affect and physical health. Specifically, we examine the role of affect variability and its interaction with mean levels of affect to predict antibody (Ab) levels in response to an influenza vaccination.

METHODS

Participants (N=83) received the vaccination and completed daily diary measures of affect four times a day for 13days. At one and four months post-vaccination, blood was collected from the participants to assess Ab levels.

RESULTS

Findings indicate that affect variability and its interaction with mean levels of affect predict an individual's immune response. Those high in mean positive affect (PA) who had more PA variability were more likely to have a lower Ab response in comparison to those who had high mean PA and less PA variability. Although it did not interact with mean negative affect (NA), NA variability on its own was associated with Ab response, whereby those with less NA variability mounted a more robust immune response.

CONCLUSION

Affect variability is related to immune response to an influenza vaccination and, in some cases, interacts with mean levels of affect. These oscillations in affective experiences are critical to consider in order to unpack the intricacies of how affect influences health. These findings suggest that future researchers should consider the important role of affect variability on physical health-relevant outcomes as well as examine the moderating effect of mean affect levels.

Social avoidance in policing: Associations with cardiovascular disease and the role of social support

PURPOSE

The purpose of this paper is to examine the association of social avoidance among police, cardiovascular disease (CVD) (metabolic syndrome (MetSyn)), and social support.

DESIGN/METHODOLOGY/APPROACH

Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress study (n = 289). Social avoidance (defined as the tendency to avoid social contact) and other subscales from the Cook-Medley Hostility Scale were analyzed. The mean number of MetSyn components across tertiles of the Cook-Medley scales was computed using analysis of variance and analysis of covariance. Social support was measured with the Social Provisions Scale, categorized as high or low based on the median.

FINDINGS

The mean number of MetSyn components increased significantly across tertiles of social avoidance (1.51 ± 0.18, 1.52 ± 0.12, and 1.81 ± 0.12); the only Cook-Medley subscale that remained significantly associated with MetSyn following adjustment for age and gender. Participants high in social avoidance reported significantly lower social support (79.9 ± 8.5 vs 85.8 ± 8.6; p = 0.001).

RESEARCH LIMITATIONS/IMPLICATIONS

The study is cross-sectional and therefore precludes causality. The authors were unable to determine the direction of associations between social avoidance and MetSyn. The measure of social support was unidimensional, including only perceived support; additional types of social support measures would be helpful.

PRACTICAL IMPLICATIONS

This study suggests that occupational-based police social isolation is associated with health outcomes and lower support. Several suggestions are made which will help to improve communication between the police and public. Examples are the use of social media, training in communication techniques, and changing the police role to one of public guardians.

ORIGINALITY/VALUE

Social avoidance is the least studied the Cook-Medley subscale associated with CVD. It is important for the health of officers to maintain a social connection with others.