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Goodyke MP, Bronas UG, Baynard T, Tintle N, DeVon HA, Collins E, Dunn SL. Relationships Among Heart Rate Variability, Perceived Social Support, and Hopelessness in Adults With Ischemic Heart Disease. J Am Heart Assoc 2024; 13:e032759. [PMID: 38348815 PMCID: PMC11010109 DOI: 10.1161/jaha.123.032759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/17/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Lower perceived social support is associated with hopelessness in patients with ischemic heart disease (IHD). Higher perceived social support is associated with higher heart rate variability (HRV) in adults following a stressful event, but the relationship between HRV and hopelessness has not been examined in patients with IHD. The purpose of this research was to evaluate the relationships among HRV, perceived social support, and hopelessness in patients with IHD. METHODS AND RESULTS Ninety-four participants were enrolled while hospitalized for an IHD event at a large hospital in the United States. Data collection occurred 2 weeks after hospital discharge and included the State-Trait Hopelessness Scale, ENRICHD Social Support Inventory, Patient Health Questionnaire-9, a demographic form, and a short-term HRV measurement taken at rest. Linear models were used to assess associations between variables in unadjusted and adjusted models. Most participants were men (67%), married (75%), and non-Hispanic White (96%) and underwent coronary artery bypass surgery (57%). There were inverse correlations between high frequency HRV and state hopelessness (r=-0.21, P=0.008) and root mean square of successive differences between normal heartbeats HRV and state hopelessness (r=-0.20, P=0.012) after adjusting for important covariates. High frequency and root mean square of successive differences between normal heartbeats did not show evidence of mediating the relationship between perceived social support and hopelessness. CONCLUSIONS There were significant inverse correlations between parasympathetic measures of HRV and hopelessness. Assessing high frequency and root mean square of successive differences between normal heartbeats during early recovery following an IHD event could provide promising evidence for understanding a possible precursor to hopelessness and targets for future interventions. Registration Information: clinicaltrials.gov. Identifiers: NCT03907891, NCT05003791.
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Affiliation(s)
| | - Ulf G. Bronas
- Columbia University, School of Nursing and Department of Rehabilitation MedicineNew YorkNYUSA
| | - Tracy Baynard
- University of Massachusetts Boston, Manning College of Nursing and Health SciencesBostonMAUSA
| | - Nathan Tintle
- University of Illinois Chicago, College of NursingChicagoILUSA
| | - Holli A. DeVon
- University of California Los Angeles, School of NursingLos AngelesCAUSA
| | - Eileen Collins
- University of Illinois Chicago, College of NursingChicagoILUSA
| | - Susan L. Dunn
- University of Illinois Chicago, College of NursingChicagoILUSA
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Park M, Lee YJ, Jung SJ. Association between pregnancy, and lactation after delivery and depressive symptoms in premenopausal Korean women and multilevel approach according to household composition: Result from the Korea Community Health Survey in 2019. J Affect Disord 2023; 329:566-572. [PMID: 36828144 DOI: 10.1016/j.jad.2023.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To evaluate the association between pregnancy, lactation after delivery and depressive symptoms in Korean women and to explore the associations according to household composition. METHODS We included 34,321 premenopausal women from the Korea Community Health Survey in 2019, a population-based cross-sectional study. We categorized the premenopausal women into 3 groups by questions about whether they were currently in menstruation: reference (women who were not pregnant or lactating after delivery), pregnancy, and lactation after delivery. Depressive symptoms (PHQ-9 ≥ 5) were assessed through questionnaires with trained interviewers. Multiple logistic regression analysis were performed. RESULTS Among 34,321 participants, 20,790 (60.6 %) had depressive symptoms. In the fully adjusted model, we found a significant association between mild depressive symptoms in lactated women after delivery (odds ratio [OR], 95 % confidence interval [CI] = 1.32 [1.04-1.65]) compared to a reference. Compared to reference, the association between women who were lactation after delivery and depressive symptoms was particularly noticeable in women living in families of 2-generation (OR, 95 % CI = 1.29 [1.00-1.65]) and 3-generation (OR, 95 % CI = 2.53 [1.31-4.89]). LIMITATIONS We utilized self-reported data on pregnancy and lactation after delivery, this exposure variable may be underestimated. CONCLUSION Our study observed associations between lactated women after delivery and depressive symptoms. This association was more pronounced in women living in 3-generation.
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Affiliation(s)
- Minseo Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Sun Jae Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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3
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Zhu C, Tran PM, Leifheit EC, Spatz ES, Dreyer RP, Nyhan K, Wang SY, Lichtman JH. Association of marital/partner status and patient-reported outcomes following myocardial infarction: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead018. [PMID: 36942107 PMCID: PMC10023828 DOI: 10.1093/ehjopen/oead018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
AIMS Little is known about the relationship between marital/partner status and patient-reported outcome measures (PROMs) following myocardial infarction (MI). We conducted a systematic review/meta-analysis and explored potential sex differences. METHODS AND RESULTS We searched five databases (Medline, Web of Science, Scopus, EMBASE, and PsycINFO) from inception to 27 July 2022. Peer-reviewed studies of MI patients that evaluated marital/partner status as an independent variable and reported its associations with defined PROMs were eligible for inclusion. Results for eligible studies were classified into four pre-specified outcome domains [health-related quality of life (HRQoL), functional status, symptoms, and personal recovery (i.e. self-efficacy, adherence, and purpose/hope)]. Study quality was appraised using Newcastle-Ottawa Scale, and data were synthesized by outcome domains. We conducted subgroup analysis by sex. We included 34 studies (n = 16 712), of which 11 were included in meta-analyses. Being married/partnered was significantly associated with higher HRQoL {six studies [n = 2734]; pooled standardized mean difference, 0.37 [95% confidence interval (CI), 0.12-0.63], I 2 = 51%} but not depression [three studies (n = 2005); pooled odds ratio, 0.72 (95% CI, 0.32-1.64); I 2 = 65%] or self-efficacy [two studies (n = 356); pooled β, 0.03 (95% CI, -0.09 to 0.14); I 2 = 0%]. The associations of marital/partner status with functional status, personal recovery outcomes, and symptoms of anxiety and fatigue were mixed. Sex differences were not evident due to mixed results from the available studies. CONCLUSIONS Married/partnered MI patients had higher HRQoL than unpartnered patients, but the associations with functional, symptom, and personal recovery outcomes and sex differences were less clear. Our findings inform better methodological approaches and standardized reporting to facilitate future research on these relationships.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Phoebe M Tran
- Department of Public Health, University of Tennessee, 1914 Andy Holt Ave, Knoxville, TN 37996, USA
| | - Erica C Leifheit
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, 195 Church St., 5th Floor, New Haven, CT 06510, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Rachel P Dreyer
- Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
- Department of Emergency Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT 06510, USA
- Department of Environmental Health Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
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Importance of Depressive Symptoms in Patients With Coronary Heart Disease - Review Article. Curr Probl Cardiol 2023; 48:101646. [PMID: 36773947 DOI: 10.1016/j.cpcardiol.2023.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Patients with myocardial infarction (MI) have both major depression as well as depressive symptoms. Therefore, due to the high prevalence of depression in post-MI patients, an assessment of its prognostic importance was put on the agenda. Patients after ACS frequently report fatigue, sleep problems, and sadness. Evaluation of these symptoms is very important because it should be clarified whether these symptoms are related only to the main disease or they indicate the presence of concomitant depression. Given a high predictive value of somatic-affective symptoms, it is recommended to assess them in post-MI patients. Further treatment of somatic and cognitive-affective symptoms of depression will improve the quality of life of patients with acute coronary events.
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Lin YK, Lin YH, Chiang CF, Yeh TM, Shih WL. Lactobacillus delbrueckii subsp. bulgaricus strain TCI904 reduces body weight gain, modulates immune response, improves metabolism and anxiety in high fat diet-induced obese mice. 3 Biotech 2022; 12:341. [PMCID: PMC9636364 DOI: 10.1007/s13205-022-03356-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022] Open
Abstract
AbstractThe multiple probiotic characteristics of strain TCI904 isolated in this study from natural fermented milk were investigated using a mouse model. TCI904 was identified as Lactobacillus delbrueckii subsp. bulgaricu (LDB), a well-known lactic acid starter bacterium found in yogurt. TCI904 exhibited an outstanding pancreatic lipase inhibition activity among several strains of lactic acid bacteria in vitro. Its in vivo effects were further studied. In a comparison of mice fed a high-fat diet (HFD) and those fed a HFD combined with TCI904 for 9 weeks, differences were observed in various aspects of health, and the adverse effects of a HFD were prevented in the latter group. TCI904 effectively prevented fat and body weight accumulation without reducing food intake; it also modulated innate immunity and increased the level of IgA in feces, reversing the increased blood sugar and insulin levels and attenuated the hyperlipidemia caused by a HFD. Based on biochemical test data, compared with the HFD group, a HFD combined with TCI904 induced significant lowering of insulin resistance indicator, homeostasis model assessment-insulin resistance (HOMA-IR) and atherogenic indices of plasma (AIP), the atherogenic coefficient (AC) and cardiac risk ratio (CRR) and increased the cardioprotective index (CPI). In addition, the administration of TCI904 alleviated mood disorders caused by a HFD. Taking the recommended human dose of TCI904 did not affect the liver or kidney function, indicating that TCI904 has sufficient in vivo safety. Taken together, the results of the present study contributed towards validation of the probiotic benefits of lactic acid starter microflora. Orally taken TCI904 exhibited positive immune- and metabolic-modulating, and anxiolytic properties, especially in HFD-induced obesity.
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Gianfredi V, Schaper NC, Odone A, Signorelli C, Amerio A, Eussen SJPM, Köhler S, Savelberg HHCM, Stehouwer CDA, Dagnelie PC, Henry RMA, van der Kallen CJH, van Greevenbroek MMJ, Schram MT, Koster A. Daily patterns of physical activity, sedentary behavior, and prevalent and incident depression-The Maastricht Study. Scand J Med Sci Sports 2022; 32:1768-1780. [PMID: 36114702 PMCID: PMC9827855 DOI: 10.1111/sms.14235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/20/2022] [Accepted: 09/08/2022] [Indexed: 01/12/2023]
Abstract
This study aims to compare the accelerometer-measured daily patterns of PA and sedentary behavior among participants with and without prevalent/incident depressive symptoms. We used data from 5582 individuals in The Maastricht Study (59.9 ± 8.6 years, 50.3% women). Daily patterns of sedentary time, light-intensity physical activity (LiPA), moderate-to-vigorous physical activity (MVPA), and sit-to-stand transitions were objectively measured at baseline with the activPAL3 activity monitor. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire, both at baseline and annually (median follow-up: 5.1 years). General linear models were used to compare patterns of physical activity and sedentary behavior between those with and without prevalent/incident depressive symptoms. Participants with prevalent depressive symptoms had significantly more sedentary time (18.6 min/day) and lower LiPA (26.8 min/day) and MVPA (4.8 min/day) than participants without depressive symptoms. Considering the daily patterns, participants with prevalent depressive symptoms had significantly more sedentary time early in the afternoon (12:00-18:00), early evening (18:00-21:00), and during the night (00:00-03:00), less time in LiPA in all periods between 09:00-21.00 and less MVPA in the morning (09:00:12:00), early afternoon (12:00-15:00), and evening (18:00-21:00), than those without. Similar differences in activity and sedentary behavior patterns between those and without incident depressive symptoms were observed albeit the differences were smaller. Overall, we did not find specific time slots particularly associated with both prevalent and incident depressive symptoms. These findings may indicate that less sedentary time and more intense PA can be important targets for the prevention of depression irrespective of the timing of the day.
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Affiliation(s)
- Vincenza Gianfredi
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - Nicolaas C. Schaper
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Anna Odone
- Department Public Health, Experimental and Forensic MedicineUniversity of PaviaPaviaItaly
| | | | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of PsychiatryUniversity of GenoaGenoaItaly,IRCCS Ospedale Policlinico San MartinoGenoaItaly,Mood Disorders ProgramTufts Medical CenterBostonMassachusettsUSA
| | - Simone J. P. M. Eussen
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of EpidemiologyMaastricht UniversityMaastrichtThe Netherlands
| | - Sebastian Köhler
- MHeNS School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands,Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtThe Netherlands
| | - Hans H. C. M. Savelberg
- Department of Nutrition and Movement SciencesMaastricht UniversityMaastrichtThe Netherlands,School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands,NUTRIM, School for Nutrition and Translation Research MaastrichtMaastricht UniversityMaastrichtThe Netherlands
| | - Coen D. A. Stehouwer
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Pieter C. Dagnelie
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Ronald M. A. Henry
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Carla J. H. van der Kallen
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. J. van Greevenbroek
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | - Miranda T. Schram
- CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,MHeNS School for Mental Health and NeuroscienceMaastricht UniversityMaastrichtThe Netherlands,Heart and Vascular CenterMaastricht University Medical Center+MaastrichtThe Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands,Department of Social MedicineMaastricht UniversityMaastrichtThe Netherlands
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Helman TJ, Headrick JP, Peart JN, Stapelberg NJC. Central and cardiac stress resiliences consistently linked to integrated immuno-neuroendocrine responses across stress models in male mice. Eur J Neurosci 2022; 56:4333-4362. [PMID: 35763309 DOI: 10.1111/ejn.15747] [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: 01/07/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
Stress resilience, and behavioural and cardiovascular impacts of chronic stress, are theorised to involve integrated neuro-endocrine/inflammatory/transmitter/trophin signalling. We tested for this integration, and whether behaviour/emotionality, together with myocardial ischaemic tolerance, are consistently linked to these pathways across diverse conditions in male C57Bl/6 mice. This included: Restraint Stress (RS), 1 hr restraint/day for 14 days; Chronic Unpredictable Mild Stress (CUMS), 7 stressors randomised over 21 days; Social Stress (SS), 35 days social isolation with brief social encounters in final 13 days; and Control conditions (CTRL; un-stressed mice). Behaviour was assessed via open field (OFT) and sucrose preference (SPT) tests, and neurobiology from frontal cortex (FC) and hippocampal transcripts. Endocrine factors, and function and ischaemic tolerance in isolated hearts, were also measured. Model characteristics ranged from no behavioural or myocardial changes with homotypic RS, to increased emotionality and cardiac ischaemic injury (with apparently distinct endocrine/neurobiological profiles) in CUMS and SS models. Highly integrated expression of HPA axis, neuro-inflammatory, BDNF, monoamine, GABA, cannabinoid and opioid signalling genes was confirmed across conditions, and consistent/potentially causal correlations identified for: i) Locomotor activity (noradrenaline, ghrelin; FC Crhr1, Tnfrsf1b, Il33, Nfkb1, Maoa, Gabra1; hippocampal Il33); ii) Thigmotaxis (adrenaline, leptin); iii) Anxiety-like behaviour (adrenaline, leptin; FC Tnfrsf1a; hippocampal Il33); iv) Depressive-like behaviour (ghrelin; FC/hippocampal s100a8); and v) Cardiac stress-resistance (noradrenaline, leptin; FC Il33, Tnfrsf1b, Htr1a, Gabra1, Gabrg2; hippocampal Il33, Tnfrsf1a, Maoa, Drd2). Data support highly integrated pathway responses to stress, and consistent adipokine, sympatho-adrenergic, inflammatory and monoamine involvement in mood and myocardial disturbances across diverse conditions.
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Affiliation(s)
- Tessa J Helman
- School of Pharmacy and Medical Science, Griffith University, Southport, Australia
| | - John P Headrick
- School of Pharmacy and Medical Science, Griffith University, Southport, Australia
| | - Jason N Peart
- School of Pharmacy and Medical Science, Griffith University, Southport, Australia
| | - Nicolas J C Stapelberg
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Gold Coast Hospital and Health Service, Southport, Australia
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Dikić A, Radmilo L, Živanović Ž, Keković G, Sekulić S, Kovačić Z, Radmilo R. Cognitive impairment and depression after acute myocardial infarction: associations with ejection fraction and demographic characteristics. Acta Neurol Belg 2021; 121:1615-1622. [PMID: 32691364 DOI: 10.1007/s13760-020-01440-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 07/07/2020] [Indexed: 12/31/2022]
Abstract
Cognitive impairment and depression are often associated with acute myocardial infarction, however, the risk factors for their occurrence after myocardial infarction are still unclear. To determine the effect of reduced ejection fraction and demographic characteristics on the occurrence of cognitive impairment and depression after myocardial infarction. In the prospective study, the final sample consisted of 82 patients. Based on the value of the ejection fraction, the patients were divided into those with a value of < 40% and those having a value of ≥ 40%. Demographic data (age, gender, education), and data on comorbidities, were collected from the patients' medical history. The instruments of studies were: Mini-mental test and Beck depression inventory. The occurrence of cognitive impairment and depression was not, to a significant degree, associated with the level of ejection fraction. In contrast, demographics have shown positive predictive effects. Among demographic characteristics, the age of the patient proved to be a significant predictor for the occurrence of cognitive impairment (p = 0.004). The probability of cognitive impairment increases 1.16 times for each year of life. Significant depression predictor was female gender (p = 0.014). The probability of depression was 3.5 times greater for female gender. Cognitive impairment after acute myocardial infarction is more common in older patients, and depression in more common in women.
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Affiliation(s)
- Aleksandar Dikić
- Emergency Department, General Hospital, Dr Radivoj Simonović, Vojvođanska 75, 25 000, Sombor, Serbia.
| | - Ljiljana Radmilo
- Department of Neurology, General Hospital, Dr Radivoj Simonović, Sombor, Serbia
| | - Željko Živanović
- Department of Neurology, Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Clinic for Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Goran Keković
- Department of Electrical and Computer Engineering, Faculty of Maritime - Academic Studies, The College of Academic Studies "DOSITEJ", Belgrade, Serbia
| | - Slobodan Sekulić
- Department of Neurology, Medical Faculty Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Clinic for Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Zoran Kovačić
- School for Primary and Secondary Education With a Dormitory "Vuk Karadžić", Sombor, Serbia
| | - Ruža Radmilo
- Blood and Blood Products Supply Service, General Hospital "Dr Radivoj Simonović", Sombor, Serbia
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Chaplin AB, Smith N, Jones PB, Khandaker GM. Direction of association between Cardiovascular risk and depressive symptoms during the first 18 years of life: A prospective birth cohort study. J Affect Disord 2021; 292:508-516. [PMID: 34146903 PMCID: PMC8324768 DOI: 10.1016/j.jad.2021.05.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and depression are bidirectionally associated in adults. However, the direction of association between CVD risk and depressive symptoms in young people and potential mechanisms are poorly understood. METHODS Using longitudinal birth cohort data, we created a CVD risk score age at 15 using age, ethnicity, physical activity, maternal social status, maternal smoking, own smoking, BMI, systolic blood pressure, LDL, HDL and triglycerides. We used regression analysis to test: (1) association between CVD risk score at age 15 and depressive symptoms at ages 12 and 18; (2) association of IL-6 and CRP at age 9 with depressive symptoms at age 12 and CVD risk score at age 15; and (3) mediating effects of CVD risk score on associations of IL-6/CRP at age 9 with depressive symptoms at age 18. RESULTS The risk set comprised 5007 participants. CVD risk score in mid-adolescence was associated with depressive symptoms in early-adulthood (adjusted beta=0.06; standard error (SE)=0.02; p<0.001). Depressive symptoms in childhood were not associated with CVD risk score in mid-adolescence (adjusted beta=0.03; SE=0.02; p=0.11). Childhood inflammatory markers were associated with CVD risk score in mid-adolescence. Adolescent CVD risk score mediated the associations between childhood inflammatory markers and depressive symptoms in early-adulthood. LIMITATIONS The cohort primarily comprises White individuals, limiting generalisability. Sample attrition required imputation for missing data. CONCLUSIONS Association between CVD risk and depression in childhood/adolescence is unidirectional, with higher CVD risk increasing the risk of depressive symptoms. Childhood inflammation may increase risk of depression by influencing adolescent CVD risk.
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Affiliation(s)
- Anna B Chaplin
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Nick Smith
- James Paget University Hospital, Norfolk, United Kingdom
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
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Liblik K, Mulvagh SL, Hindmarch CCT, Alavi N, Johri AM. Depression and anxiety following acute myocardial infarction in women. Trends Cardiovasc Med 2021; 32:341-347. [PMID: 34363978 DOI: 10.1016/j.tcm.2021.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is the leading global cause of mortality, with ischemic heart disease causing the majority of cardiovascular deaths. Despite this, diagnostic delay commonly occurs in women experiencing acute myocardial infarction (AMI) who have a higher associated in-hospital mortality. Several studies have demonstrated that women are significantly more likely than men to experience depression and anxiety following AMI which is linked with increased morbidity, rehospitalization, and mortality, as well as decreased quality of life. Thus, it is imperative that future work aims to understand the factors that put women at higher risk for depression and anxiety following AMI, informing prevention and intervention. This narrative review will summarize the current literature on the association between AMI and mental health in women, including the impact on morbidity, mortality, and quality of life.
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Affiliation(s)
- Kiera Liblik
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Charles C T Hindmarch
- Queen's Cardiopulmonary Unit, Translational Institute of Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Nazanin Alavi
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, Kingston, ON, Canada.
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHDM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFDO, Santos ECL, Piegas LS, Soeiro ADM, Negri AJDA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLDAA, Sena JP, Peixoto JM, Souza JAD, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LADO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MTD, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RDSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VDMG, Chalela WA, Mathias Júnior W. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021. Arq Bras Cardiol 2021; 117:181-264. [PMID: 34320090 PMCID: PMC8294740 DOI: 10.36660/abc.20210180] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Gilson Soares Feitosa Filho
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Centro Universitário de Tecnologia e Ciência (UniFTC), Salvador, BA - Brasil
| | - João Luiz Petriz
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
| | | | | | - Walmor Lemke
- Clínica Cardiocare, Curitiba, PR - Brasil
- Hospital das Nações, Curitiba, PR - Brasil
| | | | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - José A Marin Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | | | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCor), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Felipe Gallego Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brasil
| | - Juliana Ascenção de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Lilia Nigro Maia
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
| | | | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luís Alberto de Oliveira Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luis Augusto Palma Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Bueno da Silva Rivas
- Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Múcio Tavares de Oliveira Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, BA - Brasil
- Universidade Salvador (UNIFACS), Salvador, BA - Brasil
- Hospital EMEC, Salvador, BA - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Otávio Rizzi Coelho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | - Paulo Rogério Soares
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Talia Falcão Dalçóquio
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - William Azem Chalela
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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12
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Norton J, Pastore M, Ancelin M, Hotopf M, Tylee A, Mann A, Palacios J. Time-dependent cognitive and somatic symptoms of depression as predictors of new cardiac-related events in at-risk patients: the UPBEAT-UK cohort. Psychol Med 2021; 51:1271-1278. [PMID: 31996279 DOI: 10.1017/s0033291719004082] [Citation(s) in RCA: 7] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence suggests that somatic rather than cognitive depressive symptoms are risk factors for recurrent cardiac events in at-risk patients. However, this has never been explored using a time-dependent approach in a narrow time-frame, allowing a cardiac event-free time-window. METHODS The analysis was performed on 595 participants [70.6% male, median age 72 (27-98)] drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Depressive symptomatology was measured using the Patient Health Questionnaire-9 (PHQ-9) (four somatic, five cognitive items). New cardiac events (NCEs) including cardiac-related mortality were identified by expert examination of patient records. Analyses were performed using Cox proportional hazard models with delayed entry, with time-dependent depressive dimensions and covariates measured 12-18 months (median: 14.1, IQR: 3.5) prior to the event, with a 12-month cardiac event-free gap. RESULTS There were 95 NCEs during the follow-up [median time-to-event from baseline: 22.3 months (IQR: 13.4)]. Both the somatic (HR 1.12, 95% CI 1.05-1.20, p = 0.001) and cognitive dimensions (HR 1.11, 95% CI 1.03-1.18, p = 0.004) were time-dependent risk factors for an NCE in the multi-adjusted models. Specific symptoms (poor appetite/overeating for the somatic dimension, hopelessness and feeling like a failure for the cognitive dimension) were also significantly associated. CONCLUSION This is the first study of the association between depressive symptom dimensions and NCEs in at-risk patients using a time-to-event standardised approach. Both dimensions considered apart were independent predictors of an NCE, along with specific items, suggesting regular assessments and tailored interventions targeting specific depressive symptoms may help to prevent NCEs in at-risk populations.
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Affiliation(s)
- J Norton
- Inserm U1061, Montpellier, France
- University of Montpellier, Montpellier, France
| | - M Pastore
- University of Montpellier, Montpellier, France
- StatABio, CNRS, INSERM, Montpellier, France
| | - M Ancelin
- Inserm U1061, Montpellier, France
- University of Montpellier, Montpellier, France
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - A Tylee
- Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Mann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Palacios
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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13
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Wen Y, Yang Y, Shen J, Luo S. Anxiety and prognosis of patients with myocardial infarction: A meta-analysis. Clin Cardiol 2021; 44:761-770. [PMID: 33960435 PMCID: PMC8207975 DOI: 10.1002/clc.23605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/26/2022] Open
Abstract
Although anxiety is highly prevalent after myocardial infarction (MI), but the association between anxiety and MI is not well established. This study aimed to provide an updated and comprehensive evaluation of the association between anxiety and short-term and long-term prognoses in patients with MI. Anxiety is associated with poor short-term and long-term prognoses in patients with MI. We performed a systematic search in the PubMed and Cochrane databases (January 2000-October 2020). The study endpoints were complications, all-cause mortality, cardiac mortality, and/or major adverse cardiac events (MACEs). Pooled data were synthesized using Stata SE12.0 and expressed as risk ratios (RRs) and 95% confidence intervals (CIs). We included 9373 patients with MI from 16 published studies. Pooled analyses indicated a correlation between high anxiety and poor clinical outcomes (RR: 1.19, 95% CI: 1.13-1.26, p < .001), poor short-term complications (RR: 1.23, 95% CI: 1.09-1.38, p = .001), and poor long-term prognosis (RR: 1.27, 95% CI: 1.13-1.44, p < .001). Anxiety was also specifically associated with long-term mortality (RR: 1.16, 95% CI: 1.01-1.33, p = .033) and long-term MACEs (RR: 1.54, 95% CI: 1.26-1.90, p < .001). This study provided strong evidence that increased anxiety was associated with poor prognosis in patients with MI. Further analysis revealed that MI patients with anxiety had a 23% increased risk of short-term complications and a 27% increased risk of adverse long-term prognosis compared to those without anxiety.
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Affiliation(s)
- Yi Wen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Shen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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14
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Jung SJ, Jeon YJ, Choi KW, Yang JS, Chae J, Koenen KC, Kim HC. Correlates of psychological resilience and risk: Prospective associations of self-reported and relative resilience with Connor-Davidson resilience scale, heart rate variability, and mental health indices. Brain Behav 2021; 11:e02091. [PMID: 33638932 PMCID: PMC8119814 DOI: 10.1002/brb3.2091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There are several ways to determine psychological resilience. However, the correlation between each measurement is not clear. We explored associations of baseline relative "resilience" and risk with later self-reported trait resilience and other biological/mental health indices. METHODS We utilized baseline and follow-up survey data from 500 participants aged 30-64 in the community cohort. Baseline "relative" resilience was defined by: (a) negative life events (NLEs) in the six months before baseline and (b) depressive symptoms at baseline, yielding four groups of individuals: i) "Unexposed and well," "Vulnerable (depression)," "Reactive (depression)," and "Resilient." "Trait" resilience at follow-up was self-reported using the Connor-Davidson Resilience Scale (CD-RISC). Associations between relative resilience at baseline, CD-RISC, and heart rate variability (HRV) indices at follow-up were assessed with generalized linear regression models after adjustments. Associations between baseline resilience and subsequent loneliness/depression indices were also evaluated. RESULTS Overall trait resilience and its subfactors at follow-up showed strong negative associations with "Reactive" at baseline (adj-β for total CD-RISC score: -11.204 (men), -9.472 (women)). However, resilience at baseline was not associated with later HRV, which was compared with the significant positive association observed between CD-RISC and HRV at the same follow-up time point. The "Reactive" exhibited significantly increased depressive symptoms at follow-up. The overall distribution pattern of CD-RISC subfactors differed by baseline resilience status by sex. CONCLUSIONS The "relative" resilience based on the absence of depression despite prior adversity seems to be highly related with trait resilience at follow-up but not with HRV. The sub-factor pattern of CD-RISC was different by sex.
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Affiliation(s)
- Sun Jae Jung
- Department of Preventive MedicineYonsei University College of MedicineSeoulSouth Korea
- Department of Public HealthYonsei University Graduate SchoolSeoulSouth Korea
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ye Jin Jeon
- Department of Public HealthYonsei University Graduate SchoolSeoulSouth Korea
| | - Karmel W. Choi
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA
| | - Ji Su Yang
- Department of Public HealthYonsei University Graduate SchoolSeoulSouth Korea
| | - Jeong‐Ho Chae
- Department of PsychiatrySt. Mary’s HospitalSeoulSouth Korea
| | - Karestan C. Koenen
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Hyeon Chang Kim
- Department of Preventive MedicineYonsei University College of MedicineSeoulSouth Korea
- Department of Public HealthYonsei University Graduate SchoolSeoulSouth Korea
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15
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Associations of Dietary Patterns with Incident Depression: The Maastricht Study. Nutrients 2021; 13:nu13031034. [PMID: 33806882 PMCID: PMC8004955 DOI: 10.3390/nu13031034] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.
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Shah AS, Alonso A, Whitsel EA, Soliman EZ, Vaccarino V, Shah AJ. Association of Psychosocial Factors With Short-Term Resting Heart Rate Variability: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2021; 10:e017172. [PMID: 33631952 PMCID: PMC8174247 DOI: 10.1161/jaha.120.017172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
Background Psychosocial factors predict heart disease risk, but our understanding of underlying mechanisms is limited. We sought to evaluate the physiologic correlates of psychosocial factors by measuring their relationships with heart rate variability (HRV), a measure of autonomic health, in the ARIC (Atherosclerosis Risk in Communities) study. We hypothesize that increased psychosocial stress associates with lower HRV. Methods and Results We studied 9331 participants in ARIC with short-term HRV data at visits 2 and 4. The mean (SD) age was 54.4 (5.7) years, 55% were women, and 25% were Black. Psychosocial factors included: (1) vital exhaustion (VE), (2) anger proneness, a personality trait, and (3) perceived social support. Linear models adjusted for sociodemographic and cardiovascular risk factors. Low frequency HRV (ln ms2) was significantly lower in the highest versus lowest quartiles of VE (B=-0.14, 95% CI, -0.24 to -0.05). When comparing this effect to age (B=-0.04, 95% CI, -0.05 to -0.04), the difference was equivalent to 3.8 years of accelerated aging. Perceived social support associated with lower time-domain HRV. High VE (versus low VE) also associated with greater decreases in low frequency over time, and both anger and VE associated with greater increases in resting heart rate over time. Survival analyses were performed with Cox models, and no evidence was found that HRV explains the excess risk found with high VE and low perceived social support. Conclusions Vital exhaustion, and to a lesser extent anger and social support, were associated with worse autonomic function and greater adverse changes over time.
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Affiliation(s)
- Anish S. Shah
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGA
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Eric A. Whitsel
- Department of EpidemiologyGillings School of Global Public Health and Department of MedicineSchool of MedicineUniversity of North CarolinaChapel HillNC
| | - Elsayed Z. Soliman
- Department of Epidemiology & PreventionWake Forest School of MedicineWinston‐SalemNC
| | - Viola Vaccarino
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
| | - Amit J. Shah
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGA
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
- Division of CardiologyDepartment of MedicineSchool of MedicineEmory UniversityAtlantaGA
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17
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Dunn SL, Robbins LB, Tintle NL, Collins EG, Bronas UG, Goodyke MP, Luong A, Gutierrez-Kapheim M, DeVon HA. Heart up! RCT protocol to increase physical activity in cardiac patients who report hopelessness: Amended for the COVID-19 pandemic. Res Nurs Health 2021; 44:279-294. [PMID: 33428224 PMCID: PMC7933089 DOI: 10.1002/nur.22106] [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] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 01/19/2023]
Abstract
Hopelessness is associated with decreased physical activity (PA) and increased adverse events and death in patients with ischemic heart disease (IHD). Rates of PA in patients with IHD continue to be low in both hospital-based cardiac rehabilitation and home settings. While researchers have investigated strategies to increase PA among patients with IHD, interventions to promote PA specifically in IHD patients who report hopelessness are lacking. We describe the protocol for a NIH-funded randomized controlled trial designed to establish the effectiveness of a 6-week intervention (Heart Up!) to promote increased PA in IHD patients who report hopelessness. Participants (n = 225) are randomized to one of three groups: (1) motivational social support (MSS) from a nurse, (2) MSS from a nurse plus significant other support (SOS), or (3) attention control. Aims are to: (1) test the effectiveness of 6 weeks of MSS and MSS with SOS on increasing mean minutes per day of moderate to vigorous PA; (2) determine the effects of change in moderate to vigorous PA on hopelessness; and (3) determine if perceived social support and motivation (exercise self-regulation) mediate the effects of the intervention on PA. A total of 69 participants have been enrolled to date. The protocol has been consistently and accurately used by research personnel. We address the protocol challenges presented by the COVID-19 pandemic and steps taken to maintain fidelity to the intervention. Findings from this study could transform care for IHD patients who report hopelessness by promoting self-management of important PA goals that can contribute to better health outcomes.
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Affiliation(s)
- Susan L Dunn
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lorraine B Robbins
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Nathan L Tintle
- Department of Statistics, Dordt University, Sioux Center, Iowa, USA
| | - Eileen G Collins
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ulf G Bronas
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Madison P Goodyke
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anna Luong
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melissa Gutierrez-Kapheim
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Holli A DeVon
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
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18
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Herhaus B, Kersting A, Brähler E, Petrowski K. Depression, anxiety and health status across different BMI classes: A representative study in Germany. J Affect Disord 2020; 276:45-52. [PMID: 32697715 DOI: 10.1016/j.jad.2020.07.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/11/2020] [Accepted: 07/06/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Changes in body mass index (BMI) over the course of one's lifetime are related to the development of mental disorders. In the current study we compared symptoms of depression, generalized anxiety as well as general health status in the four BMI-classes: underweight, normal weight, overweight and obesity. Furthermore, mediator role of general health status on the relationship between BMI and depression and generalized anxiety was analyzed. METHODS A representative sample (random-route sampling) of the German population (N = 2350) was investigated in a cross-sectional survey by measuring the three questionnaires PHQ-9, GAD-7 and EQ-5D-5L. RESULTS The results showed significant differences between the four BMI-classes in all three questionnaires. Individuals with obesity demonstrated higher values in depression, anxiety and general health compared to the three other BMI-classes. However, there was no U-shaped association between BMI and depression, anxiety and health-related quality of life. Regarding to the mediation analysis, general health status fully mediated the association between BMI, depressive symptoms as well as generalized anxiety symptoms. LIMITATIONS The assessment of the three factors depression, anxiety and general health status were measured by questionnaires, but no clinical diagnoses can be provided. CONCLUSIONS Evidence supports that individuals with obesity have an increased risk for depression and anxiety as well as lower general health. Further research on potential intervention and strategies in public health policies is needed to be able to target the developing of mental disorders in individuals with obesity. Taking their general health status into account is also of great importance.
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Affiliation(s)
- Benedict Herhaus
- Medical Psychology & Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128 Mainz, Germany.
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Katja Petrowski
- Medical Psychology & Medical Sociology, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Duesbergweg 6, 55128 Mainz, Germany
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Henao Pérez M, López Medina DC, Lemos Hoyos M, Ríos Zapata P. Depression and the risk of adverse outcomes at 5 years in patients with coronary heart disease. Heliyon 2020; 6:e05425. [PMID: 33210006 PMCID: PMC7658707 DOI: 10.1016/j.heliyon.2020.e05425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/01/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022] Open
Abstract
Background Cardiovascular diseases are a public health concern worldwide, with high rates of morbidity and mortality. Depression is a frequent comorbidity in coronary heart disease (CHD). It can be caused by the experience of suffering from heart disease, but it can also influence the prognosis of the CHD. The prevalence of depression in patients with cardiovascular disease is twice as high as that in the general population. Aim Assess the influence of depression in the prognosis at 5 years in patients with CHD. Methods 145 patients diagnosed with CHD were recruited between September 2013 and June 2015. Depression was assessed based on the PHQ-9 results at the time of hospitalization and 3 months after discharged. Sociodemographic and clinical variables were collected. A 5-year follow-up was carried out to verify death, reinfarction or any adverse outcome. Results 20% of the study population had depression at hospital admission compared with 11% at 3 months. Depression at 3 months after discharged was a differentiating factor to present complications (42.6 months, CI 95% 27.3–57.9) compared with patients without depression (55 months, CI 95%, 50.9–59.1) (Log-Rank p = 0.034). In the unadjusted model, the risk of heart complications increased with patients that have comorbidities, such as diabetes (HR 2.78, 95% CI 1.21–6.3) or hypothyroidism (HR 2.5 95% CI 1.09–5.7). Also, patients with post-hospitalization depression at 3 months were 3 times (95% CI 1.023–8.8) more likely to have complications during the follow-up period than nondepressed patients. After risk factor adjustment, the HR for depression was 2.01 (95% CI 0.57–6.9). Findings Patients with depression at 3 months following the coronary event, presented complications sooner than those without depression.
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Affiliation(s)
| | | | | | - Paula Ríos Zapata
- Faculty of Psychology, Universidad Católica de Oriente, Rionegro, Colombia
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Petras M, Kalenska D, Samos M, Bolek T, Sarlinova M, Racay P, Halasova E, Strbak O, Stasko J, Musak L, Skorvanova M, Baranovicova E. NMR plasma metabolomics study of patients overcoming acute myocardial infarction: in the first 12 h after onset of chest pain with statistical discrimination towards metabolomic biomarkers. Physiol Res 2020; 69:823-834. [PMID: 32901496 DOI: 10.33549/physiolres.934417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the leading causes of death among adults in older age. Understanding mechanisms how organism responds to ischemia is essential for the ischemic patient's prevention and treatment. Despite the great prevalence and incidence only a small number of studies utilize a metabolomic approach to describe AMI condition. Recent studies have shown the impact of metabolites on epigenetic changes, in these studies plasma metabolites were related to neurological outcome of the patients making metabolomic studies increasingly interesting. The aim of this study was to describe metabolomic response of an organism to ischemic stress through the changes in energetic metabolites and aminoacids in blood plasma in patients overcoming acute myocardial infarction. Blood plasma from patients in the first 12 h after onset of chest pain was collected and compared with volunteers without any history of ischemic diseases via NMR spectroscopy. Lowered plasma levels of pyruvate, alanine, glutamine and neurotransmitter precursors tyrosine and tryptophan were found. Further, we observed increased plasma levels of 3-hydroxybutyrate and acetoacetate in balance with decreased level of lipoproteins fraction, suggesting the ongoing ketonic state of an organism. Discriminatory analysis showed very promising performance where compounds: lipoproteins, alanine, pyruvate, glutamine, tryptophan and 3-hydroxybutyrate were of the highest discriminatory power with feasibility of successful statistical discrimination.
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Affiliation(s)
- M Petras
- Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovak Republic.
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Marzolini S, Colella TJF. Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort. Can J Cardiol 2020; 37:382-390. [PMID: 32882330 DOI: 10.1016/j.cjca.2020.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions. METHODS Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately. RESULTS In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO2peak), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO2peak, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married. CONCLUSIONS Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Tracey J F Colella
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Vaccarino V, Badimon L, Bremner JD, Cenko E, Cubedo J, Dorobantu M, Duncker DJ, Koller A, Manfrini O, Milicic D, Padro T, Pries AR, Quyyumi AA, Tousoulis D, Trifunovic D, Vasiljevic Z, de Wit C, Bugiardini R. Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. Eur Heart J 2020; 41:1687-1696. [PMID: 30698764 PMCID: PMC10941327 DOI: 10.1093/eurheartj/ehy913] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/25/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road Northeast, Atlanta, GA, 30322, USA
- Department of Medicine (Cardiology), Emory University School of Medicine, 1518 Clifton Road Northeast, Atlanta, GA, 30322, USA
| | - Lina Badimon
- Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau. CiberCV-Institute Carlos III. Autonomous University of Barcelona, C/ Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive Northeast, Atlanta, GA, 30329, USA
- Department of Radiology, Emory University School of Medicine, 1364 Clifton Road Northeast, Atlanta, GA, 30322, USA
- Atlanta Veterans Administration Medical Center, 670 Clairmont Road, Decatur, GA, 30033, USA
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Judit Cubedo
- Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau. CiberCV-Institute Carlos III. Autonomous University of Barcelona, C/ Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Maria Dorobantu
- Cardiology Department, University of Medicine and Pharmacy ‘Carol Davila’ of Bucharest, Emergency Clinical Hospital of Bucharest, Calea Floreasca 8, Sector 1, Bucuresti, 014461, Romania
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Cardiovascular Research Institute COEUR, Erasmus MC, University Medical Center, Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Alkotas street, 44, 1123, Budapest, Hungary
- Department of Physiology, New York Medical College, Valhalla, NY, 10595, USA
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, HR-10000, Zagreb, Croatia
| | - Teresa Padro
- Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau. CiberCV-Institute Carlos III. Autonomous University of Barcelona, C/ Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Axel R Pries
- Department of Physiology, Charitè-University Medicine, Thielallee 71, D-14195, Berlin, Germany
| | - Arshed A Quyyumi
- Department of Medicine (Cardiology), Emory University School of Medicine, 1518 Clifton Road Northeast, Atlanta, GA, 30322, USA
| | - Dimitris Tousoulis
- First Department of Cardiology, Hippokration Hospital, University of Athens Medical School, Vasilissis Sofias 114, TK 115 28, Athens, Greece
| | - Danijela Trifunovic
- Department of Cardiology, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Zorana Vasiljevic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Cor de Wit
- Institut für Physiologie, Universität zu Lübeck and Deutsches Zentrumfür Herz-Kreislauf-Forschung (DZHK), Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
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23
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Sun ZQ, Yu TT, Ma Y, Ma QM, Jiao YD, He DX, Jia-KeWu, Wen ZY, Wang XN, Hou Y, Sun ZJ. Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study. World J Clin Cases 2020; 8:1232-1240. [PMID: 32337197 PMCID: PMC7176617 DOI: 10.12998/wjcc.v8.i7.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes. However, the association between depression and myocardial injury on cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) has still not been assessed.
AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.
METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention (P-PCI) were analyzed in this prospectivecohort study. Each subject completed the Patient Health Questionnaire-9 (PHQ-9) to assess the presence and severity of depressive symptoms. CMR was performed at a median of 3 d after P-PCI for quantifying post-MI myocardial injury. Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.
RESULTS In this study, 19 patients (17.8%) were diagnosed with major depression identified by the PHQ-9 ≥ 10. PHQ-9 was analyzed both as a continuous variable and dichotomous variable. After multivariable adjustment, the proportion of patients with large infarction size was significantly higher in the major depression group (PHQ-9 ≥ 10) (OR: 4.840, 95%CI: 1.122–20.868, P =0.034). When the PHQ-9 was evaluated as a continuous variable, after multivariable adjustment, an increased PHQ-9 score was associated with an increased risk of large infarction size (OR: 1.226, 95%CI: 1.073–1.401, P =0.003).
CONCLUSION In patients with STEMI undergoing PCI, depression was independently associated with a large infarction size.
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Affiliation(s)
- Zhao-Qing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tong-Tong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yue Ma
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Quan-Mei Ma
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Yun-Di Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Dong-Xu He
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jia-KeWu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zong-Yu Wen
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiao-Nan Wang
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Yang Hou
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Abstract
BACKGROUND The incidence of depression is very common among patients with post-acute coronary syndrome (ACS) and leads to adverse outcomes. AIMS The aim of this meta-analysis was to detect risk factors for depression among patients with ACS and to provide clinical evidence for its prevention. METHODS The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to search the PubMed, Web of Science, EMBASE, and EBSCO databases from January 1996 to March 2018. Data that met the inclusion criteria were extracted to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk factors of post-ACS depression. RESULTS A total of 30 articles met the inclusion criteria, and 25 risk factors were found to be associated with depression. The top 5 risk factors are as follows: antidepression treatment (OR, 4.25; 95% CI, 3.41-5.31), housewife status (OR, 4.17; 95% CI, 1.83-9.53), history of depressive disorders (OR, 3.52; 95% CI, 2.69-4.61), widow status (OR, 2.34; 95% CI, 1.05-5.21), and history of congestive heart failure (OR, 2.03; 95% CI, 1.04-3.97). The authors also found that a married status, high education level, and employment are protective factors. CONCLUSION Clinical personnel should be alerted with regard to the high risk factors of depression, including female gender, low education level, unmarried status, living alone, unemployed status, unhealthy lifestyle, and complications such as cardiovascular, respiratory, and metabolic diseases. In particular, staff should pay attention to a history of previous depression, be concerned with the psychological condition of the patient, and monitor and perform early interventions to reduce the incidence of depression.
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25
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Costemale-Lacoste JF, Asmar KE, Rigal A, Martin S, Kader Ait Tayeb AE, Colle R, Becquemont L, Fève B, Corruble E. Severe insomnia is associated with metabolic syndrome in women over 50 years with major depression treated in psychiatry settings: a METADAP report. J Affect Disord 2020; 264:513-518. [PMID: 32056777 DOI: 10.1016/j.jad.2019.11.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/02/2019] [Accepted: 11/12/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Major depression is associated with metabolic syndrome and cardiovascular risk. We have previously shown that severe insomnia, a core symptom of major depression episode (MDE), is associated with hypertriglyceridemia, a component of metabolic syndrome, in women but not in men with major depression. Since insomnia is related to cardiovascular morbidity in the general population and major depression also, our objective was to assess the link between insomnia and metabolic syndrome, a marker syndrome of cardiovascular risk, during MDE, in women and in men. METHODS In 624 patients with a current MDE cohort, both insomnia and metabolic syndrome were assessed in women and men. Insomnia was rated from 0 to 6 based on the HDRS corresponding items, severe insomnia being defined by a total insomnia score ≥4. RESULTS severe insomnia was associated with metabolic syndrome in women but not in men. In multivariate logistic regressions, these results in women were independent from age, educational level, major depressive disorder duration and current smoking. These results were only significant in women aged ≥50 years, a cut-off age for menopausal status but not in women under 50 years. CONCLUSION Women aged ≥50 years with a severe insomnia during MDE have an increased risk of metabolic syndrome. Severe insomnia may be a clinical marker of metabolic risk in this population. They should be particularly monitored for metabolic syndrome and may benefit from sleep recommendations and cardiovascular prevention.
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Affiliation(s)
- Jean-François Costemale-Lacoste
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « Dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France
| | - Khalil El Asmar
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « Dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Adrien Rigal
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, F-94275, France; Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Séverine Martin
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, F-94275, France; Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Abd El Kader Ait Tayeb
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, F-94275, France; Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Romain Colle
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, F-94275, France; Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Laurent Becquemont
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, F-94275, France; Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France
| | - Bruno Fève
- Sorbonne Université-Inserm, UMR S_938, Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire ICAN, F-75012, Paris, France; Service d'Endocrinologie, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, F-75012, Paris, France
| | - Emmanuelle Corruble
- Institut National de la Santé et de la Recherche Médicale UMR-1178, CESP, Équipe « dépression » Le Kremlin Bicêtre, F-94276, France; Univ Paris-Sud, Faculté de Médecine Paris-Sud, Le Kremlin Bicêtre, F-94276, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, F-94275, France; Service Hospitalo-Universitaire de Psychiatrie, Hôpital de Bicêtre, Le Kremlin Bicêtre, F-94275, France.
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Kronish IM, Moise N, Cheung YK, Clarke GN, Dolor RJ, Duer-Hefele J, Margolis KL, St Onge T, Parsons F, Retuerto J, Thanataveerat A, Davidson KW. Effect of Depression Screening After Acute Coronary Syndromes on Quality of Life: The CODIACS-QoL Randomized Clinical Trial. JAMA Intern Med 2020; 180:45-53. [PMID: 31633746 PMCID: PMC6806435 DOI: 10.1001/jamainternmed.2019.4518] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Patients with acute coronary syndrome (ACS) and elevated depressive symptoms are at increased risk for recurrent cardiovascular events and mortality, worse quality of life, and higher health care costs. These observational findings prompted multiple scientific panels to advise universal depression screening in survivors of ACS prior to evidence from randomized screening trials. OBJECTIVE To determine whether systematically screening for depression in survivors of ACS improves quality of life and depression compared with usual care. DESIGN, SETTING, AND PARTICIPANTS A 3-group multisite randomized trial enrolled 1500 patients with ACS from 4 health care systems between November 1, 2013, and March 31, 2017, with follow-up ending July 31, 2018. Patients were eligible if they had been hospitalized for ACS in the previous 2 to 12 months and had no prior history of depression. All analyses were performed on an intention-to-treat basis. INTERVENTIONS Patients with ACS were randomly assigned 1:1:1 to receive (1) systematic depression screening using the 8-item Patient Health Questionnaire, with notification of primary care clinicians and provision of centralized, patient-preference, stepped depression care for those with positive screening results (8-item Patient Health Questionnaire score ≥10; screen, notify, and treat, n = 499); (2) systematic depression screening, with notification of primary care clinicians for those with positive screening results (screen and notify, n = 501); and (3) usual care (no screening, n = 500). MAIN OUTCOMES AND MEASURES The primary outcome was change in quality-adjusted life-years. The secondary outcome was depression-free days. Adverse effects and mortality were assessed by patient interview and hospital records. RESULTS A total of 1500 patients (424 women and 1076 men; mean [SD] age, 65.9 [11.5] years) were randomized in the 18-month trial. Only 71 of 1000 eligible survivors of ACS (7.1%) had elevated 8-item Patient Health Questionnaire scores indicating depressive symptoms at screening. There were no differences in mean (SD) change in quality-adjusted life-years (screen, notify and treat, -0.06 [0.20]; screen and notify, -0.06 [0.20]; no screen, -0.06 [0.18]; P = .98) or cumulative mean (SD) depression-free days (screen, notify and treat, 343.1 [179.0] days; screen and notify, 351.3 [175.0] days; no screen, 339.0 [176.6] days; P = .63). Harms including death, bleeding, or sleep difficulties did not differ among groups. CONCLUSIONS AND RELEVANCE In patients with ACS without a history of depression, systematic depression screening with or without providing depression treatment did not alter quality-adjusted life-years, depression-free days, or harms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01993017.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | | | - Rowena J Dolor
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Joan Duer-Hefele
- Center for Personalized Medicine, Northwell Health, New York, New York
| | | | - Tara St Onge
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Faith Parsons
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jessica Retuerto
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Patel JS, Oh Y, Rand KL, Wu W, Cyders MA, Kroenke K, Stewart JC. Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005-2016. Depress Anxiety 2019; 36:813-823. [PMID: 31356710 PMCID: PMC6736700 DOI: 10.1002/da.22940] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over-detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups. METHODS U.S. population representative data came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. RESULTS Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025-0.025, TLI = 0.985-0.992, CFI = 0.986-0.991). Finally, for all steps ΔCFI was <-0.004, and ΔRMSEA was <0.01. CONCLUSIONS We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.
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Affiliation(s)
- Jay S. Patel
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Youngha Oh
- Educational Psychology, Research, Evaluation, Measurement, and Statistics (REMS), Texas Tech University, Lubbock, TX
| | - Kevin L. Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Melissa A. Cyders
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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Kearns AE, Espiritu RP, Vickers Douglass K, Thapa P, Wermers RA. Clinical characteristics and depression score response after parathyroidectomy in primary hyperparathyroidism. Clin Endocrinol (Oxf) 2019; 91:464-470. [PMID: 31168854 PMCID: PMC9362855 DOI: 10.1111/cen.14045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Several studies indicate that patients with primary hyperparathyroidism (PHPT) undergoing parathyroid surgery have improvement in mood and neuropsychological functioning. The current analysis aims to examine the relationship between biochemical and clinical variables and the improvement in depression scores and in specific symptoms, after parathyroidectomy. DESIGN A prospective observational case-control study at a referral centre. PATIENTS Patients with PHPT undergoing parathyroidectomy (n = 88) or thyroid surgery (n = 85). MEASUREMENTS The Patient Health Questionnaire-9 (PHQ-9) was utilized to obtain depression scores at enrolment and 12 months after surgery. The changes in PHQ-9 were analysed and correlated with baseline clinical and biochemical parameters. RESULTS At enrolment, there was no difference between the groups in the number with a depression diagnosis (PHPT 34.1%, thyroid surgery, 35.5%, P = 0.86). However, baseline PHQ-9 scores were significantly higher in PHPT (median 7.5, range 0-27) than thyroid surgery patients (median 3.0, range 0-18, P < 0.0001). Following surgery, all PHQ-9 scores, total and symptom group (cognitive, somatic) improved and were no longer different between PHPT (total PHQ-9 median 2, range 0-16) and thyroid (median 1, range 0-14, P = 0.31) groups. Baseline parathyroid hormone level, but not calcium, had a weak relationship with change in PHQ-9 score after parathyroid surgery (P = 0.003). Baseline PHQ-9 score was correlated with change in PHQ-9 score at 12 months after parathyroid surgery (P < 0.001). CONCLUSIONS Depression scores improve in both somatic and cognitive domains after parathyroidectomy for PHPT and baseline severity of depression predicts the response.
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Affiliation(s)
- Ann E. Kearns
- Department of Internal Medicine and the Division of
Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo College of Medicine, Mayo
Clinic, Rochester, Minnesota, USA
| | - Rachel P. Espiritu
- Department of Internal Medicine and the Division of
Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo College of Medicine, Mayo
Clinic, Rochester, Minnesota, USA
| | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo College of
Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A. Wermers
- Department of Internal Medicine and the Division of
Endocrinology, Diabetes, Nutrition, and Metabolism, Mayo College of Medicine, Mayo
Clinic, Rochester, Minnesota, USA
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Reichardt LA, van Seben R, Aarden JJ, van der Esch M, van der Schaaf M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study. J Psychosom Res 2019; 120:66-73. [PMID: 30929710 DOI: 10.1016/j.jpsychores.2019.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥ 70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge. RESULTS The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission. CONCLUSION Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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Yin H, Liu Y, Ma H, Liu G, Guo L, Geng Q. Associations of mood symptoms with NYHA functional classes in angina pectoris patients: a cross-sectional study. BMC Psychiatry 2019; 19:85. [PMID: 30836983 PMCID: PMC6402172 DOI: 10.1186/s12888-019-2061-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/18/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. However, the influence of disease severity on mood symptoms is unknown. The specific associations of mood symptoms with NYHA classes remain unexplored. METHODS In this cross-sectional study, 443 consecutive inpatients with angina pectoris (AP) confirmed by angiography were included into analysis. Somatic and cognitive symptom scores derived from Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess mood symptoms. Predictors for depression and anxiety with strict and lax standards were compared. We hypothesized NYHA classification to be an indicator of disease severity through analyses with clinical features using ordinal logistic model. Applying both binary and ordinal logistic models, we evaluated the associations of mood symptoms with NYHA classes. RESULTS Discrepancy of disease severity existed between the depressed and nondepressed. NYHA classification was proved to be an integrated index under influence of age, coronary stenosis, heart failure and diabetes. NYHA class I and II individuals with AP were at equivalent risk for depression (NYHA II vs I: binary model OR 1.32 (0.59,2.96), p = 0.50; ordinal model OR 1.17 (0.73,1.88), p = 0.52), however NYHA class III/IV patients shared a sharply higher risk (NYHA III/IV vs I: binary model OR 3.32 (1.28,8.61), p = .013; ordinal model OR 3.94 (2.11,7.36), p < .001). Analyses on somatic and cognitive depressive symptoms confirmed this finding and hinted a greater impact of education background on mood when patient's condition is unstable. Anxiety seemed in the whole picture irrelevant with NYHA classes. Comparing with NYHA class I/II, AP patients in NYHA class III/IV tended to be less anxious. However, when CHD became unstable, the calmness may immediately be broken up. A great distinction of the ratio of anxiety and depression symptom scores between NYHA class III/IV stable and unstable AP patients (p = .018) was observed. CONCLUSIONS Mood symptoms in CHD patients are to a great extend derived from disease itself. Only for patients with relatively serious physical condition, unexpected discomforts caused by disease notably impact the emotions. Education background tends to influence the mood especially when disease is still unstable.
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Affiliation(s)
- Han Yin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,0000 0004 1764 3838grid.79703.3aSchool of Medicine, South China University of Technology, Guangzhou, China
| | - Yuting Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,0000 0004 1764 3838grid.79703.3aSchool of Medicine, South China University of Technology, Guangzhou, China
| | - Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China
| | - Guihao Liu
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lan Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080 People’s Republic of China ,Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China. .,School of Medicine, South China University of Technology, Guangzhou, China.
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Dunn SL, DeVon HA, Vander Berg L, Tintle NL. Ethnic minority members may be at risk for state hopelessness following hospitalization for ischemic heart disease. Arch Psychiatr Nurs 2019; 33:51-56. [PMID: 30663625 DOI: 10.1016/j.apnu.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/25/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine differences in state and trait hopelessness between ethnic minority and White patients hospitalized with ischemic heart disease (IHD). METHODS A descriptive cross-sectional design was used to enroll 517 patients at one Midwestern U.S. hospital. The State-Trait Hopelessness Scale measured hopelessness. RESULTS State hopelessness was higher in ethnic minority patients compared to Whites. Ethnic minority patients who had never been married had higher state hopelessness than those who were married or separated/divorced. There were no differences in trait hopelessness. CONCLUSIONS Ethnic minority patients with IHD, who have never been married, may be at higher risk for state hopelessness.
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Affiliation(s)
- Susan L Dunn
- College of Nursing, Michigan State University, East Lansing, MI 48824, United States of America.
| | - Holli A DeVon
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, United States of America
| | - Lucas Vander Berg
- Department of Statistics, Dordt College, Sioux Center, IA 51250, United States of America
| | - Nathan L Tintle
- Department of Statistics, Dordt College, Sioux Center, IA 51250, United States of America
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Lee JH, Kim MS, Yoo BS, Park SJ, Park JJ, Shin MS, Youn JC, Lee SE, Jang SY, Choi S, Cho HJ, Kang SM, Choi DJ. KSHF Guidelines for the Management of Acute Heart Failure: Part II. Treatment of Acute Heart Failure. Korean Circ J 2019; 49:22-45. [PMID: 30637994 PMCID: PMC6331324 DOI: 10.4070/kcj.2018.0349] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 10/14/2018] [Accepted: 12/18/2018] [Indexed: 12/11/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute HF represent distinct disease entities. Here, we introduce the Korean guidelines for the management of acute HF with reduced or preserved ejection fraction. Part II of this guideline covers the treatment of acute HF.
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Affiliation(s)
- Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Min Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Sung Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jong Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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33
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Jamal-Omidi S, Collins C, Fulchiero E, Liu H, Colon-Zimmermann K, Fuentes-Casiano E, Tatsuoka C, Cassidy KA, Lhatoo S, Sajatovic M. Assessing depression severity with a self-rated vs. rater-administered instrument in patients with epilepsy. Epilepsy Behav 2018; 85:52-57. [PMID: 29908384 DOI: 10.1016/j.yebeh.2018.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE Up to 30-50% of individuals with epilepsy have depressive symptoms, which often complicate seizure management and reduce overall quality of life. To identify and manage depressive symptoms appropriately, clinicians need standardized instruments that can accurately identify and monitor those with clinically significant depression. The self-reported 9-item Patient Health Questionnaire (PHQ-9) has been used relatively widely to screen and monitor depression in epilepsy. The rater-administered Montgomery-Asberg Depression Rating Scale (MADRS) is a rater-administered instrument widely used in depression treatment trials but less widely applied in epilepsy. This secondary analysis from 2 epilepsy self-management clinical trials compared depression severity ratings using the PHQ-9 and the MADRS instruments. METHODS Data for this analysis were derived from pooled baseline and longitudinal data from 2 prospective epilepsy self-management randomized controlled trials (RCTs). Both RCTs assessed depression with the PHQ-9 and the MADRS. For this analysis, total depression severity scores and case classification of individuals with no/minimal, mild, moderate/moderately severe, and severe depression were assessed using both PHQ-9 and MADRS. RESULTS The sample contained 164 individuals with epilepsy. Demographic and clinical variables between the 2 studies were generally similar. There were 107 women (64.8%), 106 African-Americans (64.2%), and 51 Whites (30.9%). Individuals had epilepsy for an average of 22.1 (SD: 15.5). Mean past 30-day seizure frequency at baseline was 3.1 (SD: 11.6). Baseline mean PHQ-9 was 10.7 (SD: 6.80) with depression severity of 32 (19.6%) not or minimally depressed, 47 (28.8%) mildly depressed, 37 (22.7%) moderately depressed, 27 (16.6%) moderately severely depressed, and 20 (12.3%) severely depressed. Baseline mean MADRS severity was 18.5 (SD: 11.3) with 30 (18.8%) not or minimally depressed, 27 (16.9%) mildly depressed, 92 (56.1%) moderately depressed, and 11 (6.9%) severely depressed. The correlation between total PHQ-9 and total MADRS was 0.843 (p < .01) although case classification by depression severity varied somewhat between the two instruments. CONCLUSIONS Standardized measures to evaluate depression severity in people with epilepsy can help identify cases and monitor treatment. The PHQ-9 and MADRS both perform well in assessing depression in people with epilepsy although administration burden is less with PHQ-9 thus making it likely preferable for settings where time and epilepsy specialty resources are limited.
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Affiliation(s)
- Shirin Jamal-Omidi
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christine Collins
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Erin Fulchiero
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hongyan Liu
- Department of Neurology and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kari Colon-Zimmermann
- Department of Neurology and Neurological & Behavioral Outcomes Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Edna Fuentes-Casiano
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Curtis Tatsuoka
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristin A Cassidy
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH, USA
| | - Samden Lhatoo
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry and of Neurology, Neurological & Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, OH, USA.
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Smolderen KG, Plomondon ME, Armstrong EJ, Hess E, Waldo S, Tsai TT, Maddox TM. Depression and long-term prognostic outcomes following peripheral endovascular interventions in the VA Healthcare System. Vasc Med 2018; 23:454-460. [PMID: 29801427 DOI: 10.1177/1358863x18770275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between depression and peripheral artery disease (PAD) outcomes remains widely understudied. In patients with PAD undergoing a peripheral vascular intervention (PVI) who have a recent diagnosis of depression, it is unknown what their long-term outcomes are and what factors may mediate an adverse risk. We therefore studied 797 consecutive patients undergoing PVI across 33 Veterans Affairs (VA) centers. Depression and outcomes were documented from patients' medical records. Outcomes included: (1) all-cause death; (2) non-fatal cardiovascular events (myocardial infarction, stroke); and (3) PAD-related events (including repeat PVI or amputation). Cox proportional hazards frailty models were constructed, adjusting for age. Additional covariates were selected if they resulted in at least 5% change in the age-adjusted hazard ratio (HR) for depression on outcomes. Overall, 265 (33%) patients had a diagnosis of depression. After a median follow-up of 955 days (range 1-6.25 years), 52 (6.5%) patients died, 30 (3.8%) experienced non-fatal cardiovascular events, and 176 (22.1%) had PAD-related events. Compared to patients without depression, depressed patients had higher rates of non-fatal cardiovascular events (6.4% vs 2.4%, p-value 0.0055). No differences for the other outcomes were noted. Higher risk for non-fatal cardiovascular events persisted after adjustment for age (HR 1.6, 95% CI 1.05-2.47). The only additional covariate that met our selection criteria was hypertension. After adjusting for hypertension, the association between depression and non-fatal cardiovascular outcomes attenuated (HR 1.53, 95% CI 0.99-2.35). In conclusion, a diagnosis of depression in veterans undergoing PVI was associated with increased risk of non-fatal cardiovascular events, mediated by age and hypertension.
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Affiliation(s)
- Kim G Smolderen
- 1 University of Missouri - Kansas City, Kansas City, MO, USA.,2 Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Mary E Plomondon
- 3 University of Colorado - Denver, Denver, CO, USA.,4 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Ehrin J Armstrong
- 3 University of Colorado - Denver, Denver, CO, USA.,4 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Edward Hess
- 3 University of Colorado - Denver, Denver, CO, USA
| | - Stephen Waldo
- 3 University of Colorado - Denver, Denver, CO, USA.,4 Denver Veterans Affairs Medical Center, Denver, CO, USA
| | | | - Thomas M Maddox
- 6 Division of Cardiology, Washington University School of Medicine, St Louis, MO, USA
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Wiltink J, Michal M, Jünger C, Münzel T, Wild PS, Lackner KJ, Blettner M, Pfeiffer N, Brähler E, Beutel ME. Associations between degree and sub-dimensions of depression and metabolic syndrome (MetS) in the community: results from the Gutenberg Health Study (GHS). BMC Psychiatry 2018; 18:114. [PMID: 29699530 PMCID: PMC5921368 DOI: 10.1186/s12888-018-1691-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 04/16/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A growing number of studies have associated metabolic syndrome (MetS) and depression, both retrospectively and prospectively. However, it has remained unclear, which degrees, or sub-dimensions of depression are related to MetS and if comorbid depression affects health care utilization. The purpose of the study was to determine the associations of a) somatic and cognitive-affective symptoms to MetS and b) depression and MetS to health care utilization. METHODS In a population-based, representative survey of 14.499 participants we studied the associations of the two dimensions of depression with MetS and health care utilization. Depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9). RESULTS MetS and its components were associated with the degree of depression, particularly with moderately severe/ severe depressive symptoms (PHQ-9 > = 15). There were clear positive associations of somatic-affective depressive symptoms with the presence of MetS and its components. Cognitive-affective symptoms were negatively associated with MetS. At the single item level, disorders of sleep and appetite as well as exhaustion were positively, while trouble concentrating was negatively associated with MetS. Symptoms of depression were related to higher consultations of somatic and mental health care, while the presence of MetS was related to somatic health care utilization. There was an additional interaction of depressive symptoms and MetS with mental health care. CONCLUSIONS Somatic affective symptoms of depression are positively associated, while cognitive-affective symptoms are negatively associated with MetS.
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Affiliation(s)
- Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Claus Jünger
- grid.410607.4Center of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- grid.410607.4Center of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S. Wild
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,grid.410607.4Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany ,0000 0004 5937 5237grid.452396.fDZHK (German Center for Cardiovascular Research), partner site RhineMain, Mainz, Germany
| | - Karl J. Lackner
- grid.410607.4Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- grid.410607.4Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Elmar Brähler
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Norlund F, Lissåker C, Wallert J, Held C, Olsson EM. Factors associated with emotional distress in patients with myocardial infarction: Results from the SWEDEHEART registry. Eur J Prev Cardiol 2018; 25:910-920. [PMID: 29692223 PMCID: PMC6009178 DOI: 10.1177/2047487318770510] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Emotional distress, symptoms of depression and anxiety, is common among patients after a myocardial infarction (MI), and is associated with an increased risk of cardiovascular morbidity. Real world population data on factors associated with emotional distress in MI patients are scarce. The aim was to determine factors associated with incident emotional distress two and 12 months post MI respectively, and with persistent emotional distress, versus remittent, in patients <75 years old. Design This was a registry-based observational study. Methods Data from the national SWEDEHEART registry on 27,267 consecutive patients with a first-time MI, followed up at two and 12 months post MI (n = 22,911), were included in the analyses. Emotional distress was assessed with the EuroQol-5D questionnaire. Several candidate sociodemographic and clinical factors were analysed for their association with emotional distress in multivariate models. Results Symptoms of emotional distress were prevalent in 38% and 33% at two and 12 months post MI respectively. At both time-points, previous depression and/or anxiety, readmission for new cardiovascular event, female gender, younger age, born outside the neighbouring Nordic countries, smoking and being neither employed nor retired showed the strongest associations with emotional distress. Other factors related to medical history, the MI and its care or were only modestly associated with emotional distress. Persistent emotional distress was associated with younger age, female gender, smoking and being born outside of the Nordic countries. Conclusion Previous depression/anxiety, female gender, younger age, smoking, born outside of the Nordic countries, neither employed nor retired and readmission due to cardiovascular events were strongly associated with emotional distress post MI. These factors may be of relevance in tailoring rehabilitation programmes.
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Affiliation(s)
- Fredrika Norlund
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - Claudia Lissåker
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - John Wallert
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
| | - Claes Held
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden.,2 Department of Medical Sciences: Cardiology, Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Erik Mg Olsson
- 1 Department of Women's and Children's Health, Clinical Psychology in Healthcare, Uppsala University, Sweden
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Tolentino JC, Schmidt SL. DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry 2018; 9:450. [PMID: 30333763 PMCID: PMC6176119 DOI: 10.3389/fpsyt.2018.00450] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/30/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Depression diagnosis requires five or more symptoms (Diagnostic and Statistical Manual of Mental Disorders-DSM-5). One of them must be either Depressed mood or Anhedonia, named main criteria. Although the secondary symptoms can be divided into somatic and non-somatic clusters, the DSM-5 identify depression in all or none fashion. In contrast, depression severity is a continuous variable. Therefore, it is commonly assessed with scales such as the Hamilton Depression Rating Scale (HAMD). Previously, we reported that patients with moderate depression (MD) exhibit greater impairments in cardiac-autonomic modulation than severely depressed (SD) patients. However, clinicians usually do not use scales. Objective: To verify whether the DSM-5 symptoms would be able to discriminate SD from MD and MD from non-depressed (ND) subjects. Material and Methods: Depression was diagnosed based on the Structured Clinical Interview for DSM-5® Disorders. The HAMD evaluated depression severity. In depressed subjects, MD and SD were defined considering the HAMD scores. ND was defined considering both the absence of DSM-5 criteria for depression and the HAMD score. Among 782 outpatients, 46 SD were found. MD and ND subjects were randomly sampled to match the demographic variables of the SD group. Results: Discriminant analysis showed that Depressed Mood was the most reliable symptom to discriminate ND from MD. Anhedonia discriminated SD from MD. Among the secondary DSM-5 criteria, the somatic cluster discriminated ND from MD and the non-somatic cluster SD from MD patients. Discussion: The presence of the somatic cluster in MD may indicate decreased vagal tone and/or increased sympathetic tone, leading to higher cardiovascular risk. As SD is associated with the non-somatic cluster, these patients are at risk of committing suicide. The DSM-5 symptoms exhibited by the patient may help the choice of adequate pharmacological treatment. This would avoid the use of antidepressants that unnecessarily increase cardiac risk in MD. When the symptom cluster suggests SD, the treatment must focus on the prevention of suicide. Conclusions: Depression severity may be inferred based on the DSM-5 criteria. The presence of the Anhedonia main criterium accompanied by non-somatic criteria indicate SD. The Depressive Mood criterium followed by somatic criteria suggest MD.
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Affiliation(s)
- Julio C Tolentino
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio L Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Martens RJH, Kooman JP, Stehouwer CDA, Dagnelie PC, van der Kallen CJH, Kroon AA, Leunissen KML, van der Sande FM, Schaper NC, Sep SJS, Köhler S, Schram MT, Henry RMA. Albuminuria is associated with a higher prevalence of depression in a population-based cohort study: the Maastricht Study. Nephrol Dial Transplant 2018; 33:128-138. [PMID: 27965374 DOI: 10.1093/ndt/gfw377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/18/2016] [Indexed: 11/13/2022] Open
Abstract
Background Depression is common in individuals with chronic kidney disease (CKD). However, data on the association of albuminuria, which together with reduced estimated glomerular filtration rate (eGFR) defines CKD, with depression are scarce and conflicting. In addition, it is not clear when in the course from normal kidney function to CKD the association with depression appears. Methods We examined the cross-sectional associations of albuminuria and eGFR with depressive symptoms and depressive episodes in 2872 and 3083 40- to 75-year-old individuals, respectively, who completed the baseline survey of an ongoing population-based cohort study conducted in the southern part of The Netherlands between November 2010 and September 2013. Urinary albumin excretion (UAE) was the average UAE in two 24-h urine collections and eGFR was calculated with the Chronic Kidney Disease Epidemiology Collaboration equation based on creatinine and cystatin C. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and the presence of a minor or major depressive episode was assessed with the MINI-International Neuropsychiatric Interview. Results In total, 5.4% had a minor or major depressive episode. UAE was <15 mg/24 h in 81.2%, 15-<30 mg/24 h in 10.3% and ≥30 mg/24 h in 8.6%. In a multivariable logistic regression analysis adjusted for potential confounders, and with UAE <15 mg/24 h as reference category, the odds ratio for a minor or major depressive episode was 2.13 [95% confidence interval (CI) 1.36-3.36] for UAE 15-<30 mg/24 h and 1.81 (95% CI 1.10-2.98) for UAE ≥30 mg/24 h. The average eGFR was 88.2 ± 14.7 mL/min/1.73 m2. eGFR was not associated with the presence of a minor or major depressive episode. Results were similar when we assessed associations with depressive symptoms or clinically relevant depressive symptoms (PHQ-9 score ≥10). Conclusions Albuminuria was associated with depressive symptoms and depressive episodes, even at levels of UAE that do not fulfil the CKD criteria. Future longitudinal studies should examine the direction of this association and whether albuminuria could serve as a biomarker to identify individuals at risk of depression.
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Affiliation(s)
- Remy J H Martens
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Karel M L Leunissen
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands.,MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Heart and Vascular Centre, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Heart and Vascular Centre, Maastricht University Medical Center+, Maastricht, The Netherlands
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Impact of Home- and Hospital-Based Exercise in Cardiac Rehabilitation on Hopelessness in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2017; 37:39-48. [PMID: 27676463 DOI: 10.1097/hcr.0000000000000205] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Hopelessness is associated with increased adverse events and decreased survival in patients with coronary heart disease (CHD). The purpose of this research was to examine the effect of regular home- and hospital-based cardiac rehabilitation (CR) exercise on hopelessness levels in patients with CHD, hypothesizing that increased exercise in either setting would lead to decreased state hopelessness. METHODS A descriptive longitudinal design was used at a large teaching hospital in Michigan. A total of 324 patients provided data during hospitalization and at least 1 followup time point (3, 8, and 12 months). RESULTS The patients had persistent, modest levels of state and trait hopelessness across all time points. Among home exercisers with moderate to severe state hopelessness at baseline, both mean state (P = .002) and trait (P = .02) hopelessness were reduced at later time points compared with those who quit or did not start exercise. Multivariable models showed that when individuals had moderate to severe baseline state hopelessness, home exercise remained associated with decreases in state hopelessness compared with no exercise, even after adjusting for hospital exercise, depression, and demographic variables. CONCLUSIONS Exercise may be effective in reducing moderate to severe hopelessness in patients with CHD. Moderate to severe baseline state hopelessness was a predictor of attrition in this cohort, especially for home exercisers, but this was mediated in hospital-based programs. Further research is needed to determine how hopeless individuals can be encouraged to exercise and whether home- or a hospital-based CR exercise is superior in impacting hopelessness.
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Chirinos DA, Gurubhagavatula I, Broderick P, Chirinos JA, Teff K, Wadden T, Maislin G, Saif H, Chittams J, Cassidy C, Hanlon AL, Pack AI. Depressive symptoms in patients with obstructive sleep apnea: biological mechanistic pathways. J Behav Med 2017; 40:955-963. [PMID: 28639107 PMCID: PMC9926999 DOI: 10.1007/s10865-017-9869-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 06/16/2017] [Indexed: 12/30/2022]
Abstract
This study examined the association between depressive symptoms, as well as depressive symptom dimensions, and three candidate biological pathways linking them to Obstructive sleep apnea (OSA): (1) inflammation; (2) circulating leptin; and (3) intermittent hypoxemia. Participants included 181 obese adults with moderate-to-severe OSA enrolled in the Cardiovascular Consequences of Sleep Apnea (COSA) trial. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II). We assessed inflammation using C-reactive protein levels (CRP), circulating leptin by radioimmunoassay using a double antibody/PEG assay, and intermittent hypoxemia by the percentage of sleep time each patient had below 90% oxyhemoglobin saturation. We found no significant associations between BDI-II total or cognitive scores and CRP, leptin, or percentage of sleep time below 90% oxyhemoglobin saturation after controlling for relevant confounding factors. Somatic symptoms, however, were positively associated with percentage of sleep time below 90% saturation (β = 0.202, P = 0.032), but not with CRP or circulating leptin in adjusted models. Another significant predictor of depressive symptoms included sleep efficiency (βBDI Total = -0.230, P = 0.003; βcognitive = -0.173, P = 0.030 (βsomatic = -0.255, P = 0.001). In patients with moderate-to-severe OSA, intermittent hypoxia may play a role in somatic rather than cognitive or total depressive symptoms.
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Affiliation(s)
| | - Indira Gurubhagavatula
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA.,Philadelphia VA Medical Center. Philadelphia, PA
| | - Preston Broderick
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Julio A Chirinos
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA.,Philadelphia VA Medical Center. Philadelphia, PA
| | - Karen Teff
- Monell Chemical Senses Center, Philadelphia, PA
| | - Thomas Wadden
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | - Greg Maislin
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
| | | | - Jesse Chittams
- University of Pennsylvania, School of Nursing. Philadelphia, PA
| | - Caitlin Cassidy
- LaSalle University, Department of Psychology, Philadelphia, PA
| | | | - Allan I. Pack
- University of Pennsylvania, School of Medicine/Hospital of the University of Pennsylvania. Philadelphia, PA
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Kanthak MK, Stalder T, Hill LK, Thayer JF, Penz M, Kirschbaum C. Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion. Scand J Work Environ Health 2017; 43:475-484. [PMID: 28514792 PMCID: PMC5788013 DOI: 10.5271/sjweh.3647] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objectives Given the important role of the autonomic nervous system (ANS) in stress regulation, astonishingly little is known about ANS functioning in burnout, a condition arising after prolonged exposure to work-related stress. The current study sought to investigate ANS modulation, as indexed by vagally-mediated heart rate variability (HRV), in relation to burnout symptomatology to (i) distinguish associations between the three dimensions of burnout [emotional exhaustion (EE), cynicism, reduced personal accomplishment] and (ii) investigate overlap in associations with depressive symptomatology. Methods Assessments of vagally-mediated HRV (ie, root mean square of successive differences, RMSSD) were conducted in a large population-based sample from the Dresden Burnout Study [N=410, mean age 42.2, standard deviation (SD) 11.2 years; 33.4% male]. Vagally-mediated HRV was assessed for 90 seconds during an emotionally-arousing situation (venipuncture, recumbent), a 335-second recumbent recovery period, and a 335-second seated resting condition. Results Results from multiple linear regression analyses revealed that EE was negatively related to RMSSD during venipuncture (=β -0.11, P=0.03) and the seated rest (β= -0.09, P=0.04) even after accounting for established ANS modulators (eg, age, body mass index). This pattern was not observed for the other dimensions of burnout. Exploratory analyses of depressive symptomatology further revealed that RMSSD was significantly and inversely associated with burnout-related symptoms but not with the core criteria of depression (eg, depressed mood). Conclusions This study presents evidence for a link between exhaustion and reduced vagal function, both in burnout and depression, suggesting that ANS modulations may not be disorder-specific but rather a psychophysiological correlate of an underlying feature shared by both conditions.
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Affiliation(s)
- Magdalena K Kanthak
- Department of Biological Psychology, TU Dresden, Zellescher Weg 19, DE-01069 Dresden, Germany.
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The Relationship of Depressive Symptoms and Vitamin D Intake to Cardiac Event–Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2017; 32:480-487. [DOI: 10.1097/jcn.0000000000000369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Quinlivan EB, Gaynes BN, Lee JS, Heine AD, Shirey K, Edwards M, Modi R, Willig J, Pence BW. Suicidal Ideation is Associated with Limited Engagement in HIV Care. AIDS Behav 2017; 21:1699-1708. [PMID: 27380390 DOI: 10.1007/s10461-016-1469-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PHQ-9 data from persons living with HIV (PLWH, n = 4099) being screened for depression in three clinics in the southeastern USA were used to determine the prevalence of suicidal ideation (SI). SI was reported by 352 (8.6 %); associated with <3 years since HIV diagnosis (1.69; 95 %CI 1.35, 2.13), and HIV RNA >50 copies/ml (1.70, 95 %CI 1.35, 2.14). Data from PLWH enrolled in a depression treatment study were used to determine the association between moderate-to-high risk SI (severity) and SI frequency reported on PHQ-9 screening. Over forty percent of persons reporting that SI occurred on "more than half the days" (by the PHQ-9) were assessed as having a moderate-to-high risk for suicide completion during the Mini International Neuropsychiatric Interview. SI, including moderate-to-high risk SI, remains a significant comorbid problem for PLWH who are not fully stabilized in care (as indicated by detectable HIV RNA or HIV diagnosis for less than 3 years).
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Affiliation(s)
- E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA.
| | - Bradley N Gaynes
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Lee
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy D Heine
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Kristen Shirey
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University, Durham, NC, USA
| | - Malaika Edwards
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
| | - Riddhi Modi
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - James Willig
- Department of Medicine, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Brian W Pence
- Center for AIDS Research, University of North Carolina at Chapel Hill, 103 Wild Turkey Trail, Chapel Hill, NC, 27516-9041, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dog Ownership and Dog Walking: The Relationship With Exercise, Depression, and Hopelessness in Patients With Ischemic Heart Disease. J Cardiovasc Nurs 2017; 33:E7-E14. [PMID: 28489725 DOI: 10.1097/jcn.0000000000000418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dog ownership has been associated with increased physical activity in the general adult population. OBJECTIVE The objective of this study was to examine dog ownership and dog walking and their relationship with home-based and phase II cardiac rehabilitation exercise, depression, and hopelessness in patients with ischemic heart disease. METHODS A total of 122 patients with ischemic heart disease were included in this prospective observational study. Patients completed dog ownership/walking questions during their hospitalization. The Cardiac Rehabilitation Exercise Participation Tool, Patient Health Questionnaire-9, and State-Trait Hopelessness Scale were completed by mail at 3, 8, or 12 months later. Regression modeling was used to evaluate the significance of dog ownership/walking on exercise, depression and hopelessness. RESULTS The sample was 34.4% female and had a mean age of 64.7 ± 9.1 years. Forty-two patients (34.4%) reported owning a dog. Patients who owned but did not walk their dog reported significantly lower levels of home exercise compared with patients who walked their dogs at least 1 day per week (36.8% for non-dog walkers vs 73.9% for dog walkers, P = .019). The odds of participating in home exercise were significantly higher for dog walkers compared with non-dog walkers (odds ratio, 8.1 [1.7, 38.5] vs 1.0). There were no differences in phase II cardiac rehabilitation exercise, depression, or hopelessness between dog owners and non-dog owners or between dog walkers and non-dog walkers. CONCLUSIONS These findings show a beneficial effect on home-based exercise for those who dog-walk at least 1 day per week. Healthcare professionals should encourage dog walking to increase dog owners' physical activity levels.
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Lin IM, Lu HC, Chu CS, Lee CS, Lu YH, Lin TH. The Relationship between Brachial-Ankle Pulse Wave Velocity and Depressive Symptoms among Patients with Coronary Artery Disease. ACTA CARDIOLOGICA SINICA 2017; 33:303-309. [PMID: 28559662 PMCID: PMC5445249 DOI: 10.6515/acs20161021b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Noninvasive brachial-ankle pulse wave velocity (baPWV) is an index for arterial stiffness in coronary artery disease (CAD). Depression has been connected to increased adverse cardiac events and mortality among patients with CAD. The aim of this study was to investigate the relationship between arterial stiffness and depressive symptoms among patients with CAD. METHODS Eighty-six patients with CAD were recruited. Demographic characteristics and Beck Depressive Inventory II scores were obtained from the study participants, and resting baPWV was measured by using a noninvasive device. Thereafter, the participants were divided into mild and severe arteriosclerosis groups according to baPWV values. RESULTS After adjusting the age, use of β-blockers, and left ventricular ejection fraction, there were higher somatic symptoms of depression in the severe arteriosclerosis group than those in the mild arteriosclerosis group, in particular concentration difficulty, changes in appetite, and fatigue. A multiple regression analysis indicated that baPWV was related to somatic symptoms of depression after adjusting the covariates of CAD risk factors. However, this association was not found between baPWV and cognitive symptoms of depression, and the total score of depression. CONCLUSIONS This study supports the proposition that somatic symptom of depression was related to arterial stiffness among patients with CAD.
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Affiliation(s)
- I-Mei Lin
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University
| | - Hsueh-Chen Lu
- Department of Psychology, College of Humanities and Social Sciences, Kaohsiung Medical University
| | - Chih-Sheng Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital;
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Division of Cardiology, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Ye-Hsu Lu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital;
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Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Headrick JP, Peart JN, Budiono BP, Shum DH, Neumann DL, Stapelberg NJ. The heartbreak of depression: ‘Psycho-cardiac’ coupling in myocardial infarction. J Mol Cell Cardiol 2017; 106:14-28. [DOI: 10.1016/j.yjmcc.2017.03.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/25/2022]
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Smolderen KG, Buchanan DM, Gosch K, Whooley M, Chan PS, Vaccarino V, Parashar S, Shah AJ, Ho PM, Spertus JA. Depression Treatment and 1-Year Mortality After Acute Myocardial Infarction: Insights From the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status). Circulation 2017; 135:1681-1689. [PMID: 28209727 DOI: 10.1161/circulationaha.116.025140] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/10/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Depression among patients with acute myocardial infarction (AMI) is prevalent and associated with an adverse quality of life and prognosis. Despite recommendations from some national organizations to screen for depression, it is unclear whether treatment of depression in patients with AMI is associated with better outcomes. We aimed to determine whether the prognosis of patients with treated versus untreated depression differs. METHODS The TRIUMPH study (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) is an observational multicenter cohort study that enrolled 4062 patients aged ≥18 years with AMI between April 11, 2005, and December 31, 2008, from 24 US hospitals. Research coordinators administered the Patient Health Questionnaire-9 (PHQ-9) during the index AMI admission. Depression was defined by a PHQ-9 score of ≥10. Depression was categorized as treated if there was documentation of a discharge diagnosis, medication prescribed for depression, or referral for counseling, and as untreated if none of these 3 criteria was documented in the medical records despite a PHQ score ≥10. One-year mortality was compared between patients with AMI having: (1) no depression (PHQ-9<10; reference); (2) treated depression; and (3) untreated depression adjusting for demographics, AMI severity, and clinical factors. RESULTS Overall, 759 (18.7%) patients met PHQ-9 criteria for depression and 231 (30.4%) were treated. In comparison with 3303 patients without depression, the 231 patients with treated depression had 1-year mortality rates that were not different (6.1% versus 6.7%; adjusted hazard ratio, 1.12; 95% confidence interval, 0.63-1.99). In contrast, the 528 patients with untreated depression had higher 1-year mortality in comparison with patients without depression (10.8% versus 6.1%; adjusted hazard ratio, 1.91; 95% confidence interval, 1.39-2.62). CONCLUSIONS Although depression in patients with AMI is associated with increased long-term mortality, this association may be confined to patients with untreated depression.
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Affiliation(s)
- Kim G Smolderen
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.).
| | - Donna M Buchanan
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - Kensey Gosch
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - Mary Whooley
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - Paul S Chan
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - Viola Vaccarino
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - Susmita Parashar
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - Amit J Shah
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - P Michael Ho
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
| | - John A Spertus
- From Saint Luke's Mid America Heart Institute, Kansas City, MO (K.G.S., D.M.B., K.G., P.S.C., J.A.S.); University of Missouri, Kansas City (K.G.S., D.M.B., P.S.C., J.A.S.); University of California, Department of Veterans Affairs Medical Center, San Francisco (M.W.); Rollins School of Public Health, Department of Epidemiology, Emory University, Atlanta, GA (V.V., A.J.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (V.V., A.J.S.); Atlanta Veterans Affairs Medical Center, GA (A.J.S.); and Denver Veterans Affairs Medical Center, CO (P.M.H.)
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48
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Compostella L, Lorenzi S, Russo N, Setzu T, Compostella C, Vettore E, Isabella G, Tarantini G, Iliceto S, Bellotto F. Depressive symptoms, functional measures and long-term outcomes of high-risk ST-elevated myocardial infarction patients treated by primary angioplasty. Intern Emerg Med 2017; 12:31-43. [PMID: 27401331 DOI: 10.1007/s11739-016-1504-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
The presence of major depressive symptoms is usually considered a negative long-term prognostic factor after an acute myocardial infarction (AMI); however, most of the supporting research was conducted before the era of immediate reperfusion by percutaneous coronary intervention. The aims of this study are to evaluate if depression still retains long-term prognostic significance in our era of immediate coronary reperfusion, and to study possible correlations with clinical parameters of physical performance. In 184 patients with recent ST-elevated AMI (STEMI), treated by immediate reperfusion, moderate or severe depressive symptoms (evaluated by Beck Depression Inventory version I) were present in 10 % of cases. Physical performance was evaluated by two 6-min walk tests and by a symptom-limited cardiopulmonary exercise test: somatic/affective (but not cognitive/affective) symptoms of depression and perceived quality of life (evaluated by the EuroQoL questionnaire) are worse in patients with lower levels of physical performance. Follow-up was performed after a median of 29 months by means of telephone interviews; 32 major adverse cardiovascular events (MACE) occurred. The presence of three vessels disease and low left ventricle ejection fraction are correlated with a greater incidence of MACE; only somatic/affective (but not cognitive/affective) symptoms of depression correlate with long-term outcomes. In patients with recent STEMI treated by immediate reperfusion, somatic/affective but not cognitive/affective symptoms of depression show prognostic value on long-term MACE. Depression symptoms are not predictors "per se" of adverse prognosis, but seem to express an underlying worse cardiac efficiency, clinically reflected by poorer physical performance.
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Affiliation(s)
- Leonida Compostella
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy.
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.
| | - Sonia Lorenzi
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
| | - Nicola Russo
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Tiziana Setzu
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
| | - Caterina Compostella
- Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy
| | - Elia Vettore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Giambattista Isabella
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Fabio Bellotto
- Preventive Cardiology and Rehabilitation, Inst. Codivilla-Putti, Via Codivilla, 1, 32043, Cortina d'Ampezzo, BL, Italy
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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49
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van Dooren FEP, Pouwer F, Schalkwijk CG, Sep SJS, Stehouwer CDA, Henry RMA, Dagnelie PC, Schaper NC, van der Kallen CJH, Koster A, Denollet J, Verhey FRJ, Schram MT. Advanced Glycation End Product (AGE) Accumulation in the Skin is Associated with Depression: The Maastricht Study. Depress Anxiety 2017; 34:59-67. [PMID: 27271340 DOI: 10.1002/da.22527] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/22/2016] [Accepted: 03/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent disease with a high morbidity and mortality risk. Its pathophysiology is not entirely clear. However, type 2 diabetes is an important risk factor for depression. One mechanism that may explain this association may include the formation of advanced glycation end products (AGEs). We therefore investigated the association of AGEs with depressive symptoms and depressive disorder. In addition, we examined whether the potential association was present for somatic and/or cognitive symptoms of depression. METHODS Cross-sectional data were used from the Maastricht Study (N = 862, mean age 59.8 ± 8.5 years, 55% men). AGE accumulation was measured with skin autofluorescence (SAF) by use of the AGE Reader. Plasma levels of protein-bound pentosidine were measured with high-performance liquid chromatography and fluorescence detection. Nε-(carboxymethyl)lysine (CML) and Nε-(carboxyethyl)lysine (CEL) were measured with ultraperformance liquid chromatography and tandem mass spectrometry. Depressive symptoms and depressive disorder were assessed by the nine-item Patient Health Questionnaire and the Mini-International Neuropsychiatric Interview. RESULTS Higher SAF was associated with depressive symptoms (β = 0.42, 95% CI 0.12-0.73, P = .007) and depressive disorder (OR = 1.42, 95% CI 1.04-1.95, P = .028) after adjustment for age, sex, type 2 diabetes, smoking, BMI, and kidney function. Plasma pentosidine, CML, and CEL were not independently associated with depressive symptoms and depressive disorder. CONCLUSIONS This study shows that AGE accumulation in the skin is independently associated with higher levels of depressive symptoms and depressive disorder. This association is present for both somatic and cognitive symptoms of depression. This might suggest that AGEs are involved in the development of depression.
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Affiliation(s)
- Fleur E P van Dooren
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,MHeNS-Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Frans Pouwer
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.,Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.,Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Frans R J Verhey
- MHeNS-Alzheimer Centre Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,CARIM-Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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50
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Changing depressive symptoms following percutaneous coronary intervention, clustering and effect on adherence - The THORESCI study. J Affect Disord 2016; 204:146-53. [PMID: 27344624 DOI: 10.1016/j.jad.2016.06.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/15/2016] [Accepted: 06/15/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptom dimensions may have a differential effect on cardiac prognosis. It is yet unknown whether and how depressive symptoms change together over time and how this may affect disease progression. We examined the clustering of changing depressive symptoms over the first 6 months after percutaneous coronary intervention (PCI), and examined the influence of the change profile on the predictive value of depression for treatment adherence at 6 months post-PCI. METHODS PCI patients (N=219, age: 62±15, 20% women) reported on depressive symptoms (PHQ-9, BDI; 30 symptoms) and adherence (MOS-GAS) at 1 and 6 months post-PCI. Principal component analysis (PCA) was performed on the individual symptom change scores. Multivariable linear regression examined the role of change profiles in predicting general treatment adherence, while adjusting for demographic and clinical characteristics. RESULTS Four change-factors emerged from PCA. One somatic-affective change-factor (10 symptoms), two cognitive-affective change-factors (6 general cognitive-affective and 7 severe cognitive symptoms) and one mixed factor were identified. We extracted 5 symptom change profiles. Linear regression showed the moderating role of the change profiles. In patients reporting a net increase in depressive symptoms, higher cognitive affective symptoms (β=-.46, p=.001) and higher somatic-affective symptoms (β=-.29; p=.044) were associated with worse general adherence. DISCUSSION Four distinct depressive symptom change-factors were identified that moderated the association of somatic-affective and cognitive-affective depressive symptom levels with general treatment adherence. This is of clinical importance as not only current symptoms, but also symptom change over the preceding months may be important to consider in screening and risk prediction.
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