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Ma W, Liang X, Wang H, Wen Z, Liu L, Fan L, Zhang X. Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis. Geriatr Nurs 2024; 59:113-120. [PMID: 38996768 DOI: 10.1016/j.gerinurse.2024.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Fear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear. METHODS Prominent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size. RESULTS A total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19-1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality. CONCLUSIONS FOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.
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Affiliation(s)
- Wenlian Ma
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoli Liang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Hongyan Wang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Zhifei Wen
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linfeng Liu
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China
| | - Liangliang Fan
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiangeng Zhang
- Dean Office, Sichuan Nursing Vocational College, Chengdu, China.
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2
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Khan NH, Hassan S, Bahader S, Fatima S, Zaidi SMIH, Virk R, Jiang K, Jiang E. How Daily Obstacles Affect Frontline Healthcare Professionals' Mental Health during Omicron: A Daily Diary Study of Handwashing Behavior. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8748. [PMID: 35886597 PMCID: PMC9320559 DOI: 10.3390/ijerph19148748] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022]
Abstract
Based on coping theory, the current research examines how and why COVID-19 phobia affects frontline healthcare professionals' mental health, as well as their burnout and work-related stress. We focused on the mediating role of burnout and work-related stress in this study. In the current study, we also examined the moderating influence of healthcare professionals' handwashing behavior using the Hayes Process model. We employed a daily diary approach to collect data from respondents in Pakistan's frontline healthcare professionals (n = 79, 79 × 10 = 790) who were directly treating COVID-19 patients during the omicron wave. According to the findings of the study, COVID-19 phobia significantly disturbs healthcare professionals' mental health, as well as significantly strengthens burnout and work-related stress. The findings also demonstrated that burnout significantly negatively influences mental health. The mediation influence of burnout and work-related stress in the association between COVID-19 phobia and mental health has shown to be significant. The moderation analysis revealed that high handwashing behavior significantly buffers the negative impact of COVID-19 phobia, as well as the adverse effect of burnout on healthcare professionals' mental health. Moreover, our findings have theoretical and managerial implications, as well as new research directions for scholars to understand the adverse impact of daily obstacles on professionals' (nurses and doctors, etc.) mental health and work performance, as well as issues based on resource conversation philosophy.
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Affiliation(s)
| | - Sajid Hassan
- Department of Psychology, International Islamic University, Islamabad 44000, Pakistan; (S.H.); (S.B.)
| | - Sher Bahader
- Department of Psychology, International Islamic University, Islamabad 44000, Pakistan; (S.H.); (S.B.)
| | - Sidra Fatima
- University Gillani Law College, Bahauddin Zakariya University, Multan 60000, Pakistan;
| | | | - Razia Virk
- Department of Bio-Sciences, University Wah, Rawalpindi 47040, Pakistan;
| | - Kexin Jiang
- Institute of Nursing and Health, Henan University, Kaifeng 475004, China;
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng 475004, China;
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3
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Salem T, Frankman Z, Churko J. Tissue engineering techniques for iPSC derived three-dimensional cardiac constructs. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:891-911. [PMID: 34476988 PMCID: PMC9419978 DOI: 10.1089/ten.teb.2021.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recent developments in applied developmental physiology have provided well-defined methodologies for producing human stem cell derived cardiomyocytes. Cardiomyocytes produced in this way have become commonplace as cardiac physiology research models. This accessibility has also allowed for the development of tissue engineered human heart constructs for drug screening, surgical intervention, and investigating cardiac pathogenesis. However, cardiac tissue engineering is an interdisciplinary field that involves complex engineering and physiological concepts, which limits its accessibility. This review provides a readable, broad reaching, and thorough discussion of major factors to consider for the development of cardiovascular tissues from stem cell derived cardiomyocytes. This review will examine important considerations in undertaking a cardiovascular tissue engineering project, and will present, interpret, and summarize some of the recent advancements in this field. This includes reviewing different forms of tissue engineered constructs, a discussion on cardiomyocyte sources, and an in-depth discussion of the fabrication and maturation procedures for tissue engineered heart constructs.
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Affiliation(s)
- Tori Salem
- University of Arizona Medical Center - University Campus, 22165, Cellular and Molecular Medicine, Tucson, Arizona, United States;
| | - Zachary Frankman
- University of Arizona Medical Center - University Campus, 22165, Biomedical Engineering, Tucson, Arizona, United States;
| | - Jared Churko
- University of Arizona Medical Center - University Campus, 22165, 1501 N Campbell RD, SHC 6143, Tucson, Arizona, United States, 85724-5128;
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4
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Batelaan NM, Seldenrijk A, van den Heuvel OA, van Balkom AJLM, Kaiser A, Reneman L, Tan HL. Anxiety, Mental Stress, and Sudden Cardiac Arrest: Epidemiology, Possible Mechanisms and Future Research. Front Psychiatry 2021; 12:813518. [PMID: 35185641 PMCID: PMC8850954 DOI: 10.3389/fpsyt.2021.813518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/29/2021] [Indexed: 12/26/2022] Open
Abstract
Sudden cardiac arrest (SCA) is a leading cause of mortality and morbidity in affluent societies, which underscores the need to identify persons at risk. The etiology of SCA is however complex, with predisposing and precipitating factors interacting. Although anxiety and mental stress have been linked to SCA for decades, their precise role and impact remain unclear and the biological underpinnings are insufficiently understood. In this paper, we systematically reviewed various types of observational studies (total n = 20) examining the association between anxiety or mental stress and SCA. Multiple methodological considerations challenged the summarizing and interpretation of the findings. For anxiety, the overall picture suggests that it predisposes for SCA in physically healthy populations (unadjusted OR = 2.44; 95% CI: 1.06-5.59; n = 3). However, in populations at risk for SCA (n = 4), associations were heterogeneous but not significant. Anxiety may partly predispose to SCA by contributing to other risk factors such as cardiovascular disease and diabetes mellitus via mechanisms such as unhealthy lifestyle and metabolic abnormalities. Mental stress appears to precipitate SCA, presumably by more directly impacting on the cardiac ion channels that control the heart's electrical properties. This may lead to ventricular fibrillation, the arrhythmia that underlies SCA. To advance this field of research, experimental studies that unravel the underlying biological mechanisms are deemed important, and most easily designed for mental stress as a precipitating factor because of the short timeframe. These proof-of-concept studies should examine the whole pathway from the brain to the autonomic nervous system, and eventually to cardiac ion channels. Ultimately, such studies may facilitate the identification of persons at risk and the development of novel preventive strategies.
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Affiliation(s)
- Neeltje M Batelaan
- Department of Psychiatry, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Adrie Seldenrijk
- Department of Psychiatry, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience Research Institute, Amsterdam, Netherlands.,Department of Anatomy and Neuroscience, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Antonia Kaiser
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Liesbeth Reneman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
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5
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Mazza M, Marano G, Antonazzo B, Cavarretta E, DI Nicola M, Janiri L, Sani G, Frati G, Romagnoli E. What about heart and mind in the COVID-19 era? Minerva Cardiol Angiol 2020; 69:222-226. [PMID: 32397693 DOI: 10.23736/s2724-5683.20.05309-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
From the time of Hippocratic medicine, heart-brain interactions have been recognized and contributed to both mental and physical health. Heart-brain interactions are complex and multifaceted and appear to be bidirectional. Exposure to chronic and daily stressors such as quarantine, or severe psychological trauma like a significant person in danger of life can affect the cardiovascular system and the emotional experience of the individual, leading to an increased risk of developing a cardiovascular disease or mental illness. Subjects with comorbidities between mental disorders and heart diseases are obviously more susceptible to be influenced by emotional burden due to the spread of COVID-19, with emotional responses characterized by fear, panic, anger, frustration. Psychological services and crisis interventions are needed at an early stage to reduce anxiety, depression and post-traumatic stress disorder in such a stressful period, with a special attention to special groups of patients, such as women, children, or the elderly.
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Affiliation(s)
- Marianna Mazza
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Giuseppe Marano
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Marco DI Nicola
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Gabriele Sani
- Institute of Psychiatry and Psychology, Department of Geriatrics, Neuroscience and Orthopedics, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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6
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Kim JH, Bae SM. Association between Fear of Falling (FOF) and all-cause mortality. Arch Gerontol Geriatr 2020; 88:104017. [DOI: 10.1016/j.archger.2020.104017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
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7
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Relationship between Syntax I - Syntax II and Spielberger State-Trait Anxiety Inventory in stable angina pectoris patients. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.723413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Piña IL, Di Palo KE, Ventura HO. Psychopharmacology and Cardiovascular Disease. J Am Coll Cardiol 2019; 71:2346-2359. [PMID: 29773162 DOI: 10.1016/j.jacc.2018.03.458] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022]
Abstract
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.
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Affiliation(s)
- Ileana L Piña
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
| | - Katherine E Di Palo
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, New Orleans, Louisiana; The University of Queensland School of Medicine, St. Lucia, Queensland, Australia
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9
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Síntomas siquiátricos y diferencias relacionadas con el sexo en pacientes con infarto de miocardio con arterias coronarias no obstructivas. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Psychiatric Symptoms and Sex-related Differences in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. ACTA ACUST UNITED AC 2018; 72:686-688. [PMID: 30316754 DOI: 10.1016/j.rec.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
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11
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Roest AM, de Jonge P, Lim C, Stein DJ, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Ciutan M, de Girolamo G, Hu C, Levinson D, Nakamura Y, Navarro-Mateu F, Piazza M, Posada-Villa J, Torres Y, Wojtyniak B, Kessler RC, Scott KM. Fear and distress disorders as predictors of heart disease: A temporal perspective. J Psychosom Res 2017; 96:67-75. [PMID: 28545795 PMCID: PMC5674522 DOI: 10.1016/j.jpsychores.2017.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Few studies have been able to contrast associations of anxiety and depression with heart disease. These disorders can be grouped in fear and distress disorders. Aim of this study was to study the association between fear and distress disorders with subsequent heart disease, taking into account the temporal order of disorders. METHODS Twenty household surveys were conducted in 18 countries (n=53791; person years=2,212,430). The Composite International Diagnostic Interview assessed lifetime prevalence and age at onset of disorders, and respondents were categorized into categories based on the presence and timing of fear and distress disorders. Heart disease was indicated by self-report of physician-diagnosed heart disease or self-report of heart attack, together with year of onset. Survival analyses estimated associations between disorder categories and heart disease. RESULTS Most respondents with fear or distress disorders had either pure distress or pure fear (8.5% and 7.7% of total sample), while fear preceded distress in the large majority of respondents with comorbid fear and distress (3.8% of total sample). Compared to the "no fear or distress disorder" category, respondents with pure fear disorder had the highest odds of subsequent heart disease (OR:1.8; 95%CI:1.5-2.2; p<0.001) and compared to respondents with pure distress disorder, these respondents were at a significantly increased risk of heart disease (OR:1.3; 95%CI:1.0-1.6; p=0.020). CONCLUSION This novel analytic approach indicates that the risk of subsequent self-reported heart disease associated with pure fear disorder is significantly larger than the risk associated with distress disorder. These results should be confirmed in prospective studies using objective measures of heart disease.
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Affiliation(s)
- AM Roest
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - P de Jonge
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Groningen, The Netherlands
| | - C Lim
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - DJ Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - A Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - C Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R Bruffaerts
- Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg Leuven, Belgium
| | - B Bunting
- Psychology Research Institute, Ulster University, Northern Ireland
| | - JM Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M Ciutan
- National School of public Health, Management and Professional Development, Bucharest, Romania
| | - G de Girolamo
- IRCCS St John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Hu
- Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
| | - D Levinson
- Ministry of Health Israel, Mental Health Services, Israel
| | - Y Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - F Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Spain
| | - M Piazza
- National Institute of Health, Peru, Universidad Cayetano Hereidia, Peru
| | - J Posada-Villa
- Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Y Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - B Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - RC Kessler
- Department of Health Care Policy, Harvard University Medical School, Boston, MA, United States
| | - KM Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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12
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Chang HT, Chen HC, Chou P. Fear of falling and mortality among community-dwelling older adults in the Shih-Pai study in Taiwan: A longitudinal follow-up study. Geriatr Gerontol Int 2017; 17:2216-2223. [DOI: 10.1111/ggi.12968] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders; National Taiwan University Hospital; Taipei Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
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13
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Komasi S, Saeidi M. What is role of sex and age differences in marital conflict and stress of patients under Cardiac Rehabilitation Program? ARYA ATHEROSCLEROSIS 2016; 12:138-145. [PMID: 27752271 PMCID: PMC5055372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To investigate the role of sex and age differences in marital conflict and stress of patients who were under cardiac rehabilitation (CR) program. METHODS The data of this cross-sectional study were collected from the database of the CR Department of Imam Ali Hospital, Kermanshah, Iran. The demographics and medical data of 683 persons were collected from January 2003 and January 2010 using medical records, the Beck Anxiety Inventory, the Beck Depression Inventory, the Hudson's Index of Marital Stress, and the Structured Clinical Interview for axis I disorders. Data were analyzed through Analysis of Covariance and Bonferroni test. RESULTS About 74.8% of the subjects were male. After adjustment for age, educational level, anxiety, and depression-the findings showed that women in CR program had a higher level of marital stress compared to men (54.75 ± 2.52 vs. 49.30 ± 0.89; P = 0.042). Furthermore, it was revealed that women who aged 56-65 years and more experienced higher level of marital stress compared to younger patients (P < 0.050); however, no significant difference was observed between different age groups in male patients (P > 0.050). CONCLUSION Marital conflict and stress threaten healthiness of women who aged 56-65 years more prominently than does in males or younger patients. Regarding the effect of marital stress on recurrence of the disease and cardiac-related morbidity and mortality in women, providing effective education and interventions to this group of patients, especially older women and even their spouses could be one of the useful objectives of CR programs.
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Affiliation(s)
- Saeid Komasi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhgan Saeidi
- Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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14
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Auer CJ, Kube T, Laferton JAC, Salzmann S, Shedden-Mora M, Rief W, Moosdorf R. Welche Erwartungen sagen postoperative Depressivität und Ängstlichkeit bei herzchirurgischen Patienten am stärksten vorher? ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2016. [DOI: 10.1026/1616-3443/a000358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Depressivität und Ängstlichkeit beeinträchtigen den Behandlungserfolg von herzchirurgischen Patienten. Fragestellung: Untersucht wurde, ob und wie präoperative Patientenerwartungen mit postoperativer Depressivität und Ängstlichkeit zusammenhängen und welche präoperativen Erwartungen hierbei den höchsten prädiktiven Wert haben. Methoden: 124 aortocoronare Bypass-Patienten bearbeiteten eine Woche vor der Operation einen Fragebogen, der verschiedene Aspekte von Erwartungen mischt (Positive Health Expectation Questionnaire; PHES) und einen Fragebogen, der einzelne Erwartungsaspekte getrennt erfasst (Expected Illness Perception Questionnaire, IPQ-E) und eine Woche vor sowie eine Woche nach der Operation Fragen zu ihrer Depressivität und Ängstlichkeit (Hospital Anxiety and Depression Scale (HADS)). Ergebnisse: Postoperative Depressivität wird durch präoperative Erwartungen vorhergesagt (R2 = 0.32, F = 3.13, p = .02). Der einzig signifikante Prädiktor hierbei sind positive Gesundheitserwartungen gemessen mit dem PHES. Auch postoperative Ängstlichkeit wird durch präoperative Erwartungen vorhergesagt (R2 = 0.27, F = 2.55, p < .05). Bei der Vorhersage postoperativer Ängstlichkeit haben erwartete Konsequenzen gemessen mit dem IPQ-E den stärksten prädiktiven Wert. Schlussfolgerungen: Die Studie belegt die Relevanz von präoperativen Erwartungen bei herzchirurgischen Patienten. Interventionen, die auf die Verringerung von Depressivität herzchirurgischer Patienten abzielen, sollten den Fokus auf verschiedene Aspekte von Erwartungen legen. Bei der Verringerung postoperativer Ängstlichkeit könnten hingegen einzeln erfasste Erwartungsaspekte von Bedeutung sein.
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Affiliation(s)
- Charlotte J. Auer
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Tobias Kube
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | | | - Stefan Salzmann
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Meike Shedden-Mora
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Winfried Rief
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Rainer Moosdorf
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Gießen-Marburg
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15
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Bezgin CH, Bezgin T, Kesebir S. Temperament and Character Profiles and Psychiatric Comorbidities in Patients With Coronary Artery or Valvular Heart Disease: Relationship With Cardiac Disease Severity. J Clin Med Res 2016; 8:202-9. [PMID: 26858792 PMCID: PMC4737030 DOI: 10.14740/jocmr2440w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to investigate whether the psychopathological symptoms and temperament-character dimensions observed in patients operated due to coronary artery disease (CAD) or valvular heart disease (VHD) differ among the patients and from healthy individuals. Methods Study population was composed of subjects with CAD, VHD and healthy controls (n = 50 in each group). Socio-demographic questionnaire, temperament and character inventory (TCI) and symptom check list-90-R (SCL-90-R) were applied to all groups. Groups were compared about temperament-character dimensions and scores of subscales of SCL-90-R. Results Harm avoidance was found to be higher in VHD group than those with CAD and, lower in healthy controls than both patient groups (P = 0.004). Reward dependence was similar among both patient groups and, was higher than healthy group (P = 0.015). Depression, anxiety, somatization, obsession and interpersonal sensitivity were found to be similar in both patient groups but they were higher than those in controls (P < 0.001, P < 0.001, P < 0.001, P = 0.002 and P = 0.003, respectively). Phobia was seen equally in CAD group and healthy controls and, was found to be lower in these than in VHD (P = 0.009). Anger score was in descending order in patients with VHD, CAD and healthy controls group (P = 0.010 and 0.001). Paranoia was in descending order in patients with VHD, CAD and controls (P = 0.015 and 0.001). A weak and inverse correlation was found between ejection fraction (EF) and the persistence dimension of temperament scaled by TCI in patients with VHD (r = -0.276, P = 0.052). An inverse correlation was observed between EF and the reward dependence dimension in CAD group (r = -0.195, P = 0.044). In patients with VHD, EF demonstrated an inversely weak (r = -0.289, P = 0.042), moderate (r = -0.360, P = 0.010) and strong (r = -0.649, P < 0.001) correlation with inter-personal sensitivity, phobia and paranoia, respectively. There was an inverse and weak correlation between EF and depression and anger in VHD group (r = -0.302, P = 0.033 and r = -0.240, P = 0.054). Conclusion VHD and CAD exhibit different psychopathological symptoms and temperament traits. There is a correlation between the aforementioned psychopathological symptoms and temperament traits, and EF.
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Affiliation(s)
- Cigdem Hazal Bezgin
- Department of Psychiatry, Erenkoy Psychiatry Training and Research Hospital, Goztepe, Istanbul, Turkey
| | - Tahir Bezgin
- Department of Cardiology, Kartal Kosuyolu Heart Research Hospital, Kartal, Istanbul, Turkey
| | - Sermin Kesebir
- Department of Psychiatry, Erenkoy Psychiatry Training and Research Hospital, Goztepe, Istanbul, Turkey
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Abstract
The analytical paper summarizes the main results of recent investigations of the relationships of depression, anxiety, and stress with overall and cardiovascular mortality. It shows that depression and stress are associated with an increased risk of death mainly from cardiovascular diseases, and depression treatment and stress control can increase life expectancy.
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Affiliation(s)
- F I Belialov
- Irkutsk State Medical Academy of Postgraduate Education, Ministry of Health of Russia, Irkutsk, Russia
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17
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Plasma mid-regional pro-adrenomedullin levels are inversely associated with anxiety but unrelated to depression: Results from the observational DIAST-CHF study in patients with cardiovascular risk factors. Psychoneuroendocrinology 2015; 62:227-32. [PMID: 26342564 DOI: 10.1016/j.psyneuen.2015.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/22/2015] [Accepted: 08/05/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES It has been postulated that patients with heart failure have a high risk of ventricular arrhythmias and sudden cardiac death resulting from anxiety-induced autonomic arousal. In the prospective and multicenter DIAST-CHF (Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure) study, we therefore, tested the hypothesis that adrenomedullin (ADM), a well-established predictor for cardiovascular outcome, is associated with self-rated anxiety symptoms in patients at risk of suffering from or actually with overt heart failure. PARTICIPANTS AND MEASURES Study participants with risk factors for diastolic dysfunction were requested to complete the Hospital Anxiety and Depression Scale (HADS), and plasma mid-regional pro-adrenomedullin (MR-proADM) concentrations were measured. RESULTS In bivariate analysis, we found significantly lower plasma MR-proADM levels in patients with elevated HADS-anxiety scores above the clinically relevant cut-off level of ≥11 (n=118, 536pmol/l, interquartile range [IQR] 449-626) as compared to non-anxious study participants (n=1,292, 573pmol/l, IQR 486-702, p=0.001). A set of multivariate models adjusted for potential confounders confirmed the negative association between self-rated anxiety symptoms and plasma MR-proADM. In similar models, no significant association was detected between HADS-depression scores and MR-proADM. CONCLUSIONS The inverse relationship between plasma MR-proADM and anxiety observed in patients with cardiovascular risk factors supports a previous experimental study using a mutant mouse line with a brain-specific loss of ADM expression which displayed hyperactive and over-anxious behavior. Further experimental and clinical studies are warranted to test the hypothesis that also in humans ADM acts as a neuromodulator with anxiolytic properties.
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18
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Celano CM, Millstein RA, Bedoya CA, Healy BC, Roest AM, Huffman JC. Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. Am Heart J 2015; 170:1105-15. [PMID: 26678632 DOI: 10.1016/j.ahj.2015.09.013] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression and anxiety are common in patients with coronary artery disease (CAD). Although depression clearly has been associated with mortality in this population, the relationship between anxiety and mortality is less clear. Accordingly, we performed a series of meta-analyses to (1) examine the relationship between anxiety and mortality in patients with established CAD and (2) determine if this relationship differs in patients with stable CAD compared to those who have just had an acute coronary syndrome (ACS). METHODS AND RESULTS Systematic literature searches identified 44 articles (total N = 30,527) evaluating the prospective relationship between anxiety and mortality in individuals with established CAD. A series of 8 adjusted and unadjusted meta-analyses were performed to examine this relationship across all patients, with sensitivity analyses completed in post-ACS and stable CAD cohorts. In unadjusted analyses, anxiety was associated with a moderate increase in mortality risk (odds ratio 1.21 per SD increase in anxiety). However, when adjusting for covariates, nearly all associations became nonsignificant. In sensitivity analyses, anxiety was associated with an increased risk of poor outcomes in the stable CAD-but not post-ACS-cohort. CONCLUSIONS These analyses confirm that anxiety is associated with increased risk of mortality in patients with CAD; however, this relationship is not as strong as that of depression and may be explained partly by other clinical factors. If anxiety screening is performed, it should be performed during a period of clinical stability and should target anxiety disorders rather than anxiety symptoms alone.
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Affiliation(s)
- Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Rachel A Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brian C Healy
- Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Annelieke M Roest
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA
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19
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Ginzburg K, Kutz I, Koifman B, Roth A, Kriwisky M, David D, Bleich A. Acute Stress Disorder Symptoms Predict All-Cause Mortality Among Myocardial Infarction Patients: a 15-Year Longitudinal Study. Ann Behav Med 2015; 50:177-86. [DOI: 10.1007/s12160-015-9744-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Singh A, Babyak MA, Brummett BH, Jiang R, Watkins LL, Barefoot JC, Kraus WE, Shah SH, Siegler IC, Hauser ER, Williams RB. Computing a Synthetic Chronic Psychosocial Stress Measurement in Multiple Datasets and its Application in the Replication of G × E Interactions of the EBF1 Gene. Genet Epidemiol 2015. [PMID: 26202568 DOI: 10.1002/gepi.21910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic psychosocial stress adversely affects health and is associated with the development of disease [Williams, 2008]. Systematic epidemiological and genetic studies are needed to uncover genetic variants that interact with stress to modify metabolic responses across the life cycle that are the proximal contributors to the development of cardiovascular disease and precipitation of acute clinical events. Among the central challenges in the field are to perform and replicate gene-by-environment (G × E) studies. The challenge of measurement of individual experience of psychosocial stress is magnified in this context. Although many research datasets exist that contain genotyping and disease-related data, measures of psychosocial stress are often either absent or vary substantially across studies. In this paper, we provide an algorithm to create a synthetic measure of chronic psychosocial stress across multiple datasets, applying a consistent criterion that uses proxy indicators of stress components. We validated the computed scores of chronic psychosocial stress by observing moderately strong and significant correlations with the self-rated chronic psychosocial stress in the Multi-Ethnic Study of Atherosclerosis Cohort (Rho = 0.23, P < 0.0001) and with the measures of depressive symptoms in five datasets (Rho = 0.15-0.42, Ps = 0.005 to <0.0001) and by comparing the distributions of the self-rated and computed measures. Finally, we demonstrate the utility of this computed chronic psychosocial stress variable by providing three additional replications of our previous finding of gene-by-stress interaction with central obesity traits [Singh et al., 2015].
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Affiliation(s)
- Abanish Singh
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, North Carolina, United States of America.,Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Michael A Babyak
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Beverly H Brummett
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Rong Jiang
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Lana L Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - John C Barefoot
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - William E Kraus
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.,Duke Center for Living, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Svati H Shah
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Ilene C Siegler
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Elizabeth R Hauser
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, United States of America.,Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America
| | - Redford B Williams
- Behavioral Medicine Research Center, Duke University Medical Center, Durham, North Carolina, United States of America.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
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Power MC, Kioumourtzoglou MA, Hart JE, Okereke OI, Laden F, Weisskopf MG. The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study. BMJ 2015; 350:h1111. [PMID: 25810495 PMCID: PMC4373600 DOI: 10.1136/bmj.h1111] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether higher past exposure to particulate air pollution is associated with prevalent high symptoms of anxiety. DESIGN Observational cohort study. SETTING Nurses' Health Study. PARTICIPANTS 71,271 women enrolled in the Nurses' Health Study residing throughout the contiguous United States who had valid estimates on exposure to particulate matter for at least one exposure period of interest and data on anxiety symptoms. MAIN OUTCOME MEASURES Meaningfully high symptoms of anxiety, defined as a score of 6 points or greater on the phobic anxiety subscale of the Crown-Crisp index, administered in 2004. RESULTS The 71,271 eligible women were aged between 57 and 85 years (mean 70 years) at the time of assessment of anxiety symptoms, with a prevalence of high anxiety symptoms of 15%. Exposure to particulate matter was characterized using estimated average exposure to particulate matter <2.5 μm in diameter (PM2.5) and 2.5 to 10 μm in diameter (PM2.5-10) in the one month, three months, six months, one year, and 15 years prior to assessment of anxiety symptoms, and residential distance to the nearest major road two years prior to assessment. Significantly increased odds of high anxiety symptoms were observed with higher exposure to PM2.5 for multiple averaging periods (for example, odds ratio per 10 µg/m(3) increase in prior one month average PM2.5: 1.12, 95% confidence interval 1.06 to 1.19; in prior 12 month average PM2.5: 1.15, 1.06 to 1.26). Models including multiple exposure windows suggested short term averaging periods were more relevant than long term averaging periods. There was no association between anxiety and exposure to PM2.5-10. Residential proximity to major roads was not related to anxiety symptoms in a dose dependent manner. CONCLUSIONS Exposure to fine particulate matter (PM2.5) was associated with high symptoms of anxiety, with more recent exposures potentially more relevant than more distant exposures. Research evaluating whether reductions in exposure to ambient PM2.5 would reduce the population level burden of clinically relevant symptoms of anxiety is warranted.
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Affiliation(s)
- Melinda C Power
- Department of Epidemiology, Harvard School of Public Health, Boston MA, USA Department of Environmental Health, Harvard School of Public Health, Boston MA, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA
| | | | - Jaime E Hart
- Department of Environmental Health, Harvard School of Public Health, Boston MA, USA Channing Division of Network Medicine, Department of Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston MA, USA
| | - Olivia I Okereke
- Department of Epidemiology, Harvard School of Public Health, Boston MA, USA Channing Division of Network Medicine, Department of Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston MA, USA Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston MA, USA
| | - Francine Laden
- Department of Epidemiology, Harvard School of Public Health, Boston MA, USA Department of Environmental Health, Harvard School of Public Health, Boston MA, USA Channing Division of Network Medicine, Department of Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston MA, USA
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard School of Public Health, Boston MA, USA Department of Environmental Health, Harvard School of Public Health, Boston MA, USA
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22
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Whang W, Peacock J, Soliman EZ, Alcantara C, Nazarian S, Shah AJ, Davidson KW, Shea S, Muntner P, Shimbo D. Relations between depressive symptoms, anxiety, and T Wave abnormalities in subjects without clinically-apparent cardiovascular disease (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2014; 114:1917-22. [PMID: 25438922 DOI: 10.1016/j.amjcard.2014.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/20/2014] [Accepted: 09/20/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to test the hypothesis that depression and anxiety are associated with electrocardiographic (ECG) repolarization abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort free of symptomatic cardiovascular disease. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression Scale and trait anxiety symptoms by using the Spielberger State-Trait Anxiety Inventory; both were categorized according to uppermost quartile. T-wave inversions in ECG leads other than V1 to V3 were obtained from electrocardiograms obtained at rest during the baseline examination. Participants with major intraventricular conduction abnormalities and those taking antiarrhythmics, antidepressants, and/or antipsychotics were excluded. Logistic regression models were estimated with multivariable adjustment for traditional cardiovascular disease risk factors. Among 5,906 participants, elevated depressive symptoms were associated with increased odds of T-wave inversion after multivariable adjustment (odds ratio 2.02, 95% confidence interval 1.33 to 3.06, p = 0.001), whereas greater trait anxiety was associated with reduced odds of T-wave inversion (odds ratio 0.47, 95% confidence interval 0.29 to 0.77, p = 0.003). The divergent associations of depressive symptoms and trait anxiety with ECG T-wave inversions were similar in men and women, and these associations were present across the racial and ethnic subgroups (non-Hispanic white, African-American, Hispanic, and Chinese). In conclusion, symptoms of depression and anxiety were independently yet oppositely associated with ECG T-wave inversions. Negative emotions may have a differential impact on cardiovascular mortality through unique relations with cardiac repolarization.
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Affiliation(s)
- William Whang
- Department of Medicine, Columbia University, New York, New York.
| | - James Peacock
- Department of Medicine, Columbia University, New York, New York
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina; Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | | | - Saman Nazarian
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Amit J Shah
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | | | - Steven Shea
- Department of Medicine, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York
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23
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Farvid MS, Qi L, Hu FB, Kawachi I, Okereke OI, Kubzansky LD, Willett WC. Phobic anxiety symptom scores and incidence of type 2 diabetes in US men and women. Brain Behav Immun 2014; 36:176-82. [PMID: 24184473 PMCID: PMC3947213 DOI: 10.1016/j.bbi.2013.10.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/24/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022] Open
Abstract
CONTEXT Emotional stress may be a risk factor for type 2 diabetes (T2D), but the relation between phobic anxiety symptoms and risk of T2D is uncertain. OBJECTIVE To evaluate prospectively the association between phobic anxiety symptoms and incident T2D in three cohorts of US men and women. DESIGN, SETTING AND PATIENTS We followed 30,791 men in the Health Professional's Follow-Up Study (HPFS) (1988-2008), 68,904 women in the Nurses' Health Study (NHS) (1988-2008), and 79,960 women in the Nurses' Health Study II (NHS II) (1993-2011). Phobic anxiety symptom scores, as measured by the Crown-Crisp index (CCI), calculated from 8 questions, were administered at baseline and updated in 2004 for NHS, in 2005 for NHS II, and in 2000 for HPFS. Incident T2D was confirmed by a validated supplementary questionnaire. We used Cox proportional hazards analysis to evaluate associations with incident T2D. RESULTS During 3,099,651 person-years of follow-up, we documented 12,831 incident T2D cases. In multivariate Cox proportional-hazards models with adjustment for major lifestyle and dietary risk factors, the hazard ratios (HRs) of T2D across categories of increasing levels of CCI (scores=2 to <3, 3 to <4, 4 to <6, ⩾6), compared with a score of <2, were increased significantly by 6%, 10%, 10% and 13% (Ptrend=0.001) for NHS; and by 19%, 11%, 21%, and 29% (Ptrend<0.0001) for NHS II. Each score increment in CCI was associated with 2% higher risk of T2D in NHS (HRs, 1.02, 95% confidence intervals: 1.01-1.03) and 4% higher risk of T2D in NHS II (HRs, 1.04, 95% confidence intervals: 1.02-1.05). Further adjustment for depression did not change the results. In HPFS, the association between CCI and T2D was not significant after adjusting for lifestyle variables. CONCLUSION Our results suggest that higher phobic anxiety symptoms are associated with an increased risk of T2D in women.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States.
| | - Lu Qi
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Frank B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
| | - Olivia I Okereke
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, United States
| | - Walter C Willett
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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24
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Hoogwegt MT, Pedersen SS, Theuns DAMJ, Kupper N. Relation between emotional distress and heart rate variability in patients with an implantable cardioverter-defibrillator. Psychophysiology 2013; 51:187-96. [PMID: 24423136 DOI: 10.1111/psyp.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/07/2013] [Indexed: 11/29/2022]
Abstract
We investigated the relationship between Type D personality, depression, and anxiety, and heart rate variability (HRV) in 64 patients with an implantable cardioverter-defibrillator (ICD). HRV was obtained via 24-h Holter monitoring, and 24-h, 30-min daytime rest and 30-min nighttime sleep HRV were analyzed. In adjusted analyses, significant associations (standard deviation of normal-to-normal [NN] intervals [SDNN]: p = .043; standard deviation of NN intervals over 5-min periods [SDANN]: p = .010) and a trend (HRV triangular index: p = .09) were found for Type D personality, and trends were found for depression (lower RMSSD: p = .10; lower pNN50: p = .09). During daytime rest, similar results were found for anxiety and depression. During sleep, only noteworthy adjusted associations were found for depression (lower root mean square of successive differences in NN intervals [RMSSD]: p = .06; lower pNN50: p = .043). A Benjamini-Hochberg correction for multiple testing led to reduction of the number of significant relationships, but there was still support for lower autonomic control patients with Type D personality and depression. Future research with larger sample sizes is warranted.
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Affiliation(s)
- Madelein T Hoogwegt
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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25
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Rutledge T, Kenkre TS, Bittner V, Krantz DS, Thompson DV, Linke SE, Eastwood JA, Eteiba W, Cornell CE, Vaccarino V, Pepine CJ, Johnson BD, Bairey Merz CN. Anxiety associations with cardiac symptoms, angiographic disease severity, and healthcare utilization: the NHLBI-sponsored Women's Ischemia Syndrome Evaluation. Int J Cardiol 2013; 168:2335-40. [PMID: 23410495 PMCID: PMC3683077 DOI: 10.1016/j.ijcard.2013.01.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/21/2012] [Accepted: 01/18/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anxiety is common among patients presenting with suspected coronary artery disease (CAD). In a sample of women with signs and symptoms of ischemia, we examined three anxiety markers as predictors of CAD endpoints including: 1) cardiac symptom indicators; 2) angiographic CAD severity; and 3) healthcare utilization (cardiac hospitalizations and 5-year cardiovascular [CVD] healthcare costs). METHODS Participants completed a baseline protocol including coronary angiogram, cardiac symptoms, psychosocial measures and a median 5.9-year follow-up to track hospitalizations. We calculated CVD costs based on cardiac hospitalizations, treatment visits, and CVD medications. Anxiety measures included anxiolytic medication use, Spielberger Trait Anxiety Inventory (STAI) scores, and anxiety disorder treatment history. RESULTS The sample numbered 514 women with anxiety measure data and covariates (mean age=57.5 [11.1]). One in five (20.4%) women reported using anxiolytic agents. Anxiety correlated with cardiac symptom indicators (anxiolytic use with nighttime angina and nitroglycerine use; STAI scores and anxiety disorder treatment history with nighttime angina, shortness of breath, and angina frequency). Anxiety disorder treatment history (but not STAI scores or anxiolytics) predicted less severe CAD. Anxiolytic use (but not STAI scores or anxiety disorder treatment history) predicted hospitalizations for chest pain and coronary catheterization (HRs=2.0, 95% CIs=1.1-4.7). Anxiety measures predicted higher 5-year CVD costs (+9.0-42.7%) irrespective of CAD severity. CONCLUSIONS Among women with signs and symptoms of myocardial ischemia, anxiety measures predict cardiac endpoints ranging from cardiac symptom severity to healthcare utilization. Based on these findings, anxiety may warrant greater consideration among women with suspected CAD.
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Affiliation(s)
- Thomas Rutledge
- VA San Diego Healthcare System, San Diego, CA, United States; University of California, San Diego, CA, United States.
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26
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Carrière I, Ryan J, Norton J, Scali J, Stewart R, Ritchie K, Ancelin ML. Anxiety and mortality risk in community-dwelling elderly people. Br J Psychiatry 2013; 203:303-9. [PMID: 23929442 DOI: 10.1192/bjp.bp.112.124685] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are conflicting data on the role of anxiety in predicting mortality. AIMS To evaluate the 10-year mortality risk associated with anxiety in community-dwelling elderly people. METHOD Using data from 718 men and 1046 women aged 65 years and over, gender-stratified associations of anxiety symptoms (Spielberger State-Trait Anxiety Inventory, third tertile) and current DSM-IV anxiety disorder including generalised anxiety disorder (GAD) and phobia with all-cause and cardiovascular mortality were determined. RESULTS In women, mortality risk was increased for anxiety disorder and GAD in multivariate Cox models (hazard ratio (HR) = 1.53, 95% CI 1.02-2.27 and HR = 2.04, 95% CI 1.08-3.86 respectively), whereas for phobia it was nearly significant (HR = 1.52, 95% CI 0.94-2.47). Anxiety trait symptoms became non-significant as a result of the confounding effect of depressive symptoms. Anxiety disorder was associated with cardiovascular mortality in univariate analysis (HR = 2.42, 95% CI 1.16-5.07). No significant associations were found in men. CONCLUSIONS Our study suggests a gender-specific association of anxiety and mortality.
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Affiliation(s)
- Isabelle Carrière
- Isabelle Carrière, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France; Joanne Ryan, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France, and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia; Joanna Norton, PhD, Jacqueline Scali, MSc, Inserm U1061 and University of Montpellier I, Montpellier, France; Robert Stewart, PhD, Institute of Psychiatry, King's College London, UK; Karen Ritchie, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France, and Faculty of Medicine, Imperial College, St Mary's Hospital, London, UK; Marie Laure Ancelin, PhD, Inserm U1061 and University of Montpellier I, Montpellier, France
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Handberg EM, Eastwood JA, Eteiba W, Johnson BD, Krantz DS, Thompson DV, Vaccarino V, Bittner V, Sopko G, Pepine CJ, Merz NB, Rutledge TR. Clinical implications of the Women's Ischemia Syndrome Evaluation: inter-relationships between symptoms, psychosocial factors and cardiovascular outcomes. WOMEN'S HEALTH (LONDON, ENGLAND) 2013; 9:479-90. [PMID: 24007253 PMCID: PMC4136496 DOI: 10.2217/whe.13.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cardiovascular disease remains the leading cause of death in the USA and is associated with several modifiable (hypertension, diabetes, high cholesterol, tobacco use, physical inactivity, obesity and unhealthy diet) and nonmodifiable (age, gender and family history) risk factors. The role of psychosocial risk factors in the development of cardiovascular disease has a growing body of literature, and differences in men and women have been identified. The Women's Ischemia Syndrome Evaluation provides insight into psychosocial risk factors in a cohort of women presenting with chest pain who had a comprehensive battery of psychosocial assessments and long-term follow-up. This review focuses on symptom presentation for chest pain and its relationship to cardiovascular disease morbidity and mortality, quality of life, healthcare costs and psychosocial predictor variables, including anxiety, depression, hostility and social networks. In the Women's Ischemia Syndrome Evaluation, persistent chest pain was associated with an increased rate of adverse events and relatively high rates of depression and anxiety, with reduced functional capacity and impaired quality of life, over a median of 6 years of follow-up. More research is needed to better understand the relationships between symptoms and negative emotions and to determine whether psychological (pharmacologic and/or cognitive) interventions might impact both psychological and cardiovascular outcomes.
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Affiliation(s)
- Eileen M Handberg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA.
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Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer. J Behav Med 2012; 37:22-36. [PMID: 23085787 DOI: 10.1007/s10865-012-9461-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 10/05/2012] [Indexed: 01/10/2023]
Abstract
Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.
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Compare A, Kouloulias V, Apostolos V, Peña WM, Molinari E, Grossi E, Efstathios E, Carenini M. WELL.ME - Wellbeing therapy based on real-time personalized mobile architecture, vs. cognitive therapy, to reduce psychological distress and promote healthy lifestyle in cardiovascular disease patients: study protocol for a randomized controlled trial. Trials 2012; 13:157. [PMID: 22943627 PMCID: PMC3492018 DOI: 10.1186/1745-6215-13-157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 07/17/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is compelling evidence that psychological factors may have the same or even greater impact on the possibility of adverse events on cardiac diseases (CD) than other traditional clinical risk factors. Anxiety and depression are predictors of short- and long-term adverse outcomes, increased risk for higher rates of in-hospital complications, re-infarction, malignant arrhythmias, and mortality in CD patients. Despite researchers finding that cognitive behavior therapy (CBT) reduced depressive and anxiety symptoms, the fact that such results are maintained only in the short term and the lack of maintenance of the long-term affects the absence of changes in lifestyles, preventing the possibility of a wide generalization of results. Recently wellbeing therapy (WBT) has been proposed as a useful approach to improve healthy lifestyle behaviors and reduce psychological distress. METHODS/DESIGN The present randomized controlled study will test WBT, in comparison with CBT, as far as the reduction of symptoms of depression, anxiety and psychological distress, and the improvement of lifestyle behaviors and quality of life in cardiac patients are concerned. Moreover, innovations in communication technologies allow patients to be constantly followed in real life. Therefore WBT based on personalized mobile technology will allow the testing of its effectiveness in comparison with usual WBT. DISCUSSION The present study is a large outpatient study on the treatment of co-morbid depression, anxiety, and psychological distress in cardiac patients. The most important issues of this study are its randomized design, the focus on promotion of health-related behaviors, and the use of innovative technologies supporting patients' wellbeing in real life and in a continuous way. First results are expected in 2012. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01543815.
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Affiliation(s)
- Angelo Compare
- Human Factors and Technologies for Health - HTC Centre; Dept. of Human and Social Sciences, University of Bergamo, Piazzale S. Agostino 2, 24129, Bergamo, BG, Italy
| | | | | | | | - Enrico Molinari
- Istituto Auxologico Italiano; Catholic University of Milan, Milan, Italy
| | - Enzo Grossi
- Medical Department, Bracco SpA; IULM - University, Fondazione Bracco, Milan, Italy
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Di Simplicio M, Costoloni G, Western D, Hanson B, Taggart P, Harmer CJ. Decreased heart rate variability during emotion regulation in subjects at risk for psychopathology. Psychol Med 2012; 42:1775-1783. [PMID: 22067596 DOI: 10.1017/s0033291711002479] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dysfunctions in the regulation of emotional responses are related to poor psychological well-being and increased impact of cardiovascular disease. It has been suggested that the relationship between negative affect and higher morbidity could be mediated by a dysregulation of the autonomic nervous system (ANS), for example, of heart rate variability (HRV). Neuroticism is a personality trait associated with a maladaptive emotion regulation and also with alterations in ANS function. However, it is unknown whether subjects with high neuroticism present with specific biases in emotion regulation associated with reduced HRV. METHOD In total, 33 healthy subjects (n=13, highly neurotic) performed an emotion regulation task, during which they were instructed to either passively view negative pictures or attempt to down-regulate the affect elicited by the images. During the task an electrocardiogram was recorded and HRV was measured by calculation of the high frequency spectrum (HF-HRV). RESULTS A significant interaction between task condition and personality group was observed on HF-HRV measures (F 1,31=6.569, p=0.016). This was driven by subjects with low neuroticism presenting higher HF-HRV during down-regulation compared to passive exposure to negative stimuli, while subjects with high neuroticism reported an opposite tendency. CONCLUSIONS Our results show reduced HF-HRV during cognitive reappraisal of negative stimuli in high neuroticism and indicate a specific link between loss of flexibility in the parasympathetic cardiovascular tone and emotion regulation, consistent with previous work. Such findings support the importance of exploring the combination of ANS adaptability and emotional dysregulation in neuroticism as different facets of a common psychosomatic vulnerability factor.
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Affiliation(s)
- M Di Simplicio
- University Department of Psychiatry, Warneford Hospital, Oxford, UK.
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Proietti R, Mapelli D, Volpe B, Bartoletti S, Sagone A, Dal Bianco L, Daliento L. Mental stress and ischemic heart disease: evolving awareness of a complex association. Future Cardiol 2011; 7:425-37. [PMID: 21627481 DOI: 10.2217/fca.11.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The connection between cardiovascular disease and psychosocial risk factors has been the subject of an ever-growing body of literature over the last 50 years. Studies on the role of negative emotions, personality traits, chronic stress and social determinants have brought to light their possible role in triggering acute coronary syndromes, although further studies are required to clarify controversial results regarding the association between cardiovascular risk and important psychological problems such as depression and anxiety. The recognition of the role of emotional events in acute coronary syndromes paved the way for provocation experiments, aimed at inducing mental stress in a controlled setting and then documenting reversible impairment of myocardial perfusion, depolarization anomalies and arrhythmias. This ultimately led to the formalization of the concept of mental stress-induced myocardial ischemia. Accumulating evidence on the mechanistic bases of such phenomena outline a wide range of central and peripheral physiological changes associated with emotions and behaviors, whose effects are exerted on the cardiovascular system, sympathetic nervous system and the hypothalamus-hypophysis neuroendocrine axis. This article outlines the main steps in the identification of psychological aspects as cardiovascular risk factors and emphasizes the relevance of emotional stress as a trigger of acute cardiovascular events. Finally, a description is provided of the pathophysiological mechanisms behind mental stress-induced myocardial ischemia and pathways connecting the heart and brain.
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Compare A, Germani E, Proietti R, Janeway D. Clinical Psychology and Cardiovascular Disease: An Up-to-Date Clinical Practice Review for Assessment and Treatment of Anxiety and Depression. Clin Pract Epidemiol Ment Health 2011; 7:148-56. [PMID: 22016750 PMCID: PMC3195800 DOI: 10.2174/1745017901107010148] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/13/2011] [Accepted: 06/20/2011] [Indexed: 11/29/2022]
Abstract
The aim of the present review is underline the association between cardiac diseases and anxiety and depression. In the first part of the article, there is a description of anxiety and depression from the definitions of DSM-IV TR. In the second part, the authors present the available tests and questionnaires to assess depression and anxiety in patients with cardiovascular disease. In the last part of the review different types of interventions are reported and compared; available interventions are pharmacological or psychological treatments.
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Affiliation(s)
- Angelo Compare
- Clinical Psychology and Rehabilitation Psychology Department University of Bergamo, Italy
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Smith PJ, Blumenthal JA. [Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment]. Rev Esp Cardiol 2011. [PMID: 21889253 DOI: 10.1016/j.rec.2011.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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Smith PJ, Blumenthal JA. [Psychiatric and behavioral aspects of cardiovascular disease: epidemiology, mechanisms, and treatment]. Rev Esp Cardiol 2011; 64:924-33. [PMID: 21889253 DOI: 10.1016/j.recesp.2011.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 06/17/2011] [Indexed: 01/27/2023]
Abstract
Psychosocial and behavioral factors, including mood (depression, anxiety, anger, and stress), personality (Type A, Type D, and hostility), and social support, are associated with both the development and progression of cardiovascular disease. "Negative" emotions have been associated with increased rates of cardiovascular death and recurrent cardiac events, although the mechanisms responsible for this association remain unclear. A number of pathophysiological mechanisms have been proposed to explain these relationships, including hypothalamic-pituitary-adrenal axis dysregulation, platelet activation, and inflammation. Behavioral factors also have been implicated, such as nonadherence to prescribed medical therapies and physical inactivity. Several randomized trials of patients with cardiovascular disease have examined the impact of pharmacologic and behavioral treatments on hard cardiovascular disease events as well as on cardiovascular disease biomarkers of risk. Although psychological treatments generally have been shown to improve quality of life and psychological functioning among cardiac patients, the benefit of psychological interventions with respect to improving clinical outcomes has not been conclusively demonstrated.
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Affiliation(s)
- Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
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