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van Bronswijk SC, Howard J, Lorenzo-Luaces L. Data-driven personalized medicine approaches to cognitive-behavioral therapy allocation in a large sample: A reanalysis of the ENRICHED study. J Affect Disord 2024; 356:115-121. [PMID: 38582129 DOI: 10.1016/j.jad.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Although effective treatments for common mental health problems are available, individual responses to treatments are difficult to predict. Treatment efficacy could be optimized by targeting interventions using individual predictions of treatment outcomes. The aim of this study was to develop a prediction algorithm using data from one of the largest randomized controlled trials on psychological interventions for common mental health problems. METHODS This is a secondary analysis of the Enhancing Recovery in Coronary Heart Disease study investigating the effectiveness of cognitive behavioral therapy (CBT) and care as usual (CAU) for depression and low perceived social support following acute myocardial infarction. 2481 participants were randomly assigned to CBT and CAU. Baseline social-demographics, depression characteristics, comorbid symptoms, and stress and adversity measures were used to build an algorithm predicting post-treatment depression severity using elastic net regularization. Performance and generalizability of this algorithm were determined in a hold-out sample (n = 1203). RESULTS Treatment matching based on predictions in the hold-out sample resulted in inconsistent and small effects (d = 0.15), that were more pronounced for individuals matched to CBT (d = 0.22). We identified a small subgroup of individuals for which CBT did not appear more efficacious than CAU. LIMITATIONS Limitations are a poorly defined CAU condition, a low-severity sample, specific exclusion criteria and unavailability of certain baseline variables. CONCLUSIONS Small matching effects are likely a realistic representation of the performance and generalizability of multivariable prediction algorithms based on clinical measures. Results indicate that future work and new approaches are needed.
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Affiliation(s)
- Suzanne Catharina van Bronswijk
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | | | - Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, IN, USA
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Zoofaghari S, Nikaen F, Bahramsari S, Hashemzadeh M, Dorooshi G. Myocardial infarction without coronary artery occlusion following mental stress. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:12. [PMID: 34084191 PMCID: PMC8106406 DOI: 10.4103/jrms.jrms_128_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/15/2020] [Accepted: 08/20/2020] [Indexed: 11/04/2022]
Abstract
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is syndrome with clinical evidence of acute MI (AMI) with normal coronary arteries. This study reports the case of a 23-year-old single woman referring to the hospital with clinical manifestations of MI, with electrocardiography findings of slow ventricular tachycardia or accelerated idioventricular rhythm and atrioventricular dissociation, and high troponin levels, which was admitted with the diagnosis of MINOCA due to mental stress (grief) and was discharged after 4 days of monitoring and following stabilization of conditions and absence of symptoms. Other causes of MINOCA ruled out through imaging studies. Mental stress can lead to MINOCA.
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Affiliation(s)
- Shafeajafar Zoofaghari
- Isfahan Clinical Toxicology Research Center, Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Nikaen
- Department of Cardiology, School of Medicine, Najafabad Branch, Islamic Azad University, Najafaba, Iran
| | - Shahrzad Bahramsari
- Isfahan Clinical Toxicology Research Center, Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhdeh Hashemzadeh
- Clinical Informationist Research Group, Health Information Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamali Dorooshi
- Isfahan Clinical Toxicology Research Center, Department of Clinical Toxicology, Isfahan University of Medical Sciences, Isfahan, Iran
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O'Keefe EL, O'Keefe JH, Lavie CJ. Exercise Counteracts the Cardiotoxicity of Psychosocial Stress. Mayo Clin Proc 2019; 94:1852-1864. [PMID: 31451292 DOI: 10.1016/j.mayocp.2019.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022]
Abstract
Physical inactivity and psychosocial stress are prevalent in residents of the United States. The purpose of this article is to review the interaction between these 2 conditions and examine the effects of exercise on stress and cardiovascular (CV) health. A query of scientific references between 1974 to 2018 was performed using the PubMed search engine accessing the MEDLINE database using the search terms psychosocial stress, CV disease (CVD), physical activity, exercise, cardiac rehabilitation, and team sports. Psychosocial stress is a strong independent risk factor for adverse CV events. Conversely, people who experience CV events subsequently have drastically elevated rates of new-onset mental health disorders, including depression and anxiety. Psychosocial stress and CVD often trigger self-reinforcing feedback loops that can worsen mental health and cardiac prognosis. Exercise predictably improves CV health and prognosis and also is effective at lowering levels of psychosocial stress. Group exercise in particular seems to provide social support while at the same time boosting fitness levels and, thus, may be the single most important intervention for patients with concomitant CVD and emotional stress. Collaborative physical activity, such as group exercise, team sports, interactive physical play, and cardiac rehabilitation programs, have the potential to improve mental health and CV prognosis.
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Affiliation(s)
- Evan L O'Keefe
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA
| | - James H O'Keefe
- University of Missouri-Kansas City and Saint Luke's Mid America Heart Institute, New Orleans, LA
| | - Carl J Lavie
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA.
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Living alone and activation of the renin-angiotensin-aldosterone-system: Differential effects depending on alexithymic personality features. J Psychosom Res 2017; 96:42-48. [PMID: 28545792 DOI: 10.1016/j.jpsychores.2017.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Living alone is considered as a chronic stress factor predicting different health conditions and particularly cardiovascular disease (CVD). Alexithymia is associated with increased psychological distress, less social skills and fewer close relationships, making alexithymic subjects particularly susceptible to chronic stress imposed by "living alone". Only few studies investigated the renin-angiotensin-aldosterone-system (RAAS) activity in response to chronic stress. We aimed at evaluating the effects of "living alone" as a paradigm for chronic stress on RAAS activity and putatively differential effects depending on alexithymic personality features. METHODS Alexithymia and serum concentrations of renin and aldosterone were measured in 944 subjects from the population-based SHIP-1 study. Subgroups were formed using the median of the Toronto Alexithymia Scale-20 (TAS-20) and a cohabitation status of "living alone" or "living together". Analyses were adjusted for various psychosocial, behavioral and metabolic risk factors. RESULTS "Living alone" was associated with elevated plasma renin (p<0.01, β=0.138) but not aldosterone concentrations in the total sample. On subgroup level, we found associations of "living alone" and elevated renin concentrations only in subjects low in TAS-20 scores (p<0.01, β=0.219). Interactional effects of alexithymia×cohabitation status were found for the aldosterone-to-renin ratio (p=0.02, β=-0.234). CONCLUSIONS The association of chronic stress imposed by "living alone" with increased RAAS activity contributes to explain the relationship of this psychosocial stress condition and increased risk for CVD. In contrast, alexithymic subjects may be less affected by the deleterious effects of "living alone".
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Abstract
Heart failure is the major cause of morbidity and mortality in the United States. Stage D heart failure has a greater mortality rate than many cancers and has equivalent symptom burden and severity. There has been a paradigm shift in our understanding of the pathophysiology of heart failure. Progressive heart failure is associated with ventricular remodeling and a maladaptive neurohumoral response. Drug classes have evolved that curtail ventricular remodeling, and blunt neurohumoral responses reduce morbidity and mortality. Despite combination drug and device therapies, the management of Stage D heart failure includes palliation. Both cardiology and palliative specialists need to learn from one another in order to palliate these highly symptomatic patients. Such collaboration will enhance care and are the basis for well-conceived research trials.
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Affiliation(s)
- Mellar P Davis
- The Harry R Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA
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Hori R, Hayano JI, Kimura K, Shibata N, Kobayashi F. Psychosocial factors are preventive against coronary events in Japanese men with coronary artery disease: The Eastern Collaborative Group Study 7.7-year follow-up experience. Biopsychosoc Med 2015; 9:3. [PMID: 25621004 PMCID: PMC4304146 DOI: 10.1186/s13030-015-0030-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 01/12/2015] [Indexed: 12/03/2022] Open
Abstract
Background The Japanese Coronary-prone Behaviour Scale (JCBS) is a questionnaire developed by the Eastern Collaborative Group Study (ECGS), a multi-centre study of coronary-prone behaviour among Japanese men. Subscale C of the JCBS consists of 9 items that have been independently associated with the presence of coronary artery disease (CAD) in patients undergoing coronary angiography (CAG). There have been no reports of a relationship between any behavioural factor and the prognosis of CAD in Japan. The purpose of the current study was to investigate behavioural correlations with the prognosis of CAD as a part of the ECGS. Methods We examined the mortality and coronary events of 201 men (58 ± 10, 27-86 years) enrolled in the ECGS from 1990 to 1995, who underwent diagnostic coronary angiography and were administered the JCBS and the Japanese version of the Jenkins Activity Survey (JAS) Form C. Their health information after CAG was determined by a review of their medical records and by telephone interviews that took place from 2002 to 2003. Results Cardiac events during the follow-up period (7.7 ± 4.2 years) included 13 deaths from CAD, 25 cases of new-onset myocardial infarction, 26 cases of percutaneous coronary intervention, and 19 cases of coronary artery bypass graft surgery. There was no difference in established risk factors between groups with and without cardiac events. Seven factors were extracted by principal component analysis in order to clarify which factors were measured by the JCBS. Stepwise multivariate Cox-hazard regression analysis, in which 9 standard coronary risk factors were forced into the model, showed that Factor 4 from the JCBS (namely, the Japanese spirit of ‘Wa’) was independently associated with coronary events (hazard ratio: 0.21; p = 0.01). By other Cox-hazards regression analyses of coronary events using each set of JAS scores and the JCBS Scale C score instead of Factor 4 as selectable variables, the JAS scores or the JCBS Scale C score were not entered into the models. Conclusion The Japanese spirit of ‘Wa’ is a preventive factor against coronary events for Japanese men with CAD.
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Affiliation(s)
- Reiko Hori
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195 Japan
| | - Jun-Ichiro Hayano
- Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Japan
| | | | | | - Fumio Kobayashi
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, 1-1 Yazako Karimata, Nagakute, Aichi 480-1195 Japan
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Zarbo C, Compare A, Baldassari E, Bonardi A, Romagnoni C. In Sickness and in Health: a Literature Review about Function of Social Support within Anxiety and Heart Disease Association. Clin Pract Epidemiol Ment Health 2013; 9:255-62. [PMID: 24403952 PMCID: PMC3884151 DOI: 10.2174/1745017901309010255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 12/28/2022]
Abstract
A narrative review of the major evidence concerning the relationship between anxiety, social support and cardiac disease was conducted. Literature demonstrates that a strict relationship between anxiety, social support and cardiac disease outcomes subsists. However, the function of social support within anxiety and heart disease association remains unclear and needs to further researches to be established. Moreover evidence suggests that it's the quality of close relationships to play an important role in affecting psychological and physiological health status. The main components that the literature suggests for a better quality of social support and close relationship, and the main assessment measure are presented. Evidence about cardiac rehabilitation programs and the need to assess and intervene on psychological and psychosocial factors is discussed.
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Affiliation(s)
- Cristina Zarbo
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Elena Baldassari
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Alberto Bonardi
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Claudia Romagnoni
- Cardiovascular Division, "L. Sacco" University General Hospital, University of Milan, Milano, Italy
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Dong X, Simon MA. Urban and rural variations in the characteristics associated with elder mistreatment in a community-dwelling Chinese population. J Elder Abuse Negl 2013; 25:97-125. [PMID: 23473295 DOI: 10.1080/08946566.2013.751811] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study compares the urban and rural differences in characteristics associated with elder mistreatment (EM) in a Chinese population. A cross-sectional study of 269 urban and 135 rural participants aged 60 years or greater was performed. Among those with EM, rural participants were more likely to be women, have lower levels of education and income, have lower levels of health status and quality of life, have worse change in recent health, and have lower levels of psychosocial well-being. Both higher levels of depressive symptoms and lower levels of social support were associated with increased risk of EM.
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Affiliation(s)
- Xinqi Dong
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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Effects of social support and stressful life events on health-related quality of life in coronary artery disease patients. J Cardiovasc Nurs 2013; 28:83-9. [PMID: 22067721 DOI: 10.1097/jcn.0b013e318233e69d] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to examine the effects of social support and stressful life events on health-related quality of life (HRQoL) in coronary artery disease (CAD) patients. METHODS Five hundred sixty consecutive patients with CAD attending cardiac rehabilitation program were invited to participate in the study. Data on stressful life events, perceived social support, and HRQoL were collected from the self-administered questionnaires, Social Readjustment Rating Scale, Multidimensional Scale of Perceived Social Support, and 36-Item Short Form Medical Outcome Questionnaire, respectively. RESULTS In male patients, multivariate linear regression analyses revealed that physical domains of the HRQoL, specifically physical functioning, were associated with clinical aspects of the CAD, such as New York Heart Association class and angina pectoris class, and psychological domains of the HRQoL such as mental health, energy/vitality, and social functioning were associated with social characteristics such as stressful life events and perceived social support. In women, both physical and psychological domains of the HRQoL were associated only with social characteristics, especially with perceived social support. CONCLUSION Perceived social support and stressful life events have independent significant effects on the HRQoL in CAD patients, especially in female patients. When planning cardiac rehabilitation programs, special attention should be paid to patients who experience high levels of stress and have low social support.
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Changes in social support within the early recovery period and outcomes after acute myocardial infarction. J Psychosom Res 2012; 73:35-41. [PMID: 22691557 PMCID: PMC3374926 DOI: 10.1016/j.jpsychores.2012.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 04/14/2012] [Accepted: 04/17/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine changes in social support during early recovery after acute myocardial infarction (AMI) and determine whether these changes influence outcomes within the first year. METHODS Among 1951 AMI patients enrolled in a 19-center prospective study, we examined changes in social support between baseline (index hospitalization) and 1 month post-AMI to longitudinally assess their association with health status and depressive symptoms within the first year. We further examined whether 1-month support predicted outcomes independent of baseline support. Hierarchical repeated-measures regression evaluated associations, adjusting for site, baseline outcome level, baseline depressive symptoms, sociodemographic characteristics, and clinical factors. RESULTS During the first month of recovery, 5.6% of patients had persistently low support, 6.4% had worsened support, 8.1% had improved support, and 80.0% had persistently high support. In risk-adjusted analyses, patients with worsened support (vs. persistently high) had greater risk of angina (relative risk=1.46), lower disease-specific quality of life (β=7.44), lower general mental functioning (β=4.82), and more depressive symptoms (β=1.94) (all p≤.01). Conversely, patients with improved support (vs. persistently low) had better outcomes, including higher disease-specific quality of life (β=6.78), higher general mental functioning (β=4.09), and fewer depressive symptoms (β=1.48) (all p≤.002). In separate analyses, low support at 1 month was significantly associated with poorer outcomes, independent of baseline support level (all p≤.002). CONCLUSION Changes in social support during early AMI recovery were not uncommon and were important for predicting outcomes. Intervening on low support during early recovery may provide a means of improving outcomes.
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Leifheit-Limson EC, Kasl SV, Lin H, Buchanan DM, Peterson PN, Spertus JA, Lichtman JH. Adherence to risk factor management instructions after acute myocardial infarction: the role of emotional support and depressive symptoms. Ann Behav Med 2012; 43:198-207. [PMID: 22037964 PMCID: PMC3374717 DOI: 10.1007/s12160-011-9311-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emotional support and depression may influence adherence to risk factor management instructions after acute myocardial infarction (AMI), but their role requires further investigation. PURPOSE To examine the longitudinal association between perceived emotional support and risk factor management adherence and assess depressive symptoms as a moderator of this association. METHODS Among 2,202 AMI patients, we assessed adherence to risk factor management instructions over the first recovery year. Modified Poisson mixed-effects regression evaluated associations, with adjustment for demographic and clinical factors. RESULTS Patients with low baseline support had greater risk of poor adherence over the first year than patients with high baseline support (relative risk [RR] = 1.20, 95% confidence interval [CI] = 1.02-1.43). In stratified analyses, low support remained a significant predictor of poor adherence for non-depressed (RR = 1.41, 95% CI = 1.23-1.61) but not depressed (RR = 1.01, 95% CI = 0.78-1.30) patients (p for interaction < 0.001). CONCLUSIONS Low emotional support is associated with poor risk factor management adherence after AMI. This relationship is moderated by depression, with a significant relationship observed only among non-depressed patients.
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Joynt KE, O’Connor CM. Prognostic Implications of Depression in Ischemic Syndromes. Coron Artery Dis 2012. [DOI: 10.1007/978-1-84628-712-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Social encounters in daily life and 2-year changes in metabolic risk factors in young women. Dev Psychopathol 2011; 23:897-906. [PMID: 21756440 DOI: 10.1017/s0954579411000381] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Research shows that poor social ties increase risks of morbidity and mortality from cardiovascular disease (CVD). However, little is known about the nature of everyday social encounters that give rise to this association, or when in the course of development they begin to shape disease-relevant biological processes. In this study, 122 adolescent females recorded the qualities of their everyday social interactions using electronic diaries. At the same time we measured components of the metabolic syndrome, a precursor to CVD that includes central adiposity, high blood pressure, insulin resistance, and lipid dysregulation. Metabolic symptoms were reassessed 12 and 24 months later. Hierarchical linear modeling revealed an association between negative social interactions and metabolic symptom trajectories. To the extent that participants had more intense negative social encounters in daily life, they showed increasing scores on a composite indicator of metabolic risk over 2 years. This association was independent of a variety of potential confounders, and persisted when symptoms of depression and broader personality traits were controlled. There was no association between positive social encounters and metabolic risk trajectories. These findings suggest that even in otherwise healthy adolescents, abrasive social encounters may accelerate the progression of early stages of CVD.
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Earle A, Heymann J. Protecting the health of employees caring for family members with special health care needs. Soc Sci Med 2011; 73:68-78. [PMID: 21669484 DOI: 10.1016/j.socscimed.2011.05.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 04/09/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
Abstract
Over half of American workers are holding a paid job while also providing unpaid assistance and support to a family member. Research shows that family members who provide care to children or adults with special health care needs are themselves at risk of physical and mental health problems. Yet, little research has explored how the work environment mediates the effects of caregiving on caregivers' mental and physical health. With a sample of 2455 currently employed U.S. adults from the Work, Family, Community Nexus (WFCN) survey, a random-digit dial, nationally representative survey of Americans aged 18-69, we examine whether paid leave and flexibility policies mediate the relationship between caregiving and health. In Ordinary Least Squares regression models, we find that paid leave to address family members' health was associated with better mental health status as measured by the 5-item Mental Health Inventory and paid sick leave with better physical health status as measured by self-rated overall health status. A supportive supervisor was also associated with improvements in mental and physical health. For both men and women, paid leave and a supervisor's support offset some or all of the negative effects of caregiving, but for women, the buffering effects of working conditions are slightly larger. Enhancing the unpaid leave guaranteed in the U.S. Family and Medical Leave Act so that it is paid and passing national paid sick days legislation will help ensure that employed caregivers can retain their jobs, receive needed income, and meet their own mental and physical health needs.
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Affiliation(s)
- Alison Earle
- Institute on Urban Health Research, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, USA.
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Kendel F, Spaderna H, Sieverding M, Dunkel A, Lehmkuhl E, Hetzer R, Regitz-Zagrosek V. Eine deutsche Adaptation des ENRICHD Social Support Inventory (ESSI). DIAGNOSTICA 2011. [DOI: 10.1026/0012-1924/a000030] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Zusammenfassung. Zur Erfassung der wahrgenommenen emotionalen sozialen Unterstützung bei kardialen Patienten wird das ESSI-D (ENRICHD Social Support Inventory – Deutsch), eine deutsche Adaptation des englischen ESSI, vorgestellt. Mit einer Stichprobe von N = 1597 Patienten (22.7% Frauen), die sich einer Bypass-Operation unterzogen, wurden die psychometrischen Eigenschaften des ESSI-D überprüft. Cronbachs Alpha der Gesamtskala lag bei α = .89. Eine konfirmatorische Faktorenanalyse bestätigte die einfaktorielle Struktur der Skala. Korrelationen mit unterschiedlichen Kriteriumsvariablen wie Partnerstatus, soziale Funktionsfähigkeit, körperliche Funktion und Depressivität lieferten Hinweise für eine zufriedenstellende Konstruktvalidität. Das ESSI-D erweist sich für diese Patientengruppe als ein ökonomisches Instrument zur Erfassung der emotionalen sozialen Unterstützung mit guten psychometrischen Eigenschaften.
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Park JH, Bae SH. A Systematic Review of Psychological Distress as a Risk Factor for Recurrent Cardiac Events in Patients with Coronary Artery Disease. J Korean Acad Nurs 2011; 41:704-14. [DOI: 10.4040/jkan.2011.41.5.704] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jin-Hee Park
- Assistant Professor, College of Nursing, Ajou University, Suwon, Korea
| | - Sun Hyoung Bae
- Doctoral student, College of Nursing, Yonsei University, Seoul, Korea
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Murphy BM, Elliott PC, Worcester MUC, Higgins RO, Le Grande MR, Roberts SB, Goble AJ. Trajectories and predictors of anxiety and depression in women during the 12 months following an acute cardiac event. Br J Health Psychol 2010; 13:135-53. [PMID: 17535492 DOI: 10.1348/135910707x173312] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Many previous investigations of the recovery of emotional well-being, particularly the resolution of depression, following an acute cardiac event assume that all patients follow a similar, linear trajectory. However, it is possible that there are different groups of patients who follow different trajectories. This study tested for multiple trajectories of anxiety and depression and identified the characteristics of patients most at risk for persistent or worsening anxiety and depression in the 12 months following their cardiac event. METHOD A consecutive sample of 226 women was interviewed following either acute myocardial infarction (AMI) or coronary artery bypass graft surgery (CABGS). The Hospital Anxiety and Depression Scale were administered on four occasions over 12 months. Growth curve and growth mixture modelling were used to identify trajectories of change and univariate tests were employed to establish predictors of each trajectory. RESULTS Most women began with relatively low levels of anxiety and/or depression that improved over the 12 month period (84% women showed this trajectory for anxiety, 89% for depression). A smaller group began with relatively high levels of anxiety and/or depression that worsened over time (16% for anxiety, 11% for depression). Patients in the latter group were more likely to report high levels of loneliness, have a first language other than English, perceive their cardiac disease as more severe (anxiety group only) and have diabetes (depression group only). Trajectories were non-linear, with most change occurring in the initial 2-month period. CONCLUSION Growth modelling techniques highlight that change in anxiety and depression following an acute event follows neither a single nor linear trajectory. Most women showed early resolution of anxiety and depression following their event, indicative of a normal bereavement or adjustment response. A minority of women reported worsening anxiety and/or depression in the year following their cardiac event, particularly those who lacked social support or were from non-English speaking backgrounds. Intervention studies to explore support options for these women are warranted, both prior to and following their event.
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Dong X, Simon MA. Is impairment in physical function associated with increased risk of elder mistreatment? Findings from a community-dwelling Chinese population. Public Health Rep 2010; 125:743-53. [PMID: 20873291 DOI: 10.1177/003335491012500517] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- XinQi Dong
- Rush Institute for Health Aging, Chicago, IL 60612, USA.
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Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med 2010; 7:e1000316. [PMID: 20668659 PMCID: PMC2910600 DOI: 10.1371/journal.pmed.1000316] [Citation(s) in RCA: 3327] [Impact Index Per Article: 237.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 06/17/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality. OBJECTIVES This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk. DATA EXTRACTION Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships. RESULTS Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44). CONCLUSIONS The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Julianne Holt-Lunstad
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America.
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Heymann SJ, Gerecke M, Chaussard M. Paid health and family leave: the Canadian experience in the global context. Canadian Journal of Public Health 2010. [PMID: 20629441 DOI: 10.1007/bf03403840] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Two thirds of Canadian adults participate in the workforce. Their health and that of their families can be markedly affected by the availability of paid sick leave, paid leave to care for family members' health and paid parental leave. METHODS We gathered data from all Canadian provinces and territories on these essential leave policies and compared Canadian policies with data collected on 186 United Nations (UN) countries. RESULTS While Canada pays sickness benefits for 15 weeks for serious illnesses, globally at least 90 countries provide benefits for at least 26 weeks or until recovery. Moreover, within Canada only Saskatchewan and Quebec guarantee job protection if sick leave lasts over 12 days. The federal government guarantees Canadian workers six weeks of paid leave to provide care or support to gravely ill family members. Only 39 countries guarantee such leave with pay. Most, but not all, provinces guarantee workers' job protection during compassionate care leave. Eligibility for job protection during parental leave varies across the country from having no restrictions to requiring at least one year of service. CONCLUSION Compared with Canada, many countries offer a longer duration of paid sick leave for employees and replace a higher percentage of wages lost. Internationally, Canada performs well in having policies that guarantee paid leave to care for dependants with serious illnesses, but it lags behind in the provision of paid leave to address the health needs of children or family members' with non-life-threatening conditions. Finally, while paid parental leave is of adequate duration, the wage replacement rate lowers its accessibility to families with limited means.
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Affiliation(s)
- S Jody Heymann
- Institute for Health and Social Policy, McGill University, 1130 des Pins O., Montreal, QC H3A 1A3
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Von Dras DD, Blumenthal HT. Biological, Social-Environmental, and Psychological Dialecticism: An Integrated Model of Aging. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2010. [DOI: 10.1207/s15324834basp2203_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dong X, Simon MA. Health and aging in a Chinese population: urban and rural disparities. Geriatr Gerontol Int 2010; 10:85-93. [PMID: 20102387 DOI: 10.1111/j.1447-0594.2009.00563.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The objective of this study was to compare the rural and urban differences in sociodemographic, health and psychosocial factors in a Chinese aging population. METHODS A cross-sectional descriptive study of 135 rural and 269 urban subjects aged 60 years or greater was performed in a community-dwelling Chinese population. Variables collected included sociodemographic, health-related and psychosocial measures. RESULTS Rural subjects, compared with urban subjects, were significantly younger, more likely to be women, have lower education and income, and more likely to be widowed. Rural subjects also reported significant lower overall health status, lower quality of life and worse change in recent health. In addition, rural subjects had a significantly higher proportion of depressive symptomatology, feelings of loneliness and lower levels of social support measures. CONCLUSION In this older Chinese population, rural subjects had significantly poorer characteristics of health and well-being. These differences in characteristics were found across sociodemographic, health-related quality of life and psychosocial measures.
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Affiliation(s)
- XinQi Dong
- Department of Internal Medicine, Rush University Medical Center, Northwestern Medical Center, Chicago, Illinois 60612, USA.
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Johnson VR, Jacobson KL, Gazmararian JA, Blake SC. Does social support help limited-literacy patients with medication adherence? A mixed methods study of patients in the Pharmacy Intervention for Limited Literacy (PILL) study. PATIENT EDUCATION AND COUNSELING 2010; 79:14-24. [PMID: 19647967 DOI: 10.1016/j.pec.2009.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 06/25/2009] [Accepted: 07/02/2009] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To explore whether social support helps patients with limited health literacy adhere to their medication regimens. METHODS We interviewed 275 pharmacy patients and assessed social support's influence on medication adherence for those with limited vs. adequate health literacy. We talked with patients (n=26) and pharmacists (n=7) to explore possible explanations for the quantitative findings. RESULTS Social support was associated with better medication adherence for patients with adequate health literacy but not those with limited health literacy (p<0.05). When individual subscales for social support were analyzed, having a trusted confidant was the only type of social support associated with better medication adherence for limited-literacy patients (p<0.05). Comments from patients and pharmacists suggest that limited-literacy patients were less likely to ask the pharmacists questions and infrequently brought relatives with them to the pharmacy. CONCLUSION Unless they have a trusted confidant, limited-literacy patients might be reluctant to ask others for the kind of help needed to take their medicines correctly. PRACTICE IMPLICATIONS Pharmacists need training to increase their awareness of limited health literacy and to communicate effectively with all patients, regardless of their literacy skills. To succeed, pharmacists also need the support of the health care systems where they work.
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Affiliation(s)
- Valerie R Johnson
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Lack of social support in the etiology and the prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosom Med 2010; 72:229-38. [PMID: 20223926 DOI: 10.1097/psy.0b013e3181d01611] [Citation(s) in RCA: 363] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis on the relevance of low social support for the development and course of coronary heart disease (CHD). METHODS Three electronic databases were searched (MEDLINE, PsycINFO/PSYNDEX, and Web of Science 2007/03). More than 1700 papers were screened in a first step. We included prospective studies assessing the impact of social support in either an initially healthy study population (etiologic studies) or in a study population with preexisting CHD (prognostic studies). OUTCOMES Myocardial infarction in etiologic studies; cardiovascular mortality and all-cause mortality in prognostic studies. Effects were reported as relative risk (RR) or hazard ratio (HR). RESULTS There is some evidence for an impact of low functional social support on the prevalence of CHD in etiologic studies (RR, range, 1.00-2.23). In contrast, there is no evidence of an impact of low structural social support on the prevalence of myocardial infarction in healthy populations (RR, range, 1.01-1.2). In prognostic studies, results consistently show that low functional support negatively affects cardiac and all-cause mortality (pooled RR, range, 1.59-1.71). These results were also confirmed in analyses adjusted for other risk factors for disease progression (pooled HR, 1.59). It remains unclear whether low structural social support increases mortality in patients with CHD (pooled RR, between 1.56; pooled HR, 1.12, NS). CONCLUSIONS Because the perception of social support seems important for CHD prognosis, monitoring of functional social support is indicated in patients with CHD, and interventions to increase the perception of positive social resources are warranted.
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Heymann J, Rho HJ, Schmitt J, Earle A. Ensuring a healthy and productive workforce: comparing the generosity of paid sick day and sick leave policies in 22 countries. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2010; 40:1-22. [PMID: 20198801 DOI: 10.2190/hs.40.1.a] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
National paid sick day and paid sick leave policies are compared in 22 countries ranked highly in terms of economic and human development. The authors calculate the financial support available to workers facing two different kinds of health problems: a case of the flu that requires missing 5 days of work, and a cancer treatment that requires 50 days of absence. Only 3 countries--the United States, Canada, and Japan--have no national policy requiring employers to provide paid sick days for workers who need to miss 5 days of work to recover from the flu. Eleven countries guarantee workers earning the national median wage full pay for all 5 days. In Ireland and the United Kingdom, the full-time equivalent benefits are more generous for low-wage workers than for workers earning the national median. The United States is the only country that does not provide paid sick leave for a worker undergoing a 50-day cancer treatment. Luxembourg and Norway provide 50 full-time equivalent working days of leave, while New Zealand provides the least, at 5 days. In 6 countries, paid sick leave benefits are more generous for low-wage workers than for median-wage workers.
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Affiliation(s)
- Jody Heymann
- Institute for Health and Social Policy, McGill University, Montreal
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Marano G, Harnic D, Lotrionte M, Biondi-Zoccai G, Abbate A, Romagnoli E, Mazza M. Depression and the cardiovascular system: increasing evidence of a link and therapeutic implications. Expert Rev Cardiovasc Ther 2009; 7:1123-47. [PMID: 19764865 DOI: 10.1586/erc.09.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This review explores the epidemiological evidence for the relationship between depression and cardiovascular disease from a mechanistic standpoint. It is important to examine the biological, behavioral and social mechanisms to improve outcomes for depressed cardiac patients. A number of plausible biobehavioral mechanisms linking depression and cardiovascular disease have been identified. Tricyclic antidepressants have various effects on the cardiovascular system, while selective serotonin reuptake inhibitors are not associated with adverse cardiac effects and should, therefore, be the preferred choice for the treatment of most patients with comorbid depression and cardiovascular disease.
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Affiliation(s)
- Giuseppe Marano
- Department of Neuroscience, Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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Gender Variations in the Levels of Social Support and Risk of Elder Mistreatment in a Chinese Community Population. J Appl Gerontol 2009. [DOI: 10.1177/0733464809348057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to examine gender differences in social support and risk of elder mistreatment (EM) in a community-dwelling Chinese population. The authors conducted a cross-sectional study of 141 women and 270 men aged 60 years or above. EM was assessed using the modified Vulnerability to Abuse Screening Scale (VASS), and social support was measured using the Social Support Index (SSI). After adjusting for sociodemographic factors, socioeconomic status, depression, loneliness, and medical conditions, lower levels of social support were associated with an increased odds of EM in men (odds ratio [OR] = 5.35, 95% confidence interval [CI] = 2.18-13.15, p < .001) and in women (OR = 5.39, 95% CI = 1.95-14.85, p < .001). Perceived social support, but not instrumental social support, was associated with increased odds of EM in men and women. These findings could have important implication for health care professional and social services agencies in the detection, management, and prevention of EM among the aging Chinese population.
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Biddiss E, Brownsell S, Hawley MS. Predicting need for intervention in individuals with congestive heart failure using a home-based telecare system. J Telemed Telecare 2009; 15:226-31. [DOI: 10.1258/jtt.2009.081203] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have studied how well the need for a medical intervention can be predicted by a telecare monitoring system. During a study period of about 18 months, 45 elderly individuals with congestive heart failure used a home health monitor to enter daily information pertaining to their symptoms and health status. A total of 8576 alerts were generated by the monitoring system, although in most cases, patient and service provider interaction was not required. When system alerts were considered to be serious, or if symptoms persisted, the patient was contacted. A total of 171 key medical events (6 deaths; 28 hospital admissions; 59 changes in medication; 54 cases of advice given; 24 instances where immediate medical attention was recommended) were recorded in the monitoring logs. A multivariate logistic regression model was developed to predict these medical interventions/events. The model correctly predicted key medical events in 75% of cases with a specificity of 74% and an overall cross-validated accuracy of 74% (95% CI, 68–80%). Key predictors included the number of system alerts, self-rated mobility, self-rated health and self-rated anxiety. This suggests that subjective measures are useful in addition to physiological ones for predicting health status. A multivariate decision support model has potential to supplement practitioners and current telecare systems in identifying heart failure patients in need of medical intervention.
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Affiliation(s)
- Elaine Biddiss
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Bloorview Research Institute, Bloorview Kids Rehab, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Simon Brownsell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Medical Physics and Clinical Engineering, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
| | - Mark S Hawley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
- Department of Medical Physics and Clinical Engineering, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
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Dong X, Beck T, Simon MA. The associations of gender, depression and elder mistreatment in a community-dwelling Chinese population: the modifying effect of social support. Arch Gerontol Geriatr 2009; 50:202-8. [PMID: 19398133 DOI: 10.1016/j.archger.2009.03.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 03/24/2009] [Accepted: 03/26/2009] [Indexed: 11/15/2022]
Abstract
The aims of this study are to: (1) examine the gender differences in the association of depression and elder mistreatment (EM) in a community-dwelling Chinese population; and (2) examine the potential differential modifying effect of greater social support on these associations. We conducted a cross-sectional study of 141 women and 270 men aged 60 years or greater who presented to an urban medical center. EM was assessed using the modified Vulnerability to Abuse Screening Scale (VASS) and depression was assessed using the Geriatric Depression Scale (GDS) and overall social support was measured using the Social Support Index (SSI). After adjusting for potential confounders, depression was associated with 447% increased risk for EM among men (odds ratio, OR = 4.47; 95% confidence intervals (CI) = 1.52-13.13) and 854% increased risk for EM among women (OR = 8.54; 95% CI = 2.85-25.57). After examining the effect of greater social support on depression (social support x depression), depression was no longer associated with increased risk for EM in men (parameter estimate = PE = 0.62 + or - 0.82 (+ or - S.E.M.) = 0.82, p = 0.454). However, among women, depression remained as a significant risk factor for EM (PE = 1.49 + or - 0.68, p = 0.029). Depression is significant risk factor for EM for both men and women. However, effect of greater overall social support may have higher protective effect in men than in women.
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Affiliation(s)
- XinQi Dong
- Rush Institute for Healthy Aging, Rush University Medical Center, 1645 West Jackson Street, Suite 675, Chicago, IL 60612, USA.
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A Descriptive Study of Sex Differences in Psychosocial Factors and Elder Mistreatment in a Chinese Community Population. INT J GERONTOL 2008. [DOI: 10.1016/s1873-9598(09)70009-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Boutin-Foster C, Ogedegbe G, Peterson J, Briggs WM, Allegrante JP, Charlson ME. Psychosocial mediators of the relationship between race/ethnicity and depressive symptoms in Latino and white patients with coronary artery disease. J Natl Med Assoc 2008; 100:849-55. [PMID: 18672563 DOI: 10.1016/s0027-9684(15)31380-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The high prevalence of depressive symptoms in patients with coronary artery disease has been well documented. However, little is known about the prevalence and correlates of depressive symptoms in Latino patients with coronary artery disease. PURPOSE Among Latino and white patients who had percutaneous transluminal coronary angioplasty (PTCA), this study examined whether differences in the prevalence of depressive symptoms exist and the degree to which psychosocial factors (years of education, employment status, stressful life events, emotional social support) explained any differences. METHODS Using a cross-sectional design, closed-format questionnaires were used to obtain clinical and psychosocial history. The definition of high depressive symptoms was based on a score of > or =16 on the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS Compared to whites (n=492), Latinos (n=59) were younger, and a greater proportion were female, but fewer completed high school and fewer were employed (P<0.05). More Latinos reported experiencing > or =2 recent stressful life events, but fewer reported having emotional social support (P<0.05). There was a significant association between race/ethnicity and depressive symptoms (OR=2.3, 95% CI: 1.3-4.5). In multivariate analyses, the significance of this association diminished when psychosocial variables were added to the model. CONCLUSIONS In this study, education, employment, stressful life events and emotional social support partially explained the observed racial/ethnic differences in depressive symptoms.
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Affiliation(s)
- C Boutin-Foster
- Center for Complementary and Integrative Medicine, Weill Medical College, Cornell University, New York, NY 10021, USA.
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Lache B, Meyer T, Herrmann-Lingen C. Social support predicts hemodynamic recovery from mental stress in patients with implanted defibrillators. J Psychosom Res 2007; 63:515-23. [PMID: 17980225 DOI: 10.1016/j.jpsychores.2007.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 05/22/2007] [Accepted: 06/04/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Emotionally stressful events appear to trigger malignant ventricular arrhythmias and myocardial infarction in cardiac patients. However, the physiological pathways linking psychological stress to arrhythmias and adverse disease outcomes remain incompletely understood. In patients with implanted cardioverter-defibrillators (ICD) we investigated the impact of emotions and social support on cardiovascular recovery from mental stress. The hypothesis tested was that psychosocial resources help to maintain adaptive hemodynamic responses to mental stress. METHODS In 55 ICD patients we noninvasively measured hemodynamic and autonomic parameters during two sequentially performed mental stress tests (arithmetic and anger recall tests). The cardiovascular data obtained were associated with results from well-validated psychometric self-rating tests for anxiety and depression (HADS), anger (STAXI), and perceived social support (FSozU). RESULTS In the rest period after mental stress application the majority of the study participants (82%) showed a rapid fall in cardiac index, arterial blood pressure, and heart rate, as well as an increase in high-frequency heart rate variability, while the remainder had no or unexpected changes in the hemodynamic parameters examined. Patients missing hemodynamic recovery in the post-stress phase reported significantly less social support than normally reacting patients (P<.05). Multivariate logistic regression models confirm that social support is an independent and significant predictor of preserved hemodynamic recovery from mental stress, even after controlling for somatic confounders (multivariate odds ratio 4.1; 95% confidence interval 1.3-12.7; P=.015). CONCLUSIONS Our data indicate that in ICD patients better perceived social support is associated with a more pronounced hemodynamic recovery after mental stress.
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Affiliation(s)
- Bernhard Lache
- Department of Psychosomatics and Psychotherapy, Georg-August University, Göttingen, Göttingen, Germany
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Boutin-Foster C, Charlson ME. Do recent life events and social support explain gender differences in depressive symptoms in patients who had percutaneous transluminal coronary angioplasty? J Womens Health (Larchmt) 2007; 16:114-23. [PMID: 17324102 DOI: 10.1089/jwh.2006.m075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Previous studies have documented that among patients with coronary artery disease (CAD), depressive symptoms are more common in women than in men. The objective of this study was to determine if this disparity was explained by gender differences in stressful life events and in perceived social support. METHODS This was a cross-sectional study involving patients who recently had percutaneous transluminal coronary angioplasty (PTCA). Logistic regression was used to test the associations among gender, depressive symptoms, stressful life events, and social support. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS Of the 660 patients enrolled, 27% were women. A higher proportion of women than men were classified as having substantial depressive symptoms based on a cutoff score of > or =16 on the CES-D (43% vs. 29%, p < 0.01). More women reported experiencing personal stressful life events than men (33% vs. 23%, p < 0.05). Fewer women than men reported having tangible support, which in this study was defined as having someone available to help with chores (68% vs. 85%, p < 0.001). On mediation analysis, the strength of the association between gender and depressive symptoms was diminished after personal stress and tangible social support variables were added to the logistic regression model. CONCLUSIONS In this population of postangioplasty patients, more women reported having depressive symptoms than men. This disparity may be partially explained by the finding that compared with men, more women experienced personal stressful life events and perceived less tangible support.
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Affiliation(s)
- Carla Boutin-Foster
- Weil Medical College, Cornell University, 525 East 68th Street, Room F1421, Box 46, New York, NY 10021, USA.
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Boutin-Foster C, Alexander J. Development and validation of the Tangible, Informational, and Emotional Social Support Survey. ACTA ACUST UNITED AC 2007; 26:307-13. [PMID: 17003597 DOI: 10.1097/00008483-200609000-00006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Social support is an important resource for chronic disease management. However, it is not routinely assessed in the context of caring for patients with cardiovascular disease or as part of the cardiovascular rehabilitation process. The objective was to develop a survey designed to measure the types of social support that are necessary in cardiovascular disease prevention and management. METHODS Items were derived based on qualitative interviews with 63 patients regarding their perception of the most helpful types of social support in health behavior modification. Test-retest reliability was determined among 43 new patients. Factor analysis was conducted to determine the structural domains of the survey. The survey was then validated against the Medical Outcomes Study Social Support Survey in 130 patients. RESULTS The survey used, which was called Tangible, Informational, and Emotional Social Support Survey, contains 16 items that explore tangible, informational, and emotional social support. Cronbach coefficient was .80. Exploratory factor analysis revealed a 4-factor solution, which accounted for 54% of the total variance. Patients who were married had higher scores (P < .05), compared with those who were not and scores on Tangible, Informational, and Emotional Social Support Survey correlated with the scores on the Medical Outcomes Study Social Support Survey (r = 0.82). CONCLUSIONS Tangible, Informational, and Emotional Social Support Survey is a patient-derived, reliable, and valid social support survey. It can be used to capture salient aspects of social support that may facilitate health behavior modification in cardiovascular disease patients.
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Affiliation(s)
- Carla Boutin-Foster
- Division of General Internal Medicine, Joan and Sanford I. Weill Medical College of Cornell University, New York, NY 10021, USA.
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Abstract
PURPOSE OF REVIEW Cardiovascular disease is a serious threat to population health. The true causes are not fully known, but a number of biological and behavioral risk factors have been identified. In this review we aim at understanding psychosocial, behavioral and lifestyle factors and their role in clinical care of patients with cardiovascular disease. We describe recent scientific evidence of psychosocial and life style risk and behavioral interventions to reduce risk in cardiovascular disease. We also discuss whether intervention programs are effective against cardiovascular disease and its risk factors, and whether they are of benefit to the patients. Gender aspects and ethnic variations are highlighted. RECENT FINDINGS In recent European Guidelines of CVD Prevention in Clinical Practice, behavioral factors have become recognized to be true risk factors and identified as important barriers to lifestyle change for patients with cardiovascular disease. Lifestyle changes play a pivotal role in clinical prevention of cardiovascular disease, as they are recommended as the first choice of intervention modalities before pharmacological treatment is initiated. SUMMARY While there is now common agreement about the importance of psychosocial risk factors for cardiovascular disease, a better consensus about intervention methods is needed in order to evaluate and appreciate the future scientific evidence from behavioral cardiovascular preventive efforts.
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Affiliation(s)
- Kristina Orth-Gomér
- Department of Public Health Sciences, Preventive and Behavioral Medicine, Karolinska Institutet, Stockholm, Sweden.
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Smith PJ, Blumenthal JA, Babyak MA, Georgiades A, Sherwood A, Sketch MH, Watkins LL. Ventricular ectopy: impact of self-reported stress after myocardial infarction. Am Heart J 2007; 153:133-9. [PMID: 17174651 PMCID: PMC1832081 DOI: 10.1016/j.ahj.2006.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 10/18/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although psychologic stress has been implicated in the pathogenesis of ventricular arrhythmias, the relationship between self-reported stress and ventricular ectopy has not been evaluated under naturalistic conditions in acute post-myocardial infarction (MI) patients, a group at elevated risk for arrhythmias. MATERIALS AND METHODS Diary-reported stress was measured during 24-hour Holter monitoring in 80 patients (52 men and 28 women) approximately 12 weeks after their MI. In addition, state and trait anxiety were measured using the Spielberger State and Trait Anxiety Inventory, which was administered at the beginning of the 24-hour Holter monitoring session. The relationships between diary-reported stress, anxiety, and ventricular ectopy were evaluated. RESULTS Mean diary-reported stress was associated with total ventricular ectopy (beta = .29, P = .01). State anxiety was also associated with 24-hour ectopy (beta = .24, P = .04); however, trait anxiety was not significantly associated with ectopy. Temporal analyses of the relationship between stress and ectopy showed that diary-reported stress was associated with an increase in the number of ventricular premature beats occurring in the following hour (beta = .74, P < .0001). CONCLUSIONS These findings extend existing evidence linking psychologic factors to ventricular arrhythmias by demonstrating that psychologic stress predicts increased arrhythmic activity during routine daily activities in post-MI patients.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA
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Collins-McNeil J. Psychosocial characteristics and cardiovascular risk in African Americans with diabetes. Arch Psychiatr Nurs 2006; 20:226-33. [PMID: 17010826 DOI: 10.1016/j.apnu.2006.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 03/23/2006] [Accepted: 04/23/2006] [Indexed: 10/24/2022]
Abstract
This descriptive study examined the ability of anxiety, depressive symptoms, and perceived social support to predict cardiovascular disease (CVD) risk in African American adults (N = 57) with type 2 diabetes but no prior history of CVD events. All completed a questionnaire packet during structured interviews. Participants had CVD risk profiles that indicated a greater than 20% probability of experiencing a CVD event in the next 2 to 10 years based on diabetes status alone. The variance (10%) in CVD risk accounted for by the variables examined was not statistically significant, suggesting that other variables may be better predictors of CVD risk.
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Affiliation(s)
- Janice Collins-McNeil
- Duke University School of Nursing, Duke University Medical Center, Durham, NC 27710, USA.
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Barry LC, Kasl SV, Lichtman J, Vaccarino V, Krumholz HM. Social support and change in health-related quality of life 6 months after coronary artery bypass grafting. J Psychosom Res 2006; 60:185-93. [PMID: 16439272 DOI: 10.1016/j.jpsychores.2005.06.080] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We determined whether perceived social support predicted change in health-related quality of life, operationalized as change in mental health and physical functioning, 6 months after coronary artery bypass grafting (CABG). METHODS A prospective cohort of 1164 patients undergoing first CABG was interviewed prior to hospital discharge and 6 months later. Perceived instrumental and emotional support were assessed predischarge. Change in mental health and physical functioning was calculated as the difference between 6-month and predischarge SF-36 subscale scores. Stepwise linear regression analyses controlling for prior health-related quality of life, demographics, and clinical presentation were conducted. RESULTS A total of 1072 (1072/1164=92%) participants completed the 6-month interview; mean age 65.7 (+/-11.1) years. Frequent instrumental support predicted positive change in mental health (beta=3.27, P=.02); change scores were higher when participants had low pre-CABG mental health. Neither social support variable predicted change in physical functioning. CONCLUSIONS Assessing perceived instrumental support may help clinicians predict post-CABG mental health. More research regarding this relationship is needed before recommending intervention efforts.
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Affiliation(s)
- Lisa C Barry
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Dickens C, McGowan L, Percival C, Douglas J, Tomenson B, Cotter L, Heagerty A, Creed F. Association Between Depressive Episode Before First Myocardial Infarction and Worse Cardiac Failure Following Infarction. PSYCHOSOMATICS 2005; 46:523-8. [PMID: 16288131 DOI: 10.1176/appi.psy.46.6.523] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression following myocardial infarction is associated with a higher mortality rate. The authors studied 314 patients admitted to the hospital with a first myocardial infarction to assess whether cardiac failure after the infarction, which is also linked to a higher mortality rate, was predicted by psychosocial characteristics present before the myocardial infarction. One-fifth (20.7%) of the subjects met the ICD-10 criteria for depressive episode in the 1 month before the attack. Variables independently associated with worse cardiac failure after the myocardial infarction were greater age, a history of angina preceding the infarction, and a previous depressive episode. The impact of depression on postinfarction outcome may result from the influence of preinfarction depression on the degree of cardiac failure.
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Affiliation(s)
- Chris Dickens
- Department of Psychiatry, Manchester University, and the Department of Cardiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, U.K.
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Lett HS, Blumenthal JA, Babyak MA, Strauman TJ, Robins C, Sherwood A. Social support and coronary heart disease: epidemiologic evidence and implications for treatment. Psychosom Med 2005; 67:869-78. [PMID: 16314591 DOI: 10.1097/01.psy.0000188393.73571.0a] [Citation(s) in RCA: 289] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD). METHODS Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966-2004) and PsychINFO (1872-2004). Reviews of bibliographies also were used to identify relevant articles. RESULTS In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support. CONCLUSIONS Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events.
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Affiliation(s)
- Heather S Lett
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Orth-Gomér K, Albus C, Bagés N, DeBacker G, Deter HC, Herrmann-Lingen C, Oldenburg B, Sans S, Williams RB, Schneiderman N. Psychosocial considerations in the European guidelines for prevention of cardiovascular diseases in clinical practice: Third Joint Task Force. Int J Behav Med 2005; 12:132-41. [PMID: 16083316 DOI: 10.1207/s15327558ijbm1203_2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The International Society of Behavioral Medicine (ISBM) was one of eight societies that comprised the Third Task Force of European and Other Societies on Prevention of Cardiovascular Disease in Clinical Practice (2003-2004). This task force considered published knowledge from diverse fields related to preventive cardiology including behavioral medicine to improve risk estimation and risk factor management. The scientific evidence supporting the guidelines included findings on low socioeconomic status, social isolation, psychosocial stress, hostility, depression and negative affect, the clustering of psychosocial and lifestyle risk factors, and lifestyle psychosocial interventions. Recommendations for promoting behavior change and management of psychosocial and lifestyle factors in clinical practice include strategies for promoting healthy lifestyle, improving health care provider-patient interactions, implementing multimodal interventions, and managing psychosocial risk factors.
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Murberg TA. Long-term effect of social relationships on mortality in patients with congestive heart failure. Int J Psychiatry Med 2005; 34:207-17. [PMID: 15666956 DOI: 10.2190/gkj2-p8bd-v59x-mjnq] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Congestive heart failure is a major cause of morbidity and mortality within the Western world, and yet psychosocial impact of this disease is under-researched. The aim of this study was to evaluate the possible effects of social relationships (perceived social support and perceived social isolation) on mortality risk in 119 patients with stable, symptomatic congestive heart failure. Fifty-one deaths were registered during the six-year follow-up period, all from cardiac causes. Analysis using proportional hazard models indicated that social isolation was a significant predictor of mortality (relative risk, 1.36; confidence interval, 1.04 to 1.78; p < 0.03), controlling for neuroticism, heart failure severity, functional status, gender, and age. The small sample size was a limitation of the study; therefore, further research is required in order to confirm these findings and to illuminate the mechanisms behind the relationships between social isolation and mortality.
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Brummett BH, Mark DB, Siegler IC, Williams RB, Babyak MA, Clapp-Channing NE, Barefoot JC. Perceived social support as a predictor of mortality in coronary patients: effects of smoking, sedentary behavior, and depressive symptoms. Psychosom Med 2005; 67:40-5. [PMID: 15673622 DOI: 10.1097/01.psy.0000149257.74854.b7] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Numerous studies have shown network assessments of social contact predict mortality in patients with coronary artery disease (CAD). Fewer studies have demonstrated an association between perceived social support and longevity in patient samples. It has been suggested that 1 of the mechanisms linking social support with elevated risk for mortality is the association between social support and other risk factors associated with decreased longevity such as smoking, failure to exercise, and depressive symptoms. The present study examined an assessment of perceived support as a predictor of all-cause and CAD mortality and examined the hypothesis that smoking, sedentary behavior, and depressive symptoms may mediate and/or moderate this association. METHODS Ratings of social support and the risk factors of smoking, sedentary behavior, and depressive symptoms were examined as predictors of survival in 2711 patients with CAD, and associations between support and these risk factors were assessed. Smoking, sedentary behavior, and depressive symptoms were examined as mediators and/or moderators of the association between social support and mortality. RESULTS Social support, smoking, sedentary behavior, and depressive symptoms were predictors of mortality (p's <.01). Results also indicated that sedentary behavior, but not smoking status or depressive symptoms, may substantially mediate the relationship between support and mortality. No evidence for moderation was found. CONCLUSIONS The relation between social support and longevity may be partially accounted for by the association between support and sedentary behavior.
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Affiliation(s)
- Beverly H Brummett
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 2969, Durham, NC 27710, USA.
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Joynt KE, Whellan DJ, O'connor CM. Why is depression bad for the failing heart? A review of the mechanistic relationship between depression and heart failure. J Card Fail 2004; 10:258-71. [PMID: 15190537 DOI: 10.1016/j.cardfail.2003.09.008] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depression is 4 to 5 times as common in heart failure (HF) patients as in the general population, might confer a higher risk of developing HF, and negatively affects prognosis in established HF. METHODS AND RESULTS A review was undertaken via Medline (1966-2003) and PsycINFO (1872-2003) searches using the subject headings "depressive disorder" and "heart failure, congestive." Our findings suggest that the link between depression and HF may be due to shared pathophysiology. Depression may augment catecholamine release, arrhythmias, elaboration of proinflammatory cytokines, and platelet activation--processes that may influence prognosis in HF. Depression is also associated with a higher risk of noncompliance and lower levels of social support, which have been shown to worsen prognosis in HF. The impact of pharmacologic or behavioral treatment for depression on physiologic parameters or clinical outcomes in HF remains unclear. Inherent difficulties in recognition of depression in the setting of HF may decrease the likelihood that depressed patients receive the treatment they need. CONCLUSIONS Depression is common in HF, may contribute to the development of HF in susceptible populations, and is independently predictive of poor clinical outcomes. Pathophysiologic pathways and psychosocial issues that are shared between the 2 conditions might explain these observations and represent potential therapeutic targets. Vigilant attention to the recognition and treatment of depression in HF patients is warranted.
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Affiliation(s)
- Karen E Joynt
- Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA
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Vaglio J, Conard M, Poston WS, O'Keefe J, Haddock CK, House J, Spertus JA. Testing the performance of the ENRICHD Social Support Instrument in cardiac patients. Health Qual Life Outcomes 2004; 2:24. [PMID: 15142277 PMCID: PMC434528 DOI: 10.1186/1477-7525-2-24] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 05/13/2004] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous investigations suggest an important role of social support in the outcomes of patients treated for ischemic heart disease. The ENRICHD Social Support Instrument (ESSI) is a 7-item self-report survey that assesses social support. Validity and reliability of the ESSI, however, has not been formally tested in patients undergoing percutaneous coronary intervention (PCI). METHODS The ESSI, along with the Short Form-36 (SF-36), was sequentially administered to a cohort of 271 patients undergoing PCI. The test-retest reliability was examined with an intra-class correlation coefficient by comparing scores among 174 patients who completed both instruments 5 and 6 months after their procedure. Internal reliability was assessed using Cronbach's alpha at the time of patients' baseline procedure. The concurrent validity of the ESSI was assessed by comparing scores between depressed (MHI-5 score < 44) vs. non-depressed patients. The correlation between the ESSI and the SF-36 Social Functioning sub-scale, an accepted measure of social functioning, was also examined. RESULTS Test-retest reliability showed no significant differences in mean scores among ESSI questionnaires administered 1 month apart (27.8+/-1.4 vs 27.8+/-1.5, p = 0.98). The intra-class correlation coefficient was 0.94 and Cronbach's alpha was 0.88. Mean ESSI scores were significantly lower among depressed vs. non-depressed patients (24.6+/-1.7 vs 27+/-1.4, p < 0.018) and a positive albeit modest correlation with social functioning was seen (r = 0.19, p = 0.002). CONCLUSION The ESSI appears to be a valid and reliable measure of social support in patients undergoing treatment for coronary artery disease. It may prove to be a valuable method of controlling for patient variability in outcomes studies where the outcomes are related to patients' social support.
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Affiliation(s)
- Joseph Vaglio
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
| | - Mark Conard
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
- University of Missouri, Kansas City, MO, USA
| | - Walker S Poston
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
- University of Missouri, Kansas City, MO, USA
| | - James O'Keefe
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
| | - C Keith Haddock
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
- University of Missouri, Kansas City, MO, USA
| | - John House
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
| | - John A Spertus
- Mid America Heart Institute at St Lukes Hospital, Kansas City, MO, USA
- University of Missouri, Kansas City, MO, USA
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Barefoot JC, Burg MM, Carney RM, Cornell CE, Czajkowski SM, Freedland KE, Hosking JD, Khatri P, Pitula CR, Sheps D. Aspects of social support associated with depression at hospitalization and follow-up assessment among cardiac patients. ACTA ACUST UNITED AC 2004; 23:404-12. [PMID: 14646786 DOI: 10.1097/00008483-200311000-00002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE High levels of depressive symptoms have been shown to affect the morbidity, mortality, and functioning of patients with myocardial infarction (MI). Findings have shown that social support is associated with depression in both patient and community samples. This study examined various aspects of social support as they relate to depressive symptoms in patients with MI, both in the hospital and 2 weeks later. METHODS As part of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) pilot study, measures of perceived social support, social networks, social support received, and social conflict were administered to 196 patients with MI. These patients also were administered the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Depression was reassessed 2 weeks later. Relations between social support indicators and the depression measures were examined. RESULTS The prevalence of depression symptoms was high, especially among poorer and younger patients. There was modest improvement across time. Patients with high social support scores, particularly those reflecting perceived support, had lower scores on depression measures at baseline. High levels of perceived support and low social conflict at baseline were associated with less follow-up depression, as measured by the Beck cognitive scale, but not the Beck somatic scale nor the Hamilton scale. There were few associations with measures of social networks and received support. CONCLUSIONS Social support indicators were differentially related to depression among patients with MI while in the hospital and 2 weeks later. The pattern of associations also depended on the measure of depression. A broad assessment strategy of both social support and depression is needed for a full understanding of their interrelations.
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Emery CF, Frid DJ, Engebretson TO, Alonzo AA, Fish A, Ferketich AK, Reynolds NR, Dujardin JPL, Homan JE, Stern SL. Gender differences in quality of life among cardiac patients. Psychosom Med 2004; 66:190-7. [PMID: 15039503 DOI: 10.1097/01.psy.0000116775.98593.f4] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Prior studies of quality of life among cardiac patients have examined mostly men. This study evaluated gender differences in quality of life and examined the degree to which social support was associated with quality of life. METHODS A sample of 536 patients (35% women) was recruited during a 14-month period from the inpatient cardiology service of a University-based hospital. Participants completed assessments at baseline and at 3-month intervals over the subsequent 12 months, for a total of 5 assessments. Measures at each assessment included quality of life [Mental Component Score (MCS) and Physical Component Score (PCS) from the Medical Outcomes Study--Short Form 36] and social support [Interpersonal Support Evaluation List--Short Form]. RESULTS A total of 410 patients completed the baseline assessment and at least one follow-up, and were included in the data analyses. Linear mixed effects modeling of the MCS score revealed a significant effect of gender (p =.028) and time (p <.001), as well as a significant interaction of gender by social support (p =.009). Modeling of the PCS revealed a significant effect of gender (p =.010) and time (p <.001). CONCLUSIONS Women with cardiac disease indicated significantly lower quality of life than men with cardiac disease over the course of a 12-month longitudinal follow-up. Social support, especially a sense of belonging or companionship, was significantly associated with emotional quality of life (MCS) among women. Strategies to increase social support may be important for health and well-being of women with cardiac disease.
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Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR, Froelicher ES, Czajkowski S, Youngblood M, Huber M, Berkman LF. A Short Social Support Measure for Patients Recovering From Myocardial Infarction. ACTA ACUST UNITED AC 2003; 23:398-403. [PMID: 14646785 DOI: 10.1097/00008483-200311000-00001] [Citation(s) in RCA: 370] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Pamela H Mitchell
- Department of Biobehavioral Nursing and Health System, University of Washington, Seattle, Washington 98195-7266, USA
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Menéndez Villalva C, Montes Martínez A, Gamarra Mondelo T, Núñez Losada C, Alonso Fachado A, Bujan Garmendia S. [Influence of social support on patients with essential hypertension]. Aten Primaria 2003; 31:506-13. [PMID: 12765589 PMCID: PMC7681887 DOI: 10.1016/s0212-6567(03)70724-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2002] [Accepted: 02/03/2003] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine whether social support affects blood pressure control in patients diagnosed with essential Hypertension. DESIGN Observational, prospective study, with a year's follow-up. SERRING: Mariñamansa-A Cuña Health Centre, Ourense (Galicia), Spain. PARTICIPANTS 236 patients diagnosed with essential hypertension in health centre controls. MEASUREMENTS During the one-year follow-up the following clinical variables were measured: age, sex, blood pressure, severity of hypertension, tobacco consumption, alcohol consumption, presence of diabetes mellitus, hypercholesterolaemia, Body Mass Index and compliance with treatment. Social and family variables were: marital status, cultural level, economic and social status, type of family, stressful vital events and social support. RESULTS Mean age was 63.51 (62.05-64.96); 66.1% were women. Predominant kind of family was nuclear (64.3%). 30.2% had low social network (0-1 social contacts). We found 22% poor functional social support. Social support remained stable throughout the study. Hypertense patients with poor social networks had, after control for possible confusing variables, their systolic pressure 9.59 mm Hg (2.6716,51) and diastolic pressure 4.29 mm Hg (0.448.15) higher than hypertense patients with broader social networks. CONCLUSION Hypertense patients with a poor social network had higher blood pressure figures than hypertense patients with wider social networks.
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