Propensity to psychiatric and somatic ill-health: evidence from a birth cohort

Does childhood parental death impact late life health directly and indirectly? Evidence from a National Survey in China

Despite growing interest in understanding the impact of childhood parental death, less is known about its long-term effects on older adults. We investigated the mediating role of poor health perception in the relationship between childhood parental loss and late life health. A cross-sectional study using data from the 2016 China Longitudinal Aging Social Survey was conducted. Our final sample featured 8,547 older adults. The prevalence of childhood parental death was 9.8%. Results indicated a significant direct impact of childhood parental death on depression and cognitive function. Mediating effects were observed, with older adults who experienced childhood parental loss perceiving their health status as significantly worse. This, in turn, predicted higher levels of objective physical impairment, greater depression, and lower levels of cognitive function. Our study offers the first empirical evidence of the enduring negative effects of childhood parental death as well as the pivotal mediating role of poor health perception.

The role of neuroticism and pain in dental anxiety: A twin study

OBJECTIVES

Accumulating evidence has revealed that dental anxiety is robustly associated with dental care-related pain and discomfort, but also with the personality trait of neuroticism (i.e. the relatively stable disposition to experience the world as distressing, threatening and unsafe). However, there is a near absence of research on these risk factors in samples for which genetic information is available. With the aim of arriving at a more refined understanding of dental anxiety, this twin cohort study assessed genetic and environmental influences on neuroticism, dental care-related pain and dental anxiety, and the relation between these phenotypes.

METHODS

Participants were recruited from the Norwegian Twin Registry, and data collections were carried out in 1992-98 (Time 1) and 2011 (Time 2). Well-validated questionnaires were used to assess the study variables, including Corah's Dental Anxiety Scale, the Numerical Pain Rating Scale, the NEO Personality Inventory Revised (Time 2) and Eysenck's Personality Questionnaire (Time 1). Pearson correlation analysis and generalized estimating equations (GEE) were used to investigate phenotypic associations. Analyses of genetic and environmental influences were performed using Cholesky modelling.

RESULTS

A total of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 participated in the study. Moderate estimates of heritability for dental anxiety (0.29), treatment-related pain (0.24) and neuroticism (0.45-0.54) were found. Cholesky modelling showed furthermore that neuroticism assessed at Time 1 and Time 2 was related to dental anxiety and pain via both genetic and individual-specific environmental pathways, albeit not very strongly. The particularly high phenotypic correlation observed between dental care-related pain and anxiety (r = .68) was explained by both overlapping genetic and individual-specific environmental influences (the genetic and environmental correlations were .84 and .63 respectively).

CONCLUSIONS

The findings provide deeper insight into the aetiology of dental anxiety and confirm that while it is strongly linked to treatment-related pain experiences, this relation is to a considerable degree independent of general negative affectivity/neuroticism.

Managing medical and psychiatric multimorbidity in older patients

Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.

The Brain Overwork Scale: A Population-Based Cross-Sectional Study on the Psychometric Properties of a New 10-Item Scale to Assess Mental Distress in Mongolia

Identifying mental distress is a complex task, particularly when individuals experience physical symptoms. Traditional self-report questionnaires that detect psychiatric symptoms using emotional words may not work for these individuals. Consequently, there is a need for a screening tool that can identify both the physical and mental symptoms of mental distress in individuals without a clinical diagnosis. Our study aimed to develop and validate a scale that measures mental distress by measuring the extent of brain overwork, which can be extrapolated as the burden of mental distress. In this population-based cross-sectional study, we recruited a total of 739 adults aged 16–65 years from 64 sampling centers of a cohort in Mongolia to validate a 10-item self-report questionnaire. Internal consistency was measured using McDonald’s ω coefficient. Test–retest reliability was analyzed using intraclass correlation coefficients. Construct and convergent validities were examined using principal component analysis (PCA) and confirmatory factor analysis (CFA). The Hospital Anxiety and Depression Scale (HADS) and the abbreviated version of World Health Organization Quality of Life (WHOQOL-BREF) were used to evaluate criterion validity. Among the participants, 70.9% were women, 22% held a bachelor’s degree or higher, 38.8% were employed, and 66% were married. The overall McDonald’s ω coefficient was 0.861, demonstrating evidence of excellent internal consistency. The total intraclass correlation coefficient of the test–retest analysis was 0.75, indicating moderate external reliability. PCA and CFA established a three-domain structure that provided an excellent fit to the data (RMSEA = 0.033, TLI = 0.984, CFI = 0.989, χ2 = 58, p = 0.003). This 10-item scale, the Brain Overwork Scale (BOS-10), determines mental distress in three dimensions: excessive thinking, hypersensitivity, and restless behavior. All the items had higher item-total correlations with their corresponding domain than they did with the other domains, and correlations between the domain scores had a range of 0.547–0.615. BOS-10 correlated with HADS, whereas it was inversely correlated with WHOQOL-BREF. In conclusion, the results suggest that BOS-10 is a valid and reliable instrument for assessing mental distress in the general population. The scale screens for mental distress that is characterized by subjective symptoms such as excessive thinking, hypersensitivity, and restless behavior. The current findings also demonstrate that the BOS-10 is quantitative, simple, and applicable for large group testing. This scale may be useful for identifying at-risk individuals who may require further evaluation and treatment for mental distress.

Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort

BACKGROUND

We sought to: [1] estimate the prevalence of multimorbidity at age 46-48 in the 1970 British Cohort Study-a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity.

METHOD

A prospective longitudinal birth cohort of a community-based sample from the 1970 British Cohort Study (BCS70). Participants included all surviving children born in mainland Britain in a single week in April 1970; the analytical sample included those with valid data at age 46-48 (n = 7951; 2016-2018). The main outcome was multimorbidity, which was operationalised as a binary indicator of two or more long-term health conditions where at least one of these conditions was of physical health. It also included symptom complexes (e.g., chronic pain), sensory impairments, and alcohol problems.

RESULTS

Prevalence of mid-life multimorbidity was 33.8% at age 46-48. Those with fathers from unskilled social occupational class (vs professional) at birth had 43% higher risk of mid-life multimorbidity (risk ratio = 1.43, 95% confidence interval 1.15 to 1.77). After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity (risk ratio = 0.90, 95% confidence interval 0.84 to 0.96); a decrease of one body mass index point at age 10 was associated with 3% lower risk (risk ratio = 1.03, 95% confidence interval 1.01 to 1.05); one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk (risk ratio = 0.96, 95% confidence interval 0.91 to 1.00); an increase of one internalising problem at age 16 was equated with 4% higher risk (risk ratio = 1.04, 95% confidence interval 1.00 to 1.08) and of one externalising problem at age 16 with 6% higher risk (risk ratio = 1.06, 1.03 to 1.09).

CONCLUSION

Prevalence of multimorbidity was high in mid-life (33.8% at age 46-48) in Britain. Potentially modifiable early-life exposures, including early-life social circumstances, cognitive, physical and emotional development, were associated with elevated risk of mid-life multimorbidity.

The evolutionary genetics of personality

Genetic influences on personality differences are ubiquitous, but their nature is not well understood. A theoretical framework might help, and can be provided by evolutionary genetics. We assess three evolutionary genetic mechanisms that could explain genetic variance in personality differences: selective neutrality, mutation‐selection balance, and balancing selection. Based on evolutionary genetic theory and empirical results from behaviour genetics and personality psychology, we conclude that selective neutrality is largely irrelevant, that mutation‐selection balance seems best at explaining genetic variance in intelligence, and that balancing selection by environmental heterogeneity seems best at explaining genetic variance in personality traits. We propose a general model of heritable personality differences that conceptualises intelligence as fitness components and personality traits as individual reaction norms of genotypes across environments, with different fitness consequences in different environmental niches. We also discuss the place of mental health in the model. This evolutionary genetic framework highlights the role of gene‐environment interactions in the study of personality, yields new insight into the person‐situation‐debate and the structure of personality, and has practical implications for both quantitative and molecular genetic studies of personality. Copyright © 2007 John Wiley & Sons, Ltd.

The Distressed personality type: replicability and general health associations

The Distressed personality type, identified in a cardiac population, confers risk for worse cardiac outcomes. Whether such a class of persons is identifiable in general patient populations, as well as its health correlates, remains unknown. We investigated these questions in a sample of 482 older primary care patients. Mixture structural equation modelling revealed that a Distressed Type was identifiable in Five Factor Model (FFM) personality data and associated with higher levels of medically documented multimorbidity, and worse subjective health ratings, physician assessed physical functioning and interviewer rated psychosocial functioning. In models including paths from outcomes to both traits and types, traits and types were independently associated with health outcomes, pointing towards the value of considering both approaches in epidemiologic personology research. Copyright © 2007 John Wiley & Sons, Ltd.

Early parental death and psychosocial risk factors for dementia: A case-control study in Europe

OBJECTIVES

To assess the association between early parental death and the risk of dementia in adult life and to examine the risk factors associated with early parental death in people with and without dementia.

METHODS/DESIGN

A population-based case-control study of a sample of 65 997 participants from the Survey of Health, Ageing and Retirement in Europe study. Early parental death was operationalized as parental death at the age of ≤16 years. Main analyses were conducted using bivariate and multivariate logistic regression analyses.

RESULTS

The odds ratio (OR) for dementia in individuals who experienced early parental death (father or mother) at the age of ≤16 years was 1.83 (95%CI 1.61-2.09) and 1.54 (95%CI 1.35-1.76) adjusted for age, gender and education. In the multivariate logistic regression analysis carried out with the whole sample, early parental death increased the risk of dementia (OR = 1.50, 95%CI 1.31-1.72), along with older age (OR = 5.92, 95%CI 4.86-7.17), neuroticism (OR = 2.94, 95%CI 2.61-3.31), low education level (OR = 1.84, 95%CI 1.64-2.05) and low income (OR = 1.49, 95%CI 1.34-1.67).

DISCUSSION

Early parental death (≤16 years) was associated with an increased risk of dementia. We discuss the neurobiological markers associated with adverse childhood experiences (ACEs) and dementia as well as interventions to counteract the negative health effects on adults. J Am Geriatr Soc 68:-, 2020.

Personality traits are related to functional dyspepsia in a large sample of Iranian adults

BACKGROUND AND OBJECTIVE

Few studies have evaluated the association of personality traits with functional dyspepsia (FD). In the present study, we aimed to explore the relationship between different personality traits and FD in a sample of Iranian adults.

METHODS

This cross-sectional study was conducted on 4763 adults. FD was evaluated using a modified and validated Persian version of the Rome III questionnaire for the diagnosis of functional gastrointestinal disorders. Personality traits were assessed using the five-factor model. Logistic regression was used for data analysis.

RESULTS

After controlling for various potential confounders, neuroticism (OR = 1.043; 95% CI: 1.028, 1.059), agreeableness (OR = 0.965; 95% CI: 0.952, 0.978), extraversion (OR = 0.985; 95% CI: 0.970, 0.990), openness (OR = 0.981; 95% CI: 0.966, 0.996), and conscientious (OR = 0.980; 95% CI: 0.968, 0.991) scores were associated with risk of FD. Similar significant associations were observed in stratified analyses by sex, except for openness which tended to decrease the risk of FD marginally in women (OR = 0.983, 95% CI: 0.966, 1.001) and in men (OR = 0.979, 95% CI: 0.955, 1.003) after adjusting for multiple confounding variables.

CONCLUSION

Our study showed that the higher scores of extraversion, conscientiousness, openness, and agreeableness are independently associated with a lower risk of FD in Iranian general population while higher scores of neuroticism increase the risk of FD.

Impact of educational attainment on the association between social class at birth and multimorbidity in middle age in the Aberdeen Children of the 1950s cohort study

OBJECTIVE

Multimorbidity (the coexistence of two or more health conditions) is increasingly prevalent. No long-term cohort study has examined the impact of contemporaneously measured birth social class along with educational attainment on adult self-reported multimorbidity. We investigated the impact of educational attainment on the relationship between social class at birth and adult self-reported multimorbidity in the Aberdeen Children of the 1950s (ACONF) cohort.

METHODS

A prospective cohort study using the ACONF cohort. ACONF included 12 150 individuals born in Aberdeen, Scotland 1950-1956. In 2001, 7184 (64%) responded to a questionnaire providing information including self-reported morbidity and educational attainment. The exposure was father's social class at birth from birth records and the outcome was self-reported multimorbidity.Logistic regression assessed the association between social class and multimorbidity with adjustment for gender, then by educational attainment and finally by childhood cognition and secondary school type. ORs and 95% CIs were presented.

RESULTS

Of 7184 individuals (mean age 48, 52% female), 5.4% reported multimorbidity. Birth social class was associated with adult multimorbidity. For example, the OR of multimorbidity adjusted by gender was 0.62 (95% CI 0.39 to 1.00) in the highest social class group (I/II) in relation to the reference group (III (manual)) and was 1.85 (95% CI 1.19 to 2.88) in the lowest social class group. This was partially attenuated in all social class categories by educational attainment, for example, the OR was 0.74 (95% CI 0.45 to 1.21) in group I/II following adjustment.

CONCLUSION

Lower social class at birth was associated with developing multimorbidity in middle age. This was partially mediated by educational attainment and future research should consider identifying the other explanatory variables. The results are relevant to researchers and to those aiming to reduce the impact of multimorbidity.

Neuroticism and Somatic Complaints: Concomitant Effects of Rumination and Worry

Background: Neuroticism is associated with inflated somatic symptom reporting. Worry and rumination are a cognitive concomitant of neuroticism and potentially mediate the neuroticism–somatic complaint relationship. Aims: The present study examined the degree to which worry and rumination mediated the relationship between neuroticism and somatic complaints. Method: A sample of 170 volunteers, recruited via convenience sampling, took part. Participants completed a series of self-report measures: the Eysenck Personality Questionnaire Revised-Short Form, Penn State Worry Questionnaire, the Ruminative Response Scale and the Somatic Symptom Scale-8. Results: Analysis revealed significant positive correlations between neuroticism, rumination and worry. Neuroticism, rumination and worry also correlated positively with somatic complaints. Using structural equation modelling, a mediational model indicated that rumination fully mediated the relationship between neuroticism and somatic complaints. Conclusions: Findings are consistent with the symptom perception hypothesis and have implications for healthcare in terms of managing individuals who present with multiple somatic complaints. Future research would benefit from adopting a longitudinal approach to test how rumination interacts with neuroticism and somatic complaints over time.

Optical Coherence Tomography of Small Retinoblastoma

PURPOSE

To investigate hand-held optical coherence tomography (HH-OCT) characteristics of small (<1 mm thickness) retinoblastoma.

DESIGN

Retrospective observational case series.

METHODS

Patient and tumor data were extracted from the medical record and analyzed along with HH-OCT scans. Determination of tumor layer of origin was performed using a layer-by-layer analysis of HH-OCT data and specific HH-OCT-related features were described.

RESULTS

There were 20 sub-millimeter retinoblastomas from 16 eyes of 15 patients. Mean largest tumor basal diameter by HH-OCT was 2.2 mm (median, 1.9; range, 0.7-4.1 mm), and mean tumor thickness was 468 μm (median, 441; range, 151-998 μm). In all cases, the retinoblastoma caused discontinuity or disruption of the inner nuclear (INL), outer plexiform (OPL), outer nuclear (ONL), and external limiting membrane (ELM) layers (20/20, 100%). Tumor origin was in the INL in 19/20 (95%) and equivocal (INL vs ONL) in 1/20 (5%). Intratumoral microcalcification was present in 14/20 tumors (70%). There were 2 characteristic findings (signs) on HH-OCT including the INL "fish tail" sign with splaying of the INL at the tumor margin (19/20, 95%) and the ONL "shark fin" sign with folding of the ONL and OPL, conforming to the lateral tumor margins (15/20, 75%). Both signs were concurrently present in 15 tumors (15/20, 75%).

CONCLUSIONS

HH-OCT demonstrated that sub-millimeter retinoblastoma seems to originate from the INL, with tumor base and thickness growth progressing in a linear relationship. Characteristic HH-OCT findings included intratumoral microcalcification, INL "fish tail" sign, and ONL "shark fin" sign.

Fatigue symptoms in relation to neuroticism, anxiety-depression, and musculoskeletal pain. A longitudinal twin study

BACKGROUND

The nature of the relationship between fatigue and its risk factors is poorly understood. In the present study the genetic and environmental association between anxiety-depression, musculoskeletal (MS) pain and fatigue was examined, and the role of neuroticism as a shared risk factor that may possibly explain the co-occurrence between these phenotypes was investigated in a combined cross-sectional and longitudinal twin design.

METHODS

The sample consisted of 746 monozygotic (MZ) and 770 dizygotic (DZ) twins in the age group of 50-65 (mean = 57.11 years, SD = 4.5). Continuous measures of fatigue symptoms and the other phenotypes were employed. Using Cholesky modeling, genetic and environmental influences on the phenotypes, and the associations among them, were determined. Analyses were performed using measures of neuroticism obtained concurrently and 13-19 years earlier.

RESULTS

Results from multiple regression analyses showed that neuroticism, anxiety-depression symptoms, and MS pain were all significantly associated with fatigue, controlling for sex, education, and general health indices. The best-fitting biometric models included additive genetic and individual-specific environmental effects. Heritabilities in the 0.40-0.53 range were demonstrated. Furthermore, while there was a considerable overlap in genetic risk factors between the four phenotypes, a substantial proportion of the genetic risk shared between anxiety-depression and fatigue, and between MS pain and fatigue, was independent of neuroticism.

CONCLUSION

Evidence for a common underlying susceptibility to report fatigue symptoms, genetically linked to neuroticism, anxiety-depression, and MS pain, was found. Both unique and pleiotropic effects appear to be involved in the genetic architecture of the phenotypes.

The Effect of Paternal and Alloparental Support on the Interbirth Interval Among Contemporary North American Families

The present study investigated whether the length of interbirth intervals between first and second-born children in a North-American middle-class sample could be explained by paternal and alloparental support and firstborn children's gender. The sample consisted of 225 families in which mothers were expecting their second child. Parents reported on paternal and alloparental support (maternal kin, paternal kin, and non-kin support). The results showed that higher maternal kin support and having a firstborn son was linked with shorter interbirth-intervals. Mothers' longer work hours during the pregnancy with the second born was related to longer interbirth intervals. These results highlight the importance of maternal kin support and children's characteristics in understanding the timing of birth when parents have a second child.

Impact of personality traits and early life experience on timing of emigration and rise to alpha male status for wild male white-faced capuchin monkeys (Cebus capucinus) at Lomas Barbudal Biological Reserve, Costa Rica

It is rare in studies of long-lived animals to know enough about the personalities and early experiences of individuals to use this information to predict their behaviour during major life transitions in adolescence and adulthood. Here, we examine how personality traits and early experiences predict age of natal emigration and timing of first ascent to alpha status in 169 wild male white-faced capuchins studied at Lomas Barbudal, Costa Rica, 75 of whom emigrated and 23 of whom acquired alpha status. Males were more likely to delay natal emigration if they were more extraverted, more neurotic, if their fathers co-resided longer with them, and if there were fewer alpha male turnovers. More extraverted males attained alpha status sooner.

Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis

Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.

Personality traits and clinical/biochemical course in the first year after kidney transplant

BACKGROUND

The relationship between personality and health is frequently studied in scientific research. This study investigated the clinical/biochemical course of kidney transplant patients based on personality traits.

METHODS

A longitudinal study assessed 114 kidney transplant patients (men = 68 and women = 46) with an average age of 47.72 years (SD = 11.4). Personality was evaluated using the Brazilian Factorial Personality Inventory (BFP/Big Five Model). Clinical variables were analyzed based on patient charts (estimated glomerular filtration rate (eGFR), hypertension, acute rejection, infection, graft loss, and death). Personality types were assessed by hierarchical cluster analysis.

RESULTS

Two groups with personality types were differentiated by psychological characteristics: Cluster 1 - average neuroticism, high surgency, agreeableness and conscientiousness, and low openness; Cluster 2 - high neuroticism, average surgency and agreeableness, average conscientiousness, and low openness. There was no statistically significant difference between the clusters in terms of hypertension, acute infection, graft loss, death, and Human Leukocyte Antigen (HLA) I and II panel reactive antibodies. eGFR was associated with the personality types. Cluster 2 was associated with a better renal function in the 9-month follow-up period after kidney transplantation.

CONCLUSION

In this study, patients from Cluster 2 exhibited higher eGFR 9 months after the transplant procedure compared to those from Cluster 1. Monitoring these patients over a longer period may provide a better understanding of the relationship between personality traits and clinical course during the post-transplant period.

Posttraumatic Growth Following the Loss of a Pet

The current study examined posttraumatic growth (PTG) experienced by bereaved pet owners following the death of their pet. Using qualitative methodology, we analyzed responses of 308 participants who answered yes to a question about experiencing PTG. Within the five factors model of PTG, the most endorsed included the following: Relating to Others ( n = 76), Appreciation of Life ( n = 52), Personal Strength ( n = 51), Spiritual Change ( n = 32), and New Possibilities ( n = 29). Other themes not captured by the PTG included as follows: relating to animals ( n = 70), continuing bonds ( n = 53), attachment relationship ( n = 44), and unconditional love ( n = 13). Our findings support the notion that PTG occurs for people who have experienced pet loss, with new emergent themes.

Adult bone strength of children from single-parent families: the Midlife in the United States Study

Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adulthood.

INTRODUCTION

Because peak bone mass is acquired during childhood, bone health may be negatively impacted by childhood socio-environmental disadvantage. The goal of this study was to determine whether being raised in a single-parent household is associated with lower bone strength in adulthood.

METHODS

Using dual-energy X-ray absorptiometry data from 708 participants (mean age 57 years) in the Midlife in the United States Biomarker Project, we examined the independent associations of composite indices of femoral neck bone strength relative to load (in three failure modes: compression, bending, and impact) in adulthood with the experience of single-parent childhood and parental death or divorce in childhood.

RESULTS

After adjustment for gender, race, menopause transition stage, age, and body mass index, each additional year of single-parent childhood was associated with 0.02 to 0.03 SD lower indices of adult femoral neck strength. In those with 9-16 years of single-parent childhood, the compression strength index was 0.41 SD lower, bending strength index was 0.31 SD lower, and impact strength index was 0.25 SD lower (all p values < 0.05). In contrast, parental death or divorce during childhood was not by itself independently associated with adult bone strength indices. The magnitudes of these associations were unaltered by additional adjustment for lifestyle factors and socioeconomic status in childhood and adulthood.

CONCLUSIONS

Independent of parental death or divorce, growing up in a single-parent household is associated with lower femoral neck bone strength in adulthood, and this association is not entirely explained by childhood or adult socioeconomic conditions or lifestyle choices.

Associations between DSM-IV mental disorders and subsequent heart disease onset: beyond depression

BACKGROUND

Prior studies on the depression-heart disease association have not usually used diagnostic measures of depression, or taken other mental disorders into consideration. As a result, it is not clear whether the association between depression and heart disease onset reflects a specific association, or the comorbidity between depression and other mental disorders. Additionally, the relative magnitude of associations of a range of mental disorders with heart disease onset is unknown.

METHODS

Face-to-face household surveys were conducted in 19 countries (n=52,095; person years=2,141,194). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Heart disease was indicated by self-report of physician's diagnosis, or self-report of heart attack, together with their timing (year). Survival analyses estimated associations between first onset of mental disorders and subsequent heart disease onset.

RESULTS

After comorbidity adjustment, depression, panic disorder, specific phobia, post-traumatic stress disorder and alcohol use disorders were associated with heart disease onset (ORs 1.3-1.6). Increasing number of mental disorders was associated with heart disease in a dose-response fashion. Mood disorders and alcohol abuse were more strongly associated with earlier onset than later onset heart disease. Associations did not vary by gender.

CONCLUSIONS

Depression, anxiety and alcohol use disorders were significantly associated with heart disease onset; depression was the weakest predictor. If confirmed in future prospective studies, the breadth of psychopathology's links with heart disease onset has substantial clinical and public health implications.

Childhood determinants of adult psychiatric disorder

The aim of this project was to assess the current evidence from longitudinal studies for childhood determinants of adult mental illness. Because of the variable and often prolonged period between factors in childhood and the identification of mental illness in adults, prospective studies, particularly birth cohorts, offer the best chance of demonstrating associations in individuals.

A review was undertaken in 2006 of the published literature from longitudinal studies, together with some large-scale retrospective studies and relevant reviews which provided supplementary evidence. The main focus was upon potentially ameliorable characteristics, experiences or situations of childhood; however, other factors, not determinants but pre-cursors, associated with later mental illness could not be left out.

Seven major electronic data-bases of published research were interrogated with a range of key-words and the results supplemented from personal searches, enquiries and reference trails. In excess of 1,500 abstracts were read to select 250 papers for full review. The material was assessed in relation to ten factors:

Psychological disturbance; Genetic Influences; Neurological Deviance; Neuroticism; Behaviour; School Performance; Adversity; Child Abuse or Neglect; Parenting and parent-child relationships; Disrupted and Disfunctional Families.

In 2011 the search was repeated for the period 2006 to mid-2011, using the same search terms and supplemented in the same manner. Over 1,800 abstracts emerged and almost 200 papers selected for more detailed review. These were then integrated into the original text with modifications where necessary. The whole text was then revised and edited in January / February 2012.

There is continuing evidence for the association with later mental ill-health for each of these ten factors, but with different degrees of conviction. The evidence for each is discussed in detail and weighed both separately and in relation to others. These are then summarised, and the research implications are considered. Finally, the implications for prevention are discussed together with the practical potential for preventive and health-promoting programmes.

Pathways to lifespan health following childhood parental death

The death of a parent is a profoundly stressful form of childhood adversity, increasing the short- and long-term risk of mental health problems. Emerging research suggests it may also disrupt biological regulatory systems and increase the risk of long-term physical health problems. This article presents a theoretical framework of the process by which the experience of parental death during childhood may influence mental and physical health outcomes over time. Drawing from a broad literature on adaptation following childhood parental loss, we focus on risk and protective factors in the childhood environment that are theoretically and empirically linked to emotional and biological regulatory responses to stress later in life, the effects of which may accumulate to impact long-term health.

Personality and longevity: knowns, unknowns, and implications for public health and personalized medicine

We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or "distressed" personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine.

Early social experience affects behavioral and physiological responsiveness to stressful conditions in infant rhesus macaques (Macaca mulatta)

Studies on early development have demonstrated the profound effects of early social experience on the behavioral development and physiology of young rhesus macaques. Given these relationships, we hypothesized that rhesus macaques exposed to different nursery-rearing conditions may develop unique biobehavioral profiles. If this is true, the assessment of temperament may allow us to pinpoint successful rearing environments, thus improving the overall health of nonhuman primates that are raised in captive environments. We conducted biobehavioral assessments in order to examine differences in the development of infants raised under four different peer-rearing conditions (continuous pairing (CP), intermittent pairing, CP with partner rotation, and intermittent rotational pairing) and compared these animals with data from a mother-reared control group. Overall, continuous rotationally paired animals were most similar to mother-reared controls on most behavioral and temperament measures, suggesting that more socially complex rearing environments (greater number of social partners) favor a more active behavioral style. Cortisol profiles of mother-reared controls were similar to both CP groups, and these three groups had higher cortisol concentrations than the intermittent rotational-pairing group. In addition, intermittently paired infants displayed a significantly higher frequency of self-stroke behavior during a human intruder challenge, an abnormal behavior also known as floating limb which has been shown to be a precursor of self-biting. Overall, the data are consistent with the idea that social complexity in the nursery, as operationalized in our continuous rotational pairing, leads to a biobehavioral profile that is most similar to that of infants raised by their mothers in large, socially complex, cages.

Disgust as an adaptive system for disease avoidance behaviour

Disgust is an evolved psychological system for protecting organisms from infection through disease avoidant behaviour. This ‘behavioural immune system’, present in a diverse array of species, exhibits universal features that orchestrate hygienic behaviour in response to cues of risk of contact with pathogens. However, disgust is also a dynamic adaptive system. Individuals show variation in pathogen avoidance associated with psychological traits like having a neurotic personality, as well as a consequence of being in certain physiological states such as pregnancy or infancy. Three specialized learning mechanisms modify the disgust response: the Garcia effect, evaluative conditioning and the law of contagion. Hygiene behaviour is influenced at the group level through social learning heuristics such as ‘copy the frequent’. Finally, group hygiene is extended symbolically to cultural rules about purity and pollution, which create social separations and are enforced as manners. Cooperative hygiene endeavours such as sanitation also reduce pathogen prevalence. Our model allows us to integrate perspectives from psychology, ecology and cultural evolution with those of epidemiology and anthropology. Understanding the nature of disease avoidance psychology at all levels of human organization can inform the design of programmes to improve public health.

Personality characteristics of multiple sclerosis patients: a Rorschach investigation

OBJECTIVE

There are many studies examining cognitive deficits in patients with multiple sclerosis (MS), while significantly less attention has been given to emotional and personality changes. A chronic neurological disorder brings many life stresses and affects the patient's ability to cope with them. This study explored the personality characteristics in a sample of MS patients.

METHODS

51 MS patients (13 male and 38 female, mean age: 42.6 years, mean EDSS: 3.2). All participants were administered the Rorschach Test coded by the Comprehensive System.

RESULTS

Our findings show that the patients in our sample perceive themselves as being less competent than others, at some cost to their self-esteem. A large percentage relies on an avoidant style of coping with problems.

CONCLUSION

These findings imply that MS patients might have special needs in terms of communication with healthcare providers, decision making and adherence to their treatment plans because of their simplifying style of information processing. We argue that it is important to consider personality as well as cognitive changes in neurological disorders such as MS.

Affective lability: separable from neuroticism and the other big four?

The goals of the current study were to use specific measures of affective lability and neuroticism to examine the nomological network surrounding both constructs and to test the degree to which a measure of general personality can account for variability in affective lability. Using a psychiatric outpatient sample (n=48), we assessed personality disorder (PD) symptoms, personality, and level of functioning across a range of domains. Neuroticism and affective lability demonstrated a small but significant positive correlation and manifested a divergent pattern of correlations with PDs and measures of functioning. Specifically, neuroticism was correlated primarily with Borderline, Avoidant and Dependent PDs, whereas affective lability was primarily correlated with Cluster B PDs. In addition, neuroticism evinced significant correlations with a range of functional impairments, whereas affective lability was correlated only with self-harm. Regression analyses demonstrated that a substantial portion of the variance in affective lability scales can be explained by Five-Factor Model domains, particularly if the narrower facets are used. The current findings suggest that neuroticism and affective lability are related but in a complex manner that involves other basic personality domains in addition to neuroticism.

Clustering of psychiatric and somatic illnesses in the general population: multimorbidity and socioeconomic correlates

The distribution of psychiatric disorders and of chronic medical illnesses was studied in a population-based sample to determine whether these conditions co-occur in the same individual. A representative sample (N = 1464) of adults living in households was assessed by the Composite International Diagnostic Interview, version 1.1, as part of the São Paulo Epidemiological Catchment Area Study. The association of sociodemographic variables and psychological symptoms regarding medical illness multimorbidity (8 lifetime somatic conditions) and psychiatric multimorbidity (15 lifetime psychiatric disorders) was determined by negative binomial regression. A total of 1785 chronic medical conditions and 1163 psychiatric conditions were detected in the population concentrated in 34.1 and 20% of respondents, respectively. Subjects reporting more psychiatric disorders had more medical illnesses. Characteristics such as age range (35-59 years, risk ratio (RR) = 1.3, and more than 60 years, RR = 1.7), being separated (RR = 1.2), being a student (protective effect, RR = 0.7), being of low educational level (RR = 1.2) and being psychologically distressed (RR = 1.1) were determinants of medical conditions. Age (35-59 years, RR = 1.2, and more than 60 years, RR = 0.5), being retired (RR = 2.5), and being psychologically distressed (females, RR = 1.5, and males, RR = 1.4) were determinants of psychiatric disorders. In conclusion, psychological distress and some sociodemographic features such as age, marital status, occupational status, educational level, and gender are associated with psychiatric and medical multimorbidity. The distribution of both types of morbidity suggests the need of integrating mental health into general clinical settings.

Managing complex patients on a medical psychiatric unit: an observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention

OBJECTIVE

Although there is a suggestion that the medical psychiatric unit (MPU) may reduce length of hospital stay (LOS), little is known about costs in terms of medical service use and psychiatric interventions in MPU care.

METHOD

A record linkage study was conducted, linking cost data of hospital medical service use, LOS, and hospital psychiatric interventions to patients admitted to the MPU of the Maastricht University Medical Centre (MUMC) between 1998 and 2004. The data set was analyzed to enable comparison between cost changes of the same complex patient population following either MPU index admission or index admissions to reference MUMC medical wards.

RESULTS

Comparisons revealed lower costs of medical service use in favor of the MPU (-euro104; 95% CI -euro174 to -euro35; P<.01). However, cost of psychiatric intervention and cost of LOS were higher after MPU admission (respectively, +euro165; 95% CI +euro25 to +euro305; P<.05; and +euro202; 95% CI +euro170 to +euro235; P<.001). Total costs were higher after MPU admission compared to medical ward admission (+euro263; 95% CI +euro68 to +euro458; P<.05). These differences were not moderated by somatic diagnosis or previous pattern of admissions.

CONCLUSION

The findings suggest that patients at the interface of psychiatric and somatic morbidity are diagnosed and treated adequately at the MPU, leading to a decrease in medical service use and an appropriate increase in exposure to psychiatric interventions. These results are specifically generalizable to MPUs with a focus on psychosomatic conditions, for instance, somatoform disorders or affective disorders with comorbid somatic diseases. However, failure to show cost savings in terms of LOS compared to medical wards outweighs cost-benefit derived from lower medical service use, suggesting that MPU activities may gain in cost-effectiveness if shifted more to outpatient psychosomatic care solutions.

The personality trait of neuroticism is strongly associated with long-term morbidity in testicular cancer survivors

BACKGROUND

Neuroticism is a personality trait expressing nervousness and insecurity. Associations between neuroticism and morbidity in long-term cancer survivors have hardly been explored. The aim of this study was to explore associations between neuroticism and somatic and mental morbidity and lifestyle issues in long-term survivors of testicular cancer (TCSs).

MATERIAL AND METHODS

All Norwegian TCSs treated between 1980 and 1994 (n = 1 814) were invited to this cross-sectional study. Among them 1 428 (79% response rate) delivered valid data. Neuroticism was self-rated on an abridged version of the Eysenck Personality Inventory. Information was collected by mailed questionnaires. The associations of neuroticism and self-reported variables were tested with multivariate logistic regression analyses.

RESULTS

Neuroticism was significantly associated with presence of somatic complaints, reduced physical function, neurotoxic side-effects (tinnitus, hearing impairment, peripheral neuropathy, and Raynaud's Phenomenon), self-esteem, concerns about not being able to father children, sexual problems, hazardous alcohol use, daily use of medication, use of sedatives and hypnotics, recent visits to a general practitioner, and seeing a psychologist/ psychiatrist after ended cancer treatment. Poor self-rated health, higher number of negative life events, economical problems and problems getting loans granted showed significant associations with neuroticism.

DISCUSSION

Neuroticism in TCSs at long-term follow-up is significantly associated with somatic and mental morbidities, and several aspects of unhealthy lifestyle. High levels of neuroticism should be considered in TCSs expressing multiple complaints and concerns at follow-up consultations. Assessment of neuroticism may be clinically important in order to offer appropriate interventions to prevent and manage morbidity in TCSs.

Early personality traits as predictors of mortality risk following conjugal bereavement

This study explored pre-bereavement personality traits and gender as predictors of post-widowhood mortality risk, using newly derived life span data for participants originally recruited for Lewis Terman's classic study of the gifted. Personality traits measured in 1940 were used to predict mortality risk from 1940 through 2004 for married participants who were either widowed between 1940 and 1986 or who remained married. Results indicated that widowhood predicted a decrease in mortality risk for these (intelligent) individuals (relative hazard [rh]=0.68, N=843, p<.001) and neuroticism significantly moderated this effect. Specifically, neuroticism in young adulthood was significantly associated with decreased mortality risk among men who were later widowed (rh=0.50, N=66, p<.02) but not among women or consistently married men. Conclusions reveal the importance of personality-situation interactions and the adoption of a long-term perspective.

Comorbidity of pain and anxiety disorders

The comorbidity of anxiety disorders with pain has received little research attention even though recent studies show that these disorders are as likely to co-occur with chronic pain conditions as depressive disorder. Comorbid anxiety has implications for the impact and outcome of pain conditions. Even though it may be intuitively plausible to suppose that the anxiety occurs in the context of a preexisting pain condition, there is evidence for a reverse causal link and shared risk factors, including distal events occurring in childhood.

Influence of psychiatric morbidity and sociodemographic determinants on use of service in a catchment area in the city of São Paulo, Brazil

BACKGROUND

Recent population-based studies in Latin American and the Caribbean (LAC) countries brought evidence of the growing burden of mental illness in this region. The objective of this study is to examine determinants of health service utilization by individuals with psychiatric disorders in a defined area in the city of São Paulo, Brazil.

METHOD

Data were derived from São Paulo Catchment Area Study (SP-ECA), a cross-sectional household prevalence survey, based on a representative adult sample (N=1,464) living in two defined boroughs. The psychiatric diagnosis was assessed through the CIDI 1.1 interview, yielding ICD-10 diagnoses. The past-month use of health services--for general medical (GM) care and mental health (MH) care sectors--was investigated in their relationship with sociodemographic features, insurance coverage, GM conditions, and psychiatric morbidity.

RESULTS

Nearly one-third (32.2%) of the total sample used health services in the last month: 29.0% attended GM care and 7.8% used MH care. Logistic regression models showed that being female, older than 60 years, having private insurance coverage, and presence of psychiatric morbidity increased the level GM care seeking in the total sample. For those with 12-month psychiatric disorders, the determinants for GM sector use were female gender, age 45-59 years old, and private insurance coverage, whereas separated, divorced, or widowed women had the highest odds (OR 9.9; 95% CI: 2.7-36.5) for using MH service. Low-income people were less likely to seek MH services.

CONCLUSION

The major contribution of this article is to underscore the impact of MH on health care systems, in a LAC country where service use information is scarce. The main finding is that inequalities in the access to MH care occurred, with low-income people having less likelihood of receiving treatment for their mental disorder. Access to health service in this catchment area reflected the great degree of deregulation and lack of integration. Additional efforts should address the barriers to the utilization of MH services in Brazil, including social inequities in the access to care.

Personality and medical illness burden among older adults in primary care

OBJECTIVE

To examine the association between Five Factor Model personality traits (Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness) and physician-quantified aggregate morbidity in a sample of older adults in primary care.

METHODS

A total of 449 primary care patients, ranging in age from 65 to 97 years (75 +/- 6.9 (mean +/- standard deviation)), completed the Neo-Five Factor Inventory (NEO-FFI) and extensive interviews. A physician-investigator completed the Cumulative Illness Rating Scale (CIRS), a well-validated measure of aggregate morbidity based on a review of medical records.

RESULTS

Bivariate analyses demonstrated that all five domains of the NEO-FFI were associated with CIRS scores. Multivariate regression controlling for age, gender, education, depression, smoking, hypertension, total cholesterol, alcohol or substance misuse, and other personality traits showed that greater Conscientiousness was independently associated with lower CIRS scores (beta = -0.10, t(435) = -1.96, p = .05). Other independent predictors of less morbidity were younger age, absence of hypertension, and lower levels of depression.

CONCLUSION

Our results point toward the necessity of considering Conscientiousness and other personality traits in studies of risk factors for aggregate morbidity. More detailed characterization of at-risk populations will increase the likelihood of constructing informed and effective prevention, intervention, and policy initiatives.

The association between neuroticism and self-reported common somatic symptoms in a population cohort

OBJECTIVE

To test the hypotheses that (1) neuroticism is associated with self-reported somatic symptoms; (2) this association is especially found with regard to psychosomatic symptoms; and (3) it is not solemnly explained by somatic reflections of psychological distress.

METHODS

We studied the cross-sectional association between neuroticism (as measured by EPQ-RSS-N), psychological distress (as measured by GHQ-12 sum score), and the occurrence of 22 common somatic symptoms by linear and logistic regression analyses in a population cohort of 6894 participants.

RESULTS

Neuroticism is more strongly associated with the total number of somatic symptoms reported (beta=.32) than GHQ-12 sum score (beta=.15) and well-established risk markers such as gender (beta=.11) and age (beta=.04). Neuroticism was associated with all symptoms in individual logistic regressions controlled for age, gender, and psychological distress. Neuroticism is significantly more strongly related to psychosomatic symptoms (beta=.36) than to infectious/allergic symptoms (beta=.28).

CONCLUSION

In a large, population-based cohort, we confirmed that neuroticism is associated with self-reported somatic symptoms. The associations were not attributable to somatic reflections of psychological distress associated with neuroticism and were relatively strong with respect to psychosomatic symptoms. Future studies should include both objective and subjective measures of health to study the mechanisms that connect neuroticism and ill health.

The evolution of personality variation in humans and other animals

A comprehensive evolutionary framework for understanding the maintenance of heritable behavioral variation in humans is yet to be developed. Some evolutionary psychologists have argued that heritable variation will not be found in important, fitness-relevant characteristics because of the winnowing effect of natural selection. This article propounds the opposite view. Heritable variation is ubiquitous in all species, and there are a number of frameworks for understanding its persistence. The author argues that each of the Big Five dimensions of human personality can be seen as the result of a trade-off between different fitness costs and benefits. As there is no unconditionally optimal value of these trade-offs, it is to be expected that genetic diversity will be retained in the population.

Darwinian models of depression: a review of evolutionary accounts of mood and mood disorders

Over the last ten years, there has been increased interest in the evolutionary origins of depressive phenomena. The current article provides a review of the major schools of thought that have emerged in this area. First, we consider important Darwinian explanations of depressed mood, including an integrative social risk hypothesis recently proposed by the authors. According to the social risk hypothesis, depression represents an adaptive response to the perceived threat of exclusion from important social relationships that, over the course of evolution, have been critical to maintaining an individual's fitness prospects. We argue, moreover, that in the ancestral environment, depression minimized the likelihood of exclusion by inducing: (i) cognitive hypersensitivity to indicators of social risk/threat; (ii) signaling behaviours that reduce social threat and elicit social support; and (iii) a generalized reduction in an individual's propensity to engage in risky, appetitive behaviours. Neurobiological support for this argument is also provided. Finally, we review three models that endeavour to explain the relationship between the adaptations that underlie depressed mood and clinically significant, depressed states, followed by a consideration of the merits of each.

Risk factors for hypochondriacal concerns in a sample of military veterans

OBJECTIVE

The aim was to examine the influence of combat exposure and other risk factors on the development of hypochondriacal concerns among veterans of the Gulf War and to learn whether these concerns might be a source of increased symptom reporting among them.

METHOD

Six hundred two veterans who were deployed to the Gulf or elsewhere during the 1991 war took part in a two-phase study of symptoms and illnesses occurring among these veterans. Hypochondriacal beliefs and attitudes were assessed by the Whiteley Index and somatic symptoms by a factor-analytically derived measure. Multiple regression models were developed for these outcomes.

RESULTS

Hypochondriacal concerns were significantly associated with level of education, personal history of depression, number of prewar physical conditions, family history of functional syndromes, negative and positive temperament and disinhibition, military combat, level of military preparedness, social support, and perceived life stress. Somatic symptoms were associated with these same variables, as well as branch of service, family history of physical conditions, combat, and level of combat exposure. A regression model for hypochondriacal concerns included the number of prewar physical conditions, negative temperament, lack of social support, and perceived life stress.

CONCLUSIONS

Hypochondriacal concerns were not strongly related to combat exposure. Consequently, it is not likely that such concerns account for increased symptom reporting among the veterans studied. Hypochondriacal concerns appeared to arise in response to threats posed by physical illness. Vulnerability to such threats appeared to center on the personality dimension of negative temperament. This model may serve as a guide to future investigations.

Neuroticism: a non-informative marker of vulnerability to psychopathology

BACKGROUND

Neuroticism measures are very popular in psychopathological research, but it is unclear how useful neuroticism is in studies of the aetiology of psychopathology.

METHOD

A conceptual examination was made of the literature on the association of neuroticism and psychopathology, the ontological status of neuroticism, the purport of neuroticism questionnaires, and causal issues.

RESULTS

The research on which neuroticism is built has historically been based solely on the factor analyses of the common adjectives used to describe usual behaviours. An abundance of studies have shown that neuroticism scores predict life stress, psychological distress, emotional disorders, psychotic symptoms, substance abuse, physical tension-related symptoms, medically unexplained physical symptoms, and health care utilisation. This evidence suggests that neuroticism scales index vulnerability to many forms of negative affect and psychiatric disorder. However, the associations do not clarify the nature of this vulnerability nor the underlying psychobiological mechanisms. We present evidence that neuroticism scores reflect a person's characteristic (or mean) level of distress over a protracted period of time. In this perspective, even prospective associations of neuroticism with mental health outcomes are basically futile, and largely tautological since scores on any characteristic with substantial within-subject stability will predict, by definition, that characteristic and related variables at later points in time.

CONCLUSION

Neuroticism is not an explanatory concept in the aetiology of psychopathology, since it measures a person's characteristic level of distress over a protracted period of time. This situation will not change until knowledge becomes available about: (i) the mechanisms that produce high neuroticism scores (and, therefore, also psychopathology) and (ii) its neurobiological substrate. Only then will we understand why neuroticism appears to "predict" the outcomes it predicts.