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Plas X, Bruinsma B, van Lissa CJ, Vermetten E, van Lutterveld R, Geuze E. Long-term trajectories of depressive symptoms in deployed military personnel: A 10-year prospective study. J Affect Disord 2024; 354:702-711. [PMID: 38537760 DOI: 10.1016/j.jad.2024.03.139] [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: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Military missions, especially those involving combat exposure, are associated with an increased risk of depression. Understanding the long-term course of depressive symptoms post-deployment is important to improve decision-making regarding deployment and mental health policies in the military. This study investigates trajectories of depressive symptoms in the Dutch army, exploring the influence of factors such as demographics, early-life trauma, posttraumatic stress disorder (PTSD) symptoms, and deployment stressors. METHODS A cohort of 1032 military men and women deployed to Afghanistan (2005-2008) was studied from pre- to 10 years post-deployment. Depressive and PTSD symptoms were assessed using the Symptom CheckList-90 and the Self-Rating Inventory for PTSD. Demographics, early trauma, and deployment experiences were collected at baseline and after deployment, respectively. Latent Class Growth Analysis was used to explore heterogeneity in trajectories of depressive symptoms over time. RESULTS Four trajectories were found: resilient (65%), intermediate-stable (20%), symptomatic-chronic (9%), and late-onset-increasing (6%). The resilient group experienced fewer deployment stressors, while the symptomatic-chronic group reported more early life traumas. Trajectories with elevated depressive symptoms consistently demonstrated higher PTSD symptoms. LIMITATIONS Potential nonresponse bias and missing information due to the longitudinal design and extensive follow-up times. CONCLUSIONS This study identified multiple trajectories of depressive symptoms in military personnel up to 10 years post-deployment, associated with early trauma, deployment stressors, adverse life events and PTSD symptoms. The prevalence of the resilient trajectory suggests a substantial level of resilience among deployed military personnel. These findings provide valuable insights and a foundation for further research.
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Affiliation(s)
- Xandra Plas
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands.
| | - Bastiaan Bruinsma
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
| | - Caspar J van Lissa
- Department of Methodology and Statistics, Tilburg University, Tilburg, the Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - Remko van Lutterveld
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
| | - Elbert Geuze
- Department of Psychiatry, University Medical Centre Utrecht Brain Centre, Utrecht, the Netherlands; Brain Research and Innovation Centre, Ministry of Defence, Utrecht, the Netherlands
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Liblik K, Théberge E, Gomes Z, Burbidge E, Menon N, Gobran J, Johri AM. Improving Wellbeing After Acute Coronary Syndrome. Curr Probl Cardiol 2022:101201. [DOI: 10.1016/j.cpcardiol.2022.101201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 11/15/2022]
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3
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Ruan-Iu L, Chod D, Weissinger G, VanFossen C, Saionz R, Tien A, Diamond GS. Validation of the Behavioral Health Screen-Depression With Adolescents in Residential Care. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2022. [DOI: 10.1027/1015-5759/a000697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract. The purpose of this study was to (1) examine the psychometric properties of the Behavioral Health Screen Depression Subscale (BHS-DS), including internal consistency, factor structure, convergent and discriminant validity, and (2) identify cut-off scores on the BHS-DS to distinguish patients with depression risk and their level of severity among an acute clinical sample of adolescents in residential psychiatric care. Participants included 861 youths ages 10–24 at residential treatment centers who completed a battery of measures, including the BHS-DS and Patient Health Questionnaire (PHQ-9). Factor analysis, bivariate correlation, and Cronbach’s α suggested the BHS-DS is a unidimensional scale with evidence of internal consistency reliability and convergent and discriminant validity. Receiver operating characteristic curve analysis identified four clinical cut-off scores (no, mild, moderate, and severe depression risk). Analysis of variance, Cohen’s kappa (κ), and Wilcoxon signed-rank test results suggested the four groups differ from each other and that the BHS-DS exhibits moderate agreement with the PHQ-9. The BHS-DS demonstrates good psychometric properties among a sample of residential youth, offering clinicians a good alternative to the PHQ-9 in screening for depression.
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Affiliation(s)
- Linda Ruan-Iu
- Department of Counseling and Family Therapy, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Guy Weissinger
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Catherine VanFossen
- Department of Counseling and Family Therapy, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Rebecca Saionz
- Department of Counseling and Family Therapy, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Allen Tien
- Behavioral Health Integration, Medical Decision Logic, Inc., Baltimore, MD, USA
| | - Guy S. Diamond
- Department of Counseling and Family Therapy, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Mardani P, Zolghadriha A, Dadashi M, Javdani H, Mousavi SE. Effect of medication therapy combined with transcranial direct current stimulation on depression and response inhibition of patients with bipolar disorder type I: a clinical trial. BMC Psychiatry 2021; 21:579. [PMID: 34789181 PMCID: PMC8596350 DOI: 10.1186/s12888-021-03592-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Bipolar Disorder (BD) is one of the most common mental disorders associated with depressive symptoms and impairment in executive functions such as response inhibition. This study aimed to investigate the effectiveness of medication therapy combined with Transcranial Direct Current Stimulation (tDCS) on depression and response inhibition of patients with BD. METHOD This is a double-blinded randomized clinical trial with pretest, posttest, and follow-up design. Participants were 30 patients with BD randomly assigned to two groups of Medication+tDCS (n = 15, receiving medications plus tDCS with 2 mA intensity over dorsolateral prefrontal cortex for 10 days, two sessions per day each for 20 min) and Medication (n = 15, receiving mood stabilizers including 2-5 tables of 300 mg (mg) lithium, 200 mg sodium valproate, and 200 mg carbamazepine two times per day). Pretest, posttest and 3-month follow-up assessments were the 21-item Hamilton Depression Rating Scale (HDRS) and a Go/No-Go test. Collected data were analyzed in SPSS v.20 software. RESULTS The mean HDRS score in both groups was reduced after both interventional techniques, where the group received combined therapy showed more reduction (P < 0.01), although their effects were not maintained after 3 months. In examining response inhibition variable, only the combined therapy could reduce the commission error of patients under a go/no-go task (p < 0.05), but its effect was not maintained after 3 months. There was no significant difference in the group received medication therapy alone. CONCLUSION Medication in combination with tDCS can reduce the depressive symptoms and improve the response inhibition ability of people with BD. TRIAL REGISTRATION This study was registred by Iranian Registry of Clinical Trials (Parallel, ID: IRCT20191229045931N1 , Registration date: 24/08/2020).
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Affiliation(s)
- Parnaz Mardani
- grid.469309.10000 0004 0612 8427Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ahmad Zolghadriha
- grid.469309.10000 0004 0612 8427Department of Psychiatry, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohsen Dadashi
- grid.469309.10000 0004 0612 8427Department of Clinical Psychology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Javdani
- grid.412606.70000 0004 0405 433XDepartment of Psychiatry, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Seyedeh Elnaz Mousavi
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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5
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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: 18] [Impact Index Per Article: 6.0] [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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Esan O, Lawal K. Spirituality and Suicidality Among Patients with Schizophrenia: A Cross-sectional Study from Nigeria. JOURNAL OF RELIGION AND HEALTH 2021; 60:2547-2559. [PMID: 33779940 DOI: 10.1007/s10943-021-01244-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
Studies which have explored the effect of spirituality on suicidality among patients with schizophrenia have been characterized by inconsistent results. The aim of this study was to examine the relationship between spirituality and suicidality among stable patients with schizophrenia in Nigeria. The Daily Spiritual Experience Scale was applied to measure spirituality. There was found a significant relationship between spirituality and having had suicidal thoughts in a lifetime. Spirituality was negatively correlated with the severity of negative symptoms, total positive and negative syndrome scale score (PANSS), the severity of depression, and positively correlated with functioning.
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Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
| | - Kehinde Lawal
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
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Obeid S, Haddad C, Sacre H, Akel M, Chalhoub C, Rahme C, Abi Doumit C, Akiki M, Hallit S, Salameh P. The Lebanese Depression Scale: A scale to screen for depression in the Lebanese population. Perspect Psychiatr Care 2021; 57:620-626. [PMID: 32686132 DOI: 10.1111/ppc.12585] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/26/2020] [Accepted: 07/11/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To create a Lebanese Depression Scale (LDS) and evaluate its performance on a group of Lebanese individuals. METHODS This cross-sectional analysis enrolled 997 residents (January-December 2018). RESULTS The elements in the Lebanese Depression Scale-19 items (LDS-19) scale converged over a combination of four factors (αCronbach = .864). The correlation was positive between the LDS-19 and both the Hamilton Anxiety Scale score (r = .637; P < .001) and Lebanese Anxiety Scale score (r = .694; P < .001). According to the receiver-operating characteristics curve, the optimal score for the LDS-19 scale, which was a cutoff between healthy controls and depressive patients, was 18.50 (80.3% and 75.8%, respectively); the scale's positive predictive value was 31.0%, while the negative predictive value was 96.5%. PRACTICE IMPLICATIONS The LDS-19 is a useful tool to screen for depression in the Lebanese population, in both clinical and research settings.
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Affiliation(s)
- Sahar Obeid
- Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
| | - Chadia Haddad
- Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,UMR 1094, Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, University De Limoges, Limoges, France
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
| | - Marwan Akel
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Clarissa Chalhoub
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Clara Rahme
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Carla Abi Doumit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Maria Akiki
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
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8
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Thayabaranathan T, Andrew NE, Stolwyk R, Lannin NA, Cadilhac DA. Comparing the EQ-5D-3L anxiety or depression domain to the Hospital Anxiety and Depression Scale to identify anxiety or depression after stroke. Top Stroke Rehabil 2021; 29:146-155. [PMID: 33726636 DOI: 10.1080/10749357.2021.1895494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke.Methods: Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke.Results: Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years; 42% female. Nearly 50% reported problems (43% moderate; 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke.Conclusions: The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against "gold standard" clinical assessment is required for clinical applications.
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Affiliation(s)
- Tharshanah Thayabaranathan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Nadine E Andrew
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Rene Stolwyk
- Turner Institutefor Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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Psychosocial Risk Factors in Cardiac Rehabilitation: Time to Screen Beyond Anxiety and Depression. Glob Heart 2021; 16:16. [PMID: 33833940 PMCID: PMC7894368 DOI: 10.5334/gh.896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Although it is well acknowledged that psychosocial risk factors (PSRF) such as low socio-economic status, stress, social isolation, negative emotions and negative personality patterns may contribute to the development and adverse outcome of cardiovascular disease (CVD), screening for PSRF in CVD patients is usually limited to anxiety and depression, mainly for feasibility reasons. We therefore aimed to develop a user-friendly screening battery for routine assessment of PSRFs and to evaluate this instrument regarding feasibility of application, PSRF results and attendance of psychological counselling if recommended to cardiac rehabilitation (CR) patients. Methods This is a prospective single center cohort study including 609 consecutive CR patients. We first developed a screening instrument based on seven validated scales for the most relevant PSRFs with totally 90 questions presented in a uniform graphical design to facilitate completion called Psychocardiogram® (PCG) and applied the instrument in consecutive patients attending CR. Patients with positive screening results were invited to a psychological counseling session. Results Six hundred and nine consecutive patients, aged 34 to 86 years (mean 60.7 years), 85% men, entering the CR program at the Bern University Hospital with ischemic heart failure (CHF), coronary artery disease (CAD) or peripheral artery disease, were included in this study. Eighty-three point three percent of the patients completed the PCG within 40 minutes. Vital exhaustion and Type-D personality were the most prevalent PSRFs (56.9% and 51.1%, respectively), whereas low social support (14.4%) and elevated depressive symptoms (15.9%), were the least prevalent ones. After screening, 120 patients (52.86%) with at least one PSRF made use of psychological counseling. Conclusions We found the PCG to be a useful screening tool for PSRF in CR patients with the potential to get new insights into the prevalence of particular PSRF in specific populations and to better study their impact on occurrence and outcome of CVD.
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The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up. Psychosom Med 2020; 81:513-520. [PMID: 31033937 DOI: 10.1097/psy.0000000000000702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality. METHODS Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory - version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables. RESULTS Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366-3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220-3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis. CONCLUSIONS Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.
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Mental status and physical activity in patients with homozygous familial hypercholesterolemia: A subgroup analysis of a nationwide survey (A-HIT1 registry). J Clin Lipidol 2020; 14:361-370.e2. [PMID: 32423761 DOI: 10.1016/j.jacl.2020.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Homozygous familial hypercholesterolemia (HoFH) is a rare, life-threatening disease due to high serum low-density lipoprotein (LDL) cholesterol levels. LDL cholesterol-lowering interventions are fundamental for patients with HoFH. OBJECTIVE It was aimed to investigate the association between the mental status of patients with HoFH and healthy lifestyle behaviors. METHODS This subgroup analysis of the A-HIT1 population included the data of patients aged ≥18 years with a clinical diagnosis of HoFH undergoing therapeutic LDL apheresis. Besides the demographic and clinical characteristics of patients, healthy lifestyle behaviors were assessed, and psychiatric symptoms were screened by Symptom Check List (SCL-90-R). RESULTS The highest percentage for pathology was observed in dimensions of obsessive-compulsive, somatization, interpersonal sensitivity, and depression in SCL-90-R. Patients with any cardiovascular condition have more psychiatric symptoms in different fields of SCL-90-R. The outcomes of the correlative analysis indicated that lower the age of the first coronary event better the psychiatric status, probably denoting a better adaptation to disease and its treatment. Among 68 patients, 36 patients were not exercising regularly. Patients with regular physical activity had significantly lower scores in most dimensions of SCL-90-R and there was no association between regular physical activity and other investigated variables. The strongest predictor of regular exercising was global severity index of SCL-90-R. CONCLUSION In the HoFH population, there was a high prevalence of mental disturbances. Better psychiatric status was associated with regular exercising. Therefore, assessing the mental status of patients with HoFH and referring patients in need, to a psychiatrist, may improve the outcome of patients.
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Martínez-Quintana E, Girolimetti A, Jiménez-Rodríguez S, Fraguela-Medina C, Rodríguez-González F, Tugores A. Prevalence and predictors of psychological distress in congenital heart disease patients. J Clin Psychol 2020; 76:1705-1718. [PMID: 32149405 DOI: 10.1002/jclp.22948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine psychological distress in congenital heart disease (CHD) patients. METHODS Cross-sectional study among consecutive CHD patients recruited from a single hospital outpatient clinic to determine anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) questionnaire. RESULTS One hundred and sixty-nine CHD patients [29 (19-39) years old, 100 (59%) males] were studied. A total of 25% and 9% of CHD patients showed anxiety and depression symptoms, respectively. Patients with an HADS score ≥ 8 had a significantly worse New York Heart Association (NYHA) functional class, needed more psychological support, had more mental health history, and took more anxiolytic/antidepressant medication than the CHD patients with an HADS score below 8. A worse NYHA functional class [OR, 1.88 (1.01-3.52)] proved to be a predictor of a borderline/abnormal HADS score. CONCLUSION Psychological distress has a high prevalence among CHD patients and having an NYHA Class II and III is a significant predictor of an HADS score ≥ 8.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.,Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Angela Girolimetti
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara Jiménez-Rodríguez
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carla Fraguela-Medina
- Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Fayna Rodríguez-González
- Ophthalmology Service, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Antonio Tugores
- Research Unit, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Worcester MU, Goble AJ, Elliott PC, Froelicher ES, Murphy BM, Beauchamp AJ, Jelinek MV, Hare DL. Mild Depression Predicts Long-Term Mortality After Acute Myocardial Infarction: A 25-Year Follow-Up. Heart Lung Circ 2019; 28:1812-1818. [DOI: 10.1016/j.hlc.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
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14
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Bakeer MS, Youssef MI, Elshazly HM, Abdel-Samiee M, El-Gendy AA, Abouzed M, Othman W, Abdelkareem M, Abozeid M, Awad SM, Khalil FO, Bedair HM, Diab KA, Seif AS, Youssef MF, Sakr AA, Abdelsameea E. On-treatment improvement of an emerging psychosomatic depressive disorder among salmonella carriers: a multicenter experience from Egypt. Infect Drug Resist 2019; 12:2573-2582. [PMID: 31686865 PMCID: PMC6709802 DOI: 10.2147/idr.s206642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
Background As physicians in a referral hospital, we observed the association between history of enteric fever and somatic disorders associated with low mood. At the Al-Hussein University Hospital, Cairo and the National Liver Institute Hospital, Menoufia, we receive patients from all over Egypt, including rural areas where enteric fever is endemic. Aim Here in, 60 Egyptian patients referred to us for evaluation of different somatic disorders are reported. Methods After extensive evaluations, the patients' symptoms were function-related. Also, their typhoid carrier states were documented, and the severity of depression using Hamilton-D (HAM-D) questionnaire was evaluated and recorded. All patients were treated with ceftriaxone, 2 gm, IV, daily for 15 days. The clinical evaluation and Hamilton score were reassessed at the end of the treatment and 6 weeks thereafter. The patients did not receive any anti-depressant nor anti-anxiety treatment during their course. Typhoid carrier was defined by documenting the history of typhoid fever that was diagnosed by culturing the Salmonella species, and not by serology, isolated from stool culture along with febrile condition, plus the absence of fever in the past 3 weeks. The Widal test was not accepted as a criterion for enrollment. Results Patients showed clinically significant improvement in the somatic complaints, and their HAM-D score immediately post-treatment that was consolidated for 6 weeks post-treatment completion. Conclusion In this study, the typhoid carrier was associated with the psychosomatic depression that improved by antibiotic therapy.
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Affiliation(s)
| | | | - Helmy M Elshazly
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdel-Samiee
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - M Abouzed
- Psychiatry Department, Al-Azhar University, Cairo, Egypt
| | - Warda Othman
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mervat Abdelkareem
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mai Abozeid
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Samah Mohammed Awad
- Clinical Microbiology and Immunology and Molecular Microbiology in Liver and GIT Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Fatma O Khalil
- Clinical Microbiology and Immunology and Molecular Microbiology in Liver and GIT Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Hanan M Bedair
- Clinical Pathology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Karema A Diab
- Clinical Pathology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - A S Seif
- Tropical Medicine Hepatology and Gastroenterology Department, Shebin Elkom Teaching Hospital, Menoufia, Egypt
| | - Marwa F Youssef
- Epidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Ayman Ahmed Sakr
- Tropical Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Eman Abdelsameea
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
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Ezema CI, Akusoba PC, Nweke MC, Uchewoke CU, Agono J, Usoro G. Influence of Post-Stroke Depression on Functional Independence in Activities of Daily Living. Ethiop J Health Sci 2019; 29:841-846. [PMID: 30700951 PMCID: PMC6341441 DOI: 10.4314/ejhs.v29i1.5] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Little attention has been paid to screening of depression among stroke survivors in outpatient physiotherapy clinics. Post-stroke depression is reported to have a negative impact on functional recovery. However, the exact influence on the outcome of rehabilitation such as level of functional independence remains controversial. This study aims at ascertaining the influence of post-stroke depression on functional independence in activities of daily living. Methods The study is a cross sectional survey of stroke survivors attending outpatient physiotherapy clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, and the Enugu State University Teaching Hospital (ESUTH). Participants were evaluated for socio-demographic characteristics. Post-stroke depression and level of functional recovery in Activities of Daily Living were assessed using the Hamilton Depression Rating Scale and the Barthel Index respectively. Data was analyzed using SPSS version 23, with α set at 0.01. Results A total of 66 participants, 42 females and 24 males, were purposively recruited into the study. Over 80% (56) of the participant had depression, with over 50% (32) being severely depressed. Post-stroke depression was associated with less functional independence in activities of daily living (p=0.000). A significant difference was found in the level of functional independence between participants with and without depression (p=0.00). Conclusion Participants with post-stroke depression have less independence in activities of daily living. A longitudinal study with a larger sample size is, however, recommended so as to improve the external validity. In the mean time, outpatient rehabilitation of depressed stroke survivors should include pharmacological and psychological components.
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Affiliation(s)
- Charles I Ezema
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Petronella C Akusoba
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Martins C Nweke
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Chigozie U Uchewoke
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Joshua Agono
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
| | - Godspower Usoro
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology University of Nigeria Nsukka, Enugu Campus, Enugu Nigeria
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Cocchio S, Baldovin T, Furlan P, Buja A, Casale P, Fonzo M, Baldo V, Bertoncello C. Is depression a real risk factor for acute myocardial infarction mortality? A retrospective cohort study. BMC Psychiatry 2019; 19:122. [PMID: 31014311 PMCID: PMC6480593 DOI: 10.1186/s12888-019-2113-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression has been associated with a higher risk of cardiovascular events and a higher mortality in patients with one or more comorbidities. This study investigated whether continuative use of antidepressants (ADs), considered as a proxy of a state of depression, prior to acute myocardial infarction (AMI) is associated with a higher mortality afterwards. The outcome to assess was mortality by AD use. METHODS A retrospective cohort study was conducted in the Veneto Region on hospital discharge records with a primary diagnosis of AMI in 2002-2015. Subsequent deaths were ascertained from mortality records. Drug purchases were used to identify AD users. A descriptive analysis was conducted on patients' demographics and clinical data. Survival after discharge was assessed with a Kaplan-Meier survival analysis and Cox's multiple regression model. RESULTS Among 3985 hospital discharge records considered, 349 (8.8%) patients were classified as 'AD users'. The mean AMI-related hospitalization rate was 164.8/100,000 population/year, and declined significantly from 204.9 in 2002 to 130.0 in 2015, but only for AD users (- 40.4%). The mean overall follow-up was 4.6 ± 4.1 years. Overall, 523 patients (13.1%) died within 30 days of their AMI. The remainder survived a mean 5.3 ± 4.0 years. After adjusting for potential confounders, use of antidepressants was independently associated with mortality (adj OR = 1.75, 95% CI: 1.40-2.19). CONCLUSIONS Our findings show that AD users hospitalized for AMI have a worse prognosis in terms of mortality. The use of routinely-available records can prove an efficient way to monitor trends in the state of health of specific subpopulations, enabling the early identification of AMI survivors with a history of antidepressant use.
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Affiliation(s)
- Silvia Cocchio
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Tatjana Baldovin
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Patrizia Furlan
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Alessandra Buja
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | | | - Marco Fonzo
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121, Padova, Italy.
| | - Chiara Bertoncello
- 0000 0004 1757 3470grid.5608.bDepartment of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Loredan, 18, 35121 Padova, Italy
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Jha MK, Qamar A, Vaduganathan M, Charney DS, Murrough JW. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1827-1845. [PMID: 30975301 PMCID: PMC7871437 DOI: 10.1016/j.jacc.2019.01.041] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/11/2022]
Abstract
Depression is a common problem in patients with cardiovascular disease (CVD) and is associated with increased mortality, excess disability, greater health care expenditures, and reduced quality of life. Depression is present in 1 of 5 patients with coronary artery disease, peripheral artery disease, and heart failure. Depression complicates the optimal management of CVD by worsening cardiovascular risk factors and decreasing adherence to healthy lifestyles and evidence-based medical therapies. As such, standardized screening pathways for depression in patients with CVD offer the potential for early identification and optimal management of depression to improve health outcomes. Unfortunately, the burden of depression in patients with CVD is under-recognized; as a result, screening and management strategies targeting depression have been poorly implemented in patients with CVD. In this review, the authors discuss a practical approach for the screening and management of depression in patients with CVD.
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Affiliation(s)
- Manish K Jha
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arman Qamar
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts. https://twitter.com/AqamarMD
| | - Muthiah Vaduganathan
- Heart & Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. https://twitter.com/mvaduganathan
| | - Dennis S Charney
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Office of the Dean, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James W Murrough
- Depression and Anxiety Center for Discovery and Treatment, Department of Psychiatry, and Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York.
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A Systematic Review of the Diagnostic Accuracy of Depression Questionnaires for Cardiac Populations: IMPLICATIONS FOR CARDIAC REHABILITATION. J Cardiopulm Rehabil Prev 2019; 39:354-364. [PMID: 30870244 DOI: 10.1097/hcr.0000000000000408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Depression is overrepresented in patients with cardiovascular disease and increases risk for future cardiac events. Despite this, depression is not routinely assessed within cardiac rehabilitation. This systematic review sought to examine available depression questionnaires to use within the cardiac population. We assessed each instrument in terms of its capability to accurately identify depressed patients and its sensitivity to detect changes in depression after receiving cardiac rehabilitation. METHODS Citation searching of previous reviews, MEDLINE, PsycInfo, and PubMed was conducted. RESULTS The Beck Depression Inventory-II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS-D) are among the most widely used questionnaires. Screening questionnaires appear to perform better at accurately identifying depression when using cut scores with high sensitivity and specificity for the cardiac population. The BDI-II and the HADS-D showed the best sensitivity and negative predictive values for detecting depression. The BDI-II, the HADS-D, the Center for Epidemiological Studies-Depression Scale, and the 15-item Geriatric Depression Scale best captured depression changes after cardiac rehabilitation delivery. CONCLUSIONS The BDI-II is one of the most validated depression questionnaires within cardiac populations. Health practitioners should consider the BDI-II for depression screening and tracking purposes. In the event of time/cost constraints, a briefer 2-step procedure (the 2-item Patient Health Questionnaire, followed by the BDI-II, if positive) should be adopted. Given the emphasis on cut scores for depression diagnosis and limited available research across cardiac diagnoses, careful interpretation of these results should be done. Thoughtful use of questionnaires can help identify patients in need of referral or further treatment.
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Clarifying the Concept of Depression in Women With Coronary Heart Disease. ANS Adv Nurs Sci 2019; 42:E24-E37. [PMID: 30864985 DOI: 10.1097/ans.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of depression in women with coronary heart disease has been poorly defined for several reasons: numerous widely variable instruments that operationalize the concept, divergent proposed instrument cutoff scores, and continued lack of female participants and data analysis by gender in coronary heart disease research. In the forty articles from 1990 to 2018 evaluating depression in women with coronary heart disease, the concept is defined by specific somatic and cognitive symptoms, preceded by particular physiological and psychosocial vulnerabilities, and leads to poorer outcomes. Concept clarification is necessary for accurate diagnosis of depression, leading to more timely and appropriate interventions for women.
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Linden W, Young S, Ignaszewski A, Con A, Terhaag S, Campbell T. Psychosocial and medical predictors of 1-year functional outcome in male and female coronary bypass recipients. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_64_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Koh Y, Rashid H, Khaw S, Nasis A. Artificial FLOwering plants in Reducing Anxiety and depressive symptoms following Acute Coronary Syndromes (A-FLORA-ACS): a randomised controlled trial. Heart Vessels 2018; 34:888-897. [PMID: 30539231 DOI: 10.1007/s00380-018-1314-2] [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: 08/01/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
Patients often experience emotional distress after acute coronary syndrome (ACS). These may lead to symptoms of depression or anxiety and greater morbidity/mortality. We sought to determine whether flowering plants in the coronary care ward reduced depressive and anxiety symptoms in these patients. Patients with ACS were randomly allocated to flowering plants (intervention) or no plants (control) in their room during index hospitalisation. Baseline data were collected. The primary outcome was the Hospital Anxiety and Depression Scale (HADS) depressive and anxiety symptom scores at discharge. Secondary outcomes were HADS depression and anxiety scores at 3 months. Both modified intention-to-treat (mITT) and per-protocol (PP) analysis were performed. 122 patients were included in the analysis after case exclusion, with all completing the HADS questionnaire at discharge and 89/122 (73%) patients completing the 3-month post-discharge HADS. At discharge, mean depressive symptom scores were lower in the intervention group, but only significantly so in the PP analysis (mITT 3.6/21 vs 4.6/21, p = 0.11; PP 3.5/21 vs 4.9/21, p = 0.04). There were no significant changes in between-group anxiety symptom scores (mITT 6.4/21 vs 6.1/21, p = 0.51; PP 3.3/21 vs 3.6/21, p = 0.67). The mean increase in depressive symptom scores at 3 months was smaller in the intervention group in both analyses (mITT 0.6 ± 3.6 vs 2.2 ± 2.6, p = 0.02; PP 0.8 ± 3.6 vs 2.4 ± 2.7, p = 0.03). Mean increase in anxiety symptom scores was not significantly different between groups (mITT 2.8/21 vs 2.5/21, p = 0.86; PP 3.3/21 vs 3.6/21, p = 0.67). Flowering plants during index hospitalisation for ACS reduced depressive symptoms in a per-protocol analysis but did not have a significant impact on anxiety symptoms. Increases in depression symptom scores were significantly smaller at 3 months post exposure to flowers compared to anxiety symptom scores.
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Affiliation(s)
- Youlin Koh
- MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - Hashrul Rashid
- MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Stephanie Khaw
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Arthur Nasis
- MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
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Relationship between the number of behavioral symptoms in dementia and caregiver distress: what is the tipping point? Int Psychogeriatr 2018; 30:1099-1107. [PMID: 29143722 PMCID: PMC7103581 DOI: 10.1017/s104161021700237x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:Behavioral and psychological symptoms of dementia (BPSD) are a primary manifestation of brain dysfunction in dementia and a great challenge in caregiving. While BPSD are historically associated with caregiver distress, it is unclear whether there is an identifiable point where BPSD number is associated with heightened caregiver distress. The purpose of this study was to determine if such a tipping point exists to assist clinicians in identifying caregiver compromise. METHODS Analyses were performed with three datasets totaling 569 community-dwelling persons with dementia and their caregivers. Each included identical demographic, BPSD, cognitive, and caregiver well-being measures. Linear regression was performed with 16 BPSD symptoms on caregiver well-being measures and predictive values determined with receiver operating characteristic (ROC) curves and pre-defined scores for clinically significant distress. RESULTS Of the 569 persons with dementia, 549 (96%) displayed at least one BPSD, mean of 5.7 (SD = 3.06) symptoms in the past month. After controlling for covariates, BPSD symptom number was significantly associated with caregiver depression and burden (p < 0.01 for both models). Findings indicate ≥ 4 BPSD has strong predictive values for depression (sensitivity 85%, specificity 44%, area under ROC curve 0.62, p < 0.01), and burden (sensitivity 84%, specificity 43%, area under ROC curve 0.67, p < 0.01). CONCLUSIONS Caring for persons with four or more BPSD appears to reflect a tipping point for clinically meaningful distress. Findings have implications for clinicians working with persons with dementia and their caregivers and suggest need for continuous monitoring of BPSD and identification of at risk caregivers.
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Red yeast rice as an adjunct to sertraline for treatment of depression in patients with percutaneous coronary intervention: Placebo-controlled trial. ADVANCES IN INTEGRATIVE MEDICINE 2018. [DOI: 10.1016/j.aimed.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Riordan P, Briscoe J, Kamal AH, Jones CA, Webb JA. Top Ten Tips Palliative Care Clinicians Should Know About Mental Health and Serious Illness. J Palliat Med 2018; 21:1171-1176. [DOI: 10.1089/jpm.2018.0207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paul Riordan
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Psychiatry, and Duke University School of Medicine, Durham, North Carolina
| | - Joshua Briscoe
- Department of Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Arif H. Kamal
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University, Durham, North Carolina
- Duke Fuqua School of Business, Duke University, Durham, North Carolina
| | - Christopher A. Jones
- Perelman School of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason A. Webb
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Department of Psychiatry, and Duke University School of Medicine, Durham, North Carolina
- Department of Section of Palliative Medicine, Duke University School of Medicine, Durham, North Carolina
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Tommasi M, Ferrara G, Saggino A. Application of Bayes' Theorem in Valuating Depression Tests Performance. Front Psychol 2018; 9:1240. [PMID: 30083119 PMCID: PMC6064972 DOI: 10.3389/fpsyg.2018.01240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
The validity of clinical diagnoses is a fundamental topic in clinical psychology, because now there are some political administrations, as the IOM or the U.K. government, which are focusing on best evidence-based practice in clinical psychology. The most problematic issue in clinical psychology is to avoid wrong diagnoses which can have negative consequences on individual life and on the utility of clinical treatments. In the case of diagnoses based on self-report tests, the diagnostic decision about individual health is based on the comparison between its score and the cutoff, according to the frequentist approach to probability. However, the frequentist approach underestimates the possible risks of incorrect diagnoses based on cutoffs only. The Bayesian approach is a valid alternative to make diagnoses on the basis of the scores from psychological tests. The Bayes' theorem estimates the posterior probability of the presence of a pathology on the basis of the knowledge about the diffusion of this pathology (prior probability) and of the knowledge of sensitivity and specificity values of the test. With all this information, it is possible to estimate the diagnostic accuracy of some self-report tests used for assessing depression. We analyzed the diagnostic accuracy of the most used psychological tests of depression (Zung's Self-Rating Depression Scale, Hamilton Rating Scale for Depression, Center for Epidemiological Studies for Depression and the Beck Depression Inventory), together with a new scale (Teate Depression Inventory) developed with the IRT procedure, by analyzing the published works in which data about sensitivity and specificity of these scales are reported. Except the TDI, none of these scales can reach a satisfactory level of diagnostic accuracy, probably for the absence of an optimal procedure to select test items and subjects with clearly defined pathological symptoms which could allow the reduction of false positives in test scoring.
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Affiliation(s)
- Marco Tommasi
- Department of Psychological, Health and Territorial Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
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Pedersen M, Overgaard D, Andersen I, Baastrup M, Egerod I. Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: A convergent mixed methods study. J Adv Nurs 2018; 74:2181-2195. [PMID: 29772607 DOI: 10.1111/jan.13715] [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] [Received: 12/18/2017] [Accepted: 05/02/2018] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to explore the extent to which the qualitative and quantitative data converge and explain mechanisms and drivers of social inequality in cardiac rehabilitation attendance. BACKGROUND Social inequality in cardiac rehabilitation attendance has been a recognized problem for many years. However, to date the mechanisms driving these inequalities are still not fully understood. DESIGN The study was designed as a convergent mixed methods study. METHODS From March 2015-March 2016, patients hospitalized with acute coronary syndrome to two Danish regional hospitals were included in a quantitative prospective observational study (N = 302). Qualitative interview informants (N = 24) were sampled from the quantitative study population and half brought a close relative (N = 12) for dyadic interviews. Interviews were conducted from August 2015 to February 2016. Integrated analyses were conducted in joint displays by merging the quantitative and qualitative findings. RESULTS Qualitative and quantitative findings primarily confirmed and expanded each other; however, discordant results were also evident. Integrated analyses identified socially differentiated lifestyles, health beliefs, travel barriers and self-efficacy as potential drivers of social inequality in cardiac rehabilitation. CONCLUSION Our study adds empirical evidence regarding how a mixed methods study can be used to obtain an understanding of complex healthcare problems. The study provides new knowledge concerning the mechanisms driving social inequality in cardiac rehabilitation attendance. To prevent social inequality, cardiac rehabilitation should be accommodated to patients with a history of unhealthy behaviour and low self-efficacy. In addition, the rehabilitation programme should be offered in locations not requiring a long commute.
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Affiliation(s)
- Maria Pedersen
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Dorthe Overgaard
- Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Baastrup
- Medical Helpline 1813, Emergency Medical Services, Capital Region of Denmark, Denmark
| | - Ingrid Egerod
- Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Pedersen M, Egerod I, Overgaard D, Baastrup M, Andersen I. Social inequality in phase II cardiac rehabilitation attendance: The impact of potential mediators. Eur J Cardiovasc Nurs 2017; 17:345-355. [PMID: 29185799 DOI: 10.1177/1474515117746011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiac rehabilitation participation is an essential component of the contemporary management of coronary heart disease. However, patients with low socioeconomic position are less likely to attend the rehabilitation programme. AIM We aimed to explore the effect of potential mediators between socioeconomic position defined by educational attainment and cardiac rehabilitation attendance. METHODS Prospective observational study of patients with acute coronary syndrome ( N=302). Logistic regression and mediation analysis was conducted to explore mechanisms of non-attendance. RESULTS Thirty per cent attended full cardiac rehabilitation. Patients with low educational attainment, comorbidities, long commute to cardiac rehabilitation centre, and lone dwelling were less likely to attend full cardiac rehabilitation, whereas patients with high anxiety and depression score were more likely to attend full cardiac rehabilitation. Patients with low educational attainment had lower self-efficacy and longer commute compared with patients with high educational attainment. The potential mediators included in the study, however, did not have a significant mediation effect. CONCLUSION Our study demonstrated a variety of mechanisms contributing to cardiac rehabilitation non-attendance. Further, the study demonstrated that non-attendance was especially related to the cardiac rehabilitation elements involving lifestyle modifications. However, the mechanisms explaining social inequality in full cardiac rehabilitation are still not fully understood.
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Affiliation(s)
- Maria Pedersen
- 1 Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, University of Copenhagen, Denmark
| | - Ingrid Egerod
- 2 University of Copenhagen, Rigshospitalet, Intensive Care Unit 4131, Denmark
| | - Dorthe Overgaard
- 3 Department of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Marie Baastrup
- 4 Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Denmark
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Lorenzo-Luaces L, Driessen E, DeRubeis RJ, Van HL, Keefe JR, Hendriksen M, Dekker J. Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy. Behav Ther 2017; 48:581-595. [PMID: 28711109 DOI: 10.1016/j.beth.2016.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 11/05/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N=282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d=0.33). In SPSP, the alliance was a modest but robust predictor of change, irrespective of prior episodes (d=0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d=0.86), moderate for those with 1 prior episode (d=0.49), and small for those with 2+ prior episodes (d=0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.
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Affiliation(s)
| | | | | | | | | | | | - Jack Dekker
- VU University Amsterdam, Arkin Mental Health Care, Amsterdam
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Janmohamed N, Steinhart AH. Measuring Severity of Anxiety and Depression in Patients with Inflammatory Bowel Disease: Low Concordance Between Patients and Male Gastroenterologists. Inflamm Bowel Dis 2017; 23:1168-1173. [PMID: 28613229 DOI: 10.1097/mib.0000000000001107] [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: 12/09/2022]
Abstract
BACKGROUND Studies have indicated that anxiety and depression are significant contributors to reporting of increased disease activity in patients with inflammatory bowel disease (IBD). Thus, for the appropriate clinical management of these patients, it is important that gastroenterologists are able to recognize these conditions. This study aimed to examine the level of agreement between gastroenterologists and patients with IBD for the presence of clinically significant anxiety and depression. METHODS Before consultation, patients completed the Hospital Anxiety and Depression Survey. After the consultation, the gastroenterologist recorded whether they believed the patient was anxious and depressed and if so, whether any further action had been taken. RESULTS Seventy-five patients participated in this study, with a response rate of 88%. Self-reported questionnaires indicated that 31% and 11% of patients were identified as probable for having anxiety and depression, respectively. The level of agreement between the patient and gastroenterologist as to the presence of anxiety or depression was fair to moderate (kappa statistic 0.32 and 0.41, respectively). In only 50% of cases was further action taken by gastroenterologists during consultation for distressed patients, mostly in the form of a patient discussion. CONCLUSIONS Agreement between gastroenterologists and IBD patients regarding the presence of clinically significant anxiety or depression was low, with no further action taken after consultation for 50% of patients who were identified by gastroenterologists as being anxious or depressed. This study highlights the need for educating gastroenterologists to improve their ability to identify IBD patient distress.
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Affiliation(s)
- Neha Janmohamed
- Department of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
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Macêdo EA, Appenzeller S, Costallat LTL. Depression in systemic lupus erythematosus: gender differences in the performance of the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). Lupus 2017; 27:179-189. [PMID: 28587586 DOI: 10.1177/0961203317713142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prevalence of depressive symptoms in patients with systemic lupus erythematosus (SLE) varies widely between different cohorts (17-75%), primarily due to factors such as the heterogeneity of the samples and the instruments used to detect depressive symptoms. Most of these instruments are self-administered questionnaires that have different characteristics and approaches to depressive symptoms. This study aimed to evaluate gender differences in the performance of three questionnaires used to assess depressive symptoms in patients with SLE: the Beck Depression Inventory (BDI), Center for Epidemiologic Studies Depression Scale (CES-D), and Hospital Anxiety and Depression Scale (HADS). This study included 54 male and 54 female SLE patients. Depressive symptoms were assessed using BDI (cutoffs 13 and 15), CES-D and HADS. The gold standard method used was the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Regarding the performance of the BDI questionnaire, no significant differences in sensitivity or specificity were found between the genders. The specificity of the CES-D questionnaire was significantly greater for the male group (83% vs. 62.5%, p = 0.0309), and its sensitivity was non-significantly higher for the female group (92.9% for women and 71.4% for men; p = 0.2474). Regarding the performance of the HADS, we found similar sensitivities between the genders (71.4%) but a higher specificity among the men (95.7% in men and 82.5% in women, p = 0.0741). In conclusion, our results suggest the presence of gender differences in the performance of the questionnaires in SLE patients. The BDI had the most similar performances between the male and female groups. In contrast, the CES-D and HADS-D showed considerable variation in performances between men and women with SLE.
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Affiliation(s)
- E A Macêdo
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
| | - L T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Science, State University of Campinas, Brazil
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Van Beek MH, Roest AM, Wardenaar KJ, Van Balkom AJ, Speckens AE, Oude Voshaar RC, Zuidersma M. The Prognostic Effect of Physical Health Complaints With New Cardiac Events and Mortality in Patients With a Myocardial Infarction. PSYCHOSOMATICS 2017; 58:121-131. [DOI: 10.1016/j.psym.2016.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
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Madsen MT, Isbrand A, Andersen UO, Andersen LJ, Taskiran M, Simonsen E, Gögenur I. The effect of MElatonin on Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome (MEDACIS): study protocol for a randomized controlled trial. Trials 2017; 18:81. [PMID: 28228148 PMCID: PMC5322602 DOI: 10.1186/s13063-017-1806-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/20/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression following acute coronary syndrome (ACS) constitutes a serious and debilitating problem. Approximately one in five patients will develop significant depression following ACS and less severe depressive symptoms are even more frequent. Furthermore, anxiety symptoms and sleep-wake disturbances are frequent. The objective of the MEDACIS trial is to investigate whether prophylactic treatment with melatonin has a preventive effect on depression, depressive and anxiety symptoms, sleep, and circadian disturbances following ACS. METHODS/DESIGN "The effect of MElatonin and Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome" trial (MEDACIS) is a multicenter, double-blinded, placebo-controlled, randomized clinical trial. A total of 240 patients with ACS and no depressive symptoms will be included in the trial for treatment with either 25 mg melatonin or placebo for a 12-week period. Development and severity of depressive symptoms will be evaluated using Major Depression Inventory every 2 weeks with the purpose of investigating the potential preventive effect of melatonin on depressive symptoms. DISCUSSION Previously, only selective serotonin reuptake inhibitors (SSRIs) have been investigated in a primary preventive setup in patients following ACS. However, SSRIs are associated with several side effects. An ideal intervention would constitute the highest degree of prevention of depressive symptoms with the lowest risk of side effects. In this regard, melatonin may have advantages due to its low toxicity as well as its proven anxiolytic and hypnotic effects. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02451293 . Registered on 12 May 2015. EudraCT nr. 2015-002116-32.
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Affiliation(s)
- Michael Tvilling Madsen
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Cardiology, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Koegevej 7-13, 4000 Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, Bygning 3, 4. Sal., 4200 Slagelse, Denmark
| | - Anders Isbrand
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | | | - Lars Juel Andersen
- Department of Cardiology, Zealand University Hospital, Roskilde, Koegevej 7-13, 4000 Roskilde, Denmark
| | - Mustafa Taskiran
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, Bygning 3, 4. Sal., 4200 Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebaekvej 1, 4600 Koege, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pagé MG, Watt-Watson J, Choinière M. Do depression and anxiety profiles over time predict persistent post-surgical pain? A study in cardiac surgery patients. Eur J Pain 2017; 21:965-976. [DOI: 10.1002/ejp.998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
Affiliation(s)
- M. Gabrielle Pagé
- Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM); QC Canada
- Department of Biomedical Sciences; Faculty of Medicine; Université de Montréal; QC Canada
| | - J. Watt-Watson
- Bloomberg Faculty of Nursing; University of Toronto; ON Canada
| | - M. Choinière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM); QC Canada
- Department of Anesthesiology; Faculty of Medicine; Université de Montréal; QC Canada
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Van Beek MHCT, Zuidersma M, Lappenschaar M, Pop G, Roest AM, Van Balkom AJLM, Speckens AEM, Voshaar RCO. Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction. Br J Psychiatry 2016; 209:400-406. [PMID: 27539297 DOI: 10.1192/bjp.bp.115.174870] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 04/23/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context remains unclear. AIMS To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction. METHOD We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months (n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms. RESULTS The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HRbaseline = 1.59, 95% CI 1.04-2.43; HR4-months = 1.77, 95% CI 1.04-3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HRbaseline = 1.23, 95% CI 0.99-1.53; HR4-months = 1.77, 95% CI 1.04-1.83). CONCLUSIONS Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms.
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Affiliation(s)
- Maria H C T Van Beek
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Marij Zuidersma
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Martijn Lappenschaar
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Gheorghe Pop
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Anton J L M Van Balkom
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Anne E M Speckens
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Richard C Oude Voshaar
- Maria H. C. T. Van Beek, MD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Marij Zuidersma, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Martijn Lappenschaar, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Gheorghe Pop, MD, PhD, Department of Cardiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands; Annelieke M. Roest, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands; Anton J. L. M. Van Balkom, MD, PhD, Department of Psychiatry and EMGO+ Institute, VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands; Anne E. M. Speckens, MD, PhD, Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands; Richard C. Oude Voshaar, MD, PhD, University Medical Center Groningen, University Center for Psychiatry, and Interdisciplinary Center for Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
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Schür RR, Boks MP, Geuze E, Prinsen HC, Verhoeven-Duif NM, Joëls M, Kahn RS, Vermetten E, Vinkers CH. Development of psychopathology in deployed armed forces in relation to plasma GABA levels. Psychoneuroendocrinology 2016; 73:263-270. [PMID: 27566489 DOI: 10.1016/j.psyneuen.2016.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/13/2016] [Accepted: 08/15/2016] [Indexed: 12/11/2022]
Abstract
The GABA system is pivotal for an adequate response to a stressful environment but has remained largely unexplored in this context. The present study investigated the relationship of prospectively measured plasma GABA levels with psychopathology symptoms in military deployed to Afghanistan at risk for developing psychopathology following trauma exposure during deployment, including posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Plasma GABA levels were measured in military personnel (N=731) one month prior to deployment (T0), and one (T1) and six months (T2) after deployment using ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS). Mental health problems and depressive symptoms were measured with the Dutch revised Symptom Checklist (SCL-90) and PTSD symptoms with the Dutch Self-Rating Inventory for PTSD (SRIP). Six months after deployment increases in GABA concentrations were present in individuals who had developed mental health problems (T2: β=0.06, p=1.6×10-2, T1: β=4.7×10-2, p=0.13), depressive symptoms (T2: β=0.29, p=7.9×10-3, T1: β=0.23, p=0.072) and PTSD symptoms at T2 (T2: β=0.12, p=4.3×10-2, T1: β=0.11, p=0.13). Plasma GABA levels prior to and one month after deployment poorly predicted a high level of psychopathology symptoms either one or six months after deployment. The number of previous deployments, trauma experienced during deployment, childhood trauma, age and sex were not significantly associated with plasma GABA levels over time. Exclusion of subjects who either started or stopped smoking, alcohol or medication use between the three time points rendered the association of increasing GABA levels with the emergence of psychopathology symptoms more pronounced (mental health problems at T2: β=0.09, p=4.2×10-3; depressive symptoms at T2: β=0.35, p=3.5×10-3, PTSD symptoms at T2: β=0.17, p=1.7×10-2). To our knowledge, this is the first study to provide prospective evidence that the development of psychopathology after military deployment is associated with increasing plasma GABA levels. Our finding that plasma GABA rises after the emergence of psychopathology symptoms suggests that GABA increase may constitute a compensatory mechanism and warrants further exploration of the GABA system as a potential target for treatment.
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Affiliation(s)
- Remmelt R Schür
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Marco P Boks
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Elbert Geuze
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Research Center-Military Mental Healthcare, Ministry of Defence, Lundlaan 1, 3584 EZ Utrecht, The Netherlands
| | - Hubertus C Prinsen
- Department of Genetics, Section Metabolic Diagnostics, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Nanda M Verhoeven-Duif
- Department of Genetics, Section Metabolic Diagnostics, Wilhelmina Children's Hospital, University Medical Center Utrecht (UMCU), Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Marian Joëls
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Eric Vermetten
- Research Center-Military Mental Healthcare, Ministry of Defence, Lundlaan 1, 3584 EZ Utrecht, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Albinusweg 2, 2333 ZA Leiden, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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The Brief Symptom Inventory and the Outcome Questionnaire-45 in the Assessment of the Outcome Quality of Mental Health Interventions. PSYCHIATRY JOURNAL 2016; 2016:7830785. [PMID: 27699166 PMCID: PMC5031914 DOI: 10.1155/2016/7830785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/11/2016] [Indexed: 12/02/2022]
Abstract
Self-report questionnaires are economical instruments for routine outcome assessment. In this study, the performance of the German version of the Outcome Questionnaire-45 (OQ-45) and the Brief Symptom Inventory (BSI) was evaluated when applied in analysis of the outcome quality of psychiatric and psychotherapeutic interventions. Pre-post data from two inpatient samples (N = 5711) and one outpatient sample (N = 239) were analyzed. Critical differences (reliable change index) and cut-off points between functional and dysfunctional populations were calculated using the Jacobson and Truax method of calculating clinical significance. Overall, the results indicated that the BSI was more accurate than the OQ-45 in correctly classifying patients as clinical subjects. Nonetheless, even with the BSI, about 25% of inpatients with schizophrenia attained a score at admission below the clinical cut-off. Both questionnaires exhibited the highest sensitivity to psychopathology with patients with personality disorders. When considering the differences in the prescores, both questionnaires showed the same sensitivity to change. The advantage of using these self-report measures is observed primarily in assessing outpatient psychotherapy outcome. In an inpatient setting two main problems—namely, the low response rate and the scarce sensitivity to psychopathology with severely ill patients—limit the usability of self-report questionnaires.
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Pajer KA, Edwards MC, Lourie AE, Fields S, Kalman S. Depressive symptoms, hostility, and hopelessness in inner-city adolescent health clinic patients: factor structure and demographic correlates. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0009/ijamh-2016-0009.xml. [PMID: 27508952 DOI: 10.1515/ijamh-2016-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression, hostility, and hopelessness are risk factors for adult cardiovascular disease (CVD). People living in inner-city environments are particularly vulnerable. These associations may begin in adolescence, but research in this area is hampered by inadequate knowledge about how these negative psychological factors are related in teens and how they are affected by demographic characteristics. We hypothesized that depression, hostility, and hopelessness are one construct, and that this construct would be associated with race and gender in attendees at an inner-city adolescent health clinic. METHODS Two hundred and forty-six 15-18-year-old patients filled out instruments measuring depressive symptoms, hostility, and hopelessness. Confirmatory factor analysis was used to determine whether the negative psychological factors comprised a single construct or three separate ones. General linear modeling (GLM) was used to test the associations between demographic characteristics and the results of the factor analysis. RESULTS Depressive symptoms, hostility, and hopelessness were best characterized as three separate constructs, not one (root mean square error of approximation (RMSEA)=0.041, 90% confidence interval (CI)=(0.035, 0.047), comparative fit index (CFI)=0.98). There were no significant relationships between demographic variables and depressive symptoms or hostility. Six percent of the variance in hopelessness scores was accounted for by gender, race, and the interaction between the two (F=3.76; p=0.006), with White males, reporting the highest levels of hopelessness. CONCLUSION In an urban adolescent health clinic population, depressive symptoms, hostility, and hopelessness were best understood as three separate constructs. Hopelessness was significantly higher in White males. Implications for future clinical research on negative psychological factors in teens are discussed.
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Affiliation(s)
- Kathleen A Pajer
- Department of Psychiatry, Children's Hospital of Eastern Ontario and Professor of Psychiatry, University of Ottawa Faculty of Medicine, 401 Smyth Rd., Ottawa, ON K1H 8L1 Canada, Phone: +1-613-737-7600 Ext. 2723, Fax: +1-613-737-2257
| | | | - Andrea E Lourie
- Denison University, Department of Psychology, Granville, OH, USA
| | - Sherecce Fields
- Texas A&M, Department of Psychology, College Station, TX, USA
| | - Savannah Kalman
- Oklahoma Department of Mental Health and Substance Abuse Services, Bethany, OK, USA
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Donnelly TT, Al Suwaidi JM, Al-Qahtani A, Asaad N, Fung T, Singh R, Qader NA. Mood disturbance and depression in Arab women following hospitalisation from acute cardiac conditions: a cross-sectional study from Qatar. BMJ Open 2016; 6:e011873. [PMID: 27388362 PMCID: PMC4947790 DOI: 10.1136/bmjopen-2016-011873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Depression is associated with increased morbidity and mortality rates among cardiovascular patients. Depressed patients have three times higher risk of death than those who are not. We sought to determine the presence of depressive symptoms, and whether gender and age are associated with depression among Arab patients hospitalised with cardiac conditions in a Middle Eastern country. SETTING Using a non-probability convenient sampling technique, a cross-sectional survey was conducted with 1000 Arab patients ≥20 years who were admitted to cardiology units between 2013 and 2014 at the Heart Hospital in Qatar. Patients were interviewed 3 days after admission following the cardiac event. Surveys included demographic and clinical characteristics, and the Arabic version of the Beck Depression Inventory Second Edition (BDI-II). Depression was assessed by BDI-II clinical classification scale. RESULTS 15% of the patients had mild mood disturbance and 5% had symptoms of clinical depression. Twice as many females than males suffered from mild mood disturbance and clinical depression symptoms, the majority of females were in the age group 50 years and above, whereas males were in the age group 40-49 years. χ(2) Tests and multivariate logistic regression analyses indicated that gender and age were statistically significantly related to depression (p<0.001 for all). CONCLUSIONS Older Arab women are more likely to develop mood disturbance and depression after being hospitalised with acute cardiac condition. Gender and age differences approach, and routine screening for depression should be conducted with all cardiovascular patients, especially for females in the older age groups. Mental health counselling should be available for all cardiovascular patients who exhibit depressive symptoms.
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Affiliation(s)
- Tam Truong Donnelly
- Faculty of Nursing and Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jassim Mohd Al Suwaidi
- Department of Adult Cardiology, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
| | - Awad Al-Qahtani
- Department of Adult Cardiology, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
| | - Nidal Asaad
- Department of Adult Cardiology, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
| | - Tak Fung
- University of Calgary, Math/Information Technology, Calgary, Alberta, Canada
| | - Rajvir Singh
- Hamad Medical Corporation, Hamad General Hospital, Research Center/Adult Cardiology, Doha, Qatar
| | - Najlaa Abdul Qader
- Department of Psychiatry, Hamad Medical Corporation, Hamad General Hospital, Doha, Qatar
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Polshkova S, Chaban O, Walton MA. Alcohol Use, Depression, and High-Risk Occupations Among Young Adults in the Ukraine. Subst Use Misuse 2016; 51:948-51. [PMID: 27144438 PMCID: PMC4974938 DOI: 10.3109/10826084.2016.1156700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined alcohol consumption in relation to anxiety, depression, and involvement with high risk occupations (HRO; e.g., coal miners), among young adults in the Ukraine (aged 18-25) (N = 192; 60.9% male; 100% Caucasian). Participants were grouped on the basis of drinking status: (1) current drinkers (CDs; n = 132) or (2) nondrinkers (NDs; n = 60). Questionnaires assessed frequency of alcohol use, motives for drinking, problem identification, as well as anxiety and depression (i.e., Hamilton scales). Bivariate analyses showed that CDs were more likely than NDs to be single, have a HRO, and have greater anxiety and depression; for example, 91.7% of CDs had a HRO as compared to 56.7% of NDs. Drinking status was not significantly related to age or gender. Among CDs, common motives for use included: to reduce anxiety and fears (60.6%), because my friends use alcohol (75.0%), to fight stress (78.8%), and to increase self-esteem (64.4%). Among CDs, past month drinking days were: 25% 1-2 days, 37.9% 3-7 days, 25% 8-21 days, and 12.1% 22-30 days. Regarding problem identification, 29.5% reported not having a problem, 34.8% reported possibly having a problem, 21.9% reported having a problem but not needing help, and 13.6% reported having a problem/needing help. Young adults involved in HRO may be a particularly high risk population given increased likelihood of alcohol use, anxiety, and depression. Early intervention strategies that incorporate motivational interviewing approaches to address coping and social motives for use may be beneficial to address substance use and mental health problems.
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Affiliation(s)
- Svitlana Polshkova
- a Departments of Psychiatry and Addiction Research Center , University of Michigan , Ann Arbor , Michigan , USA.,b Department of Psychosomatic Medicine and Psychotherapy, Ukrainian Scientific Research Institute of Social and Forensic Psychiatry and Narcology , Kyiv , Ukraine
| | - Oleg Chaban
- a Departments of Psychiatry and Addiction Research Center , University of Michigan , Ann Arbor , Michigan , USA.,b Department of Psychosomatic Medicine and Psychotherapy, Ukrainian Scientific Research Institute of Social and Forensic Psychiatry and Narcology , Kyiv , Ukraine
| | - Maureen A Walton
- a Departments of Psychiatry and Addiction Research Center , University of Michigan , Ann Arbor , Michigan , USA.,b Department of Psychosomatic Medicine and Psychotherapy, Ukrainian Scientific Research Institute of Social and Forensic Psychiatry and Narcology , Kyiv , Ukraine
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Mello APD, Carvalho ACDC, Higa EMS. Depressive symptoms in patients with acute coronary syndrome. EINSTEIN-SAO PAULO 2016; 9:326-31. [PMID: 26761100 DOI: 10.1590/s1679-45082011ao1721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 12/20/2010] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To trace an epidemiological profile, to verify presence of depressive symptoms in patients with previous diagnosis of acute coronary syndrome and to identify factors that contribute to maintenance of depressive symptoms in the sample. METHODS A cross-section study carried out at the Cardiology Outpatients Clinics of Universidade Federal de São Paulo. An instrument prepared by the authors was used, which was based on similar studies with patient identification data, questions related to the psychological follow-up, relationship with family members and friends, in addition to use of the Beck Depression Inventory. METHODS A cross-section study carried out at the Cardiology Outpatients Clinics of Universidade Federal de São Paulo. An instrument prepared by the authors was used, which was based on similar studies with patient identification data, questions related to the psychological follow-up, relationship with family members and friends, in addition to use of the Beck Depression Inventory. RESULTS A total of 200 patients were interviewed, 127 (63.5%) were male. The mean age was 60.19 years with a standard deviation of 9.38, minimum age of 36 years and maximum of 81 years; 164 (82%) denied any follow-up with a psychologist or psychiatrist in the phase after acute coronary syndrome diagnosis and treatment. In the utilization of Beck Depression Inventory, 67 (33.5%) presented scores between 0 and 4, indicating mild depressive symptoms; 72 (36%) had scores between 5 and 9, indicating mild to moderate depressive symptoms, and 61 (30.5%) presented scores greater than 9, which point out moderate to severe depressive symptoms. CONCLUSION The evaluation and multiprofessional follow-up can help patients cope with the illness in addition to providing greater compliance to drug therapy and beginning changes in life habits.
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van Beek MHCT, Oude Voshaar RC, van Deelen FM, van Balkom AJLM, Pop G, Speckens AEM. Inverse correlation between cardiac injury and cardiac anxiety: a potential role for communication. J Cardiovasc Nurs 2015; 29:448-53. [PMID: 23782865 DOI: 10.1097/jcn.0b013e3182982550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. METHODS We assessed cardiac anxiety in 237 patients admitted with ACS using the Cardiac Anxiety Questionnaire and gathered information on sociodemographic, psychological, and cardiac disease characteristics. Univariate, multivariate logistic, and linear regression analyses were used to determine which characteristics were associated with cardiac anxiety. RESULTS Cardiac anxiety was not associated with sociodemographic variables. More severe cardiac injury, as indicated by ST-elevated myocardial infarction and troponin level, was associated with less cardiac anxiety. Psychological variables (depressive symptoms, agoraphobic cognitions, avoidance behavior) were associated with more cardiac anxiety. DISCUSSION Cardiac anxiety in ACS patients is associated with more psychological distress but lower severity of cardiac injury as indicated by ST-elevated myocardial infarction and troponin level. Two explanations seem likely for this latter finding. First, anxious persons might seek help earlier, thus being diagnosed more often with minor cardiac pathology. Second, cardiac anxiety might partly be caused by diagnostic uncertainty. Future research should focus on communication strategies to reassure patients more efficiently.
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Affiliation(s)
- Maria H C T van Beek
- Maria H.C.T. van Beek, MD Psychiatrist, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands. Richard C. Oude Voshaar, MD, PhD Senior researcher at the Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, and Professor, Old Age Psychiatry at University Center of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands. Femke M. van Deelen, MD Medical Doctor, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands. Anton J.L.M. van Balkom, MD, PhD Professor of Psychiatry, Department of Psychiatry and EMGO+ Institute, VU University Medical Centre and GGZinGeest, Amsterdam, the Netherlands. Gheorghe Pop, MD, PhD Cardiologist, Radboud University Nijmegen Medical Centre, Department of Cardiology, Nijmegen, the Netherlands. Anne E.M. Speckens, MD, PhD Professor of Psychiatry, Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, the Netherlands
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Nitric oxide dysregulation in patients with heart failure: the association of depressive symptoms with L-arginine, asymmetric dimethylarginine, symmetric dimethylarginine, and isoprostane. Psychosom Med 2015; 77:292-302. [PMID: 25790241 DOI: 10.1097/psy.0000000000000162] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nitric oxide (NO) regulation plays a critical role in cardiovascular diseases including heart failure (HF). Markers of NO dysregulation have been found in individuals with depression without cardiovascular disease. Because depression is associated with poor HF outcomes, the present study tested the hypothesis that depression is associated with a dysregulated NO pathway in patients with HF. METHODS Serum levels of NO regulation (L-arginine, asymmetric dimethylarginine [ADMA], and symmetric dimethylarginine [SDMA]) and oxidative stress (isoprostane 8-epi prostaglandin F2α) were measured in 104 patients with HF (mean [standard deviation] age = 65.7 [8.4] years, 28% women) at baseline and 12 months. Depressive symptoms were measured using the Beck Depression Inventory. The associations between depressive symptoms with markers of NO regulation were examined with mixed-model analysis, adjusted for age, sex, time of assessment, left ventricular ejection fraction, creatinine, and hypertension. RESULTS Depressive symptoms were correlated with a lower L-arginine/ADMA ratio (r = -0.22, p = .003) and higher SDMA levels (r = 0.28, p < .001). Associations were similar for somatic depressive symptoms and cognitive-affective symptoms (L-arginine/ADMA ratio: r = -0.20 [p = .009] versus r = -0.19 [p = .013]; ADMA: r = 0.16 [p = .043] versus r = 0.10 [p = .20]; SDMA: r = 0.27 [p < .001] versus r = 0.22 [p = .005], respectively). No associations were found between depressive symptoms and isoprostane. The association between depression and the L-arginine/ADMA ratio remained significant in multivariate adjusted models. CONCLUSIONS Depressive symptoms were associated with markers of NO dysregulation, particularly the L-arginine/ADMA ratio and SDMA, in patients with HF. The lower L-arginine/ADMA ratio indicates less available NO, suggesting that NO-related endothelial dysfunction may play a role in the adverse risk of HF progression associated with depression.
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Lafitte M, Tastet S, Perez P, Serisé MA, Grandoulier AS, Aouizerate B, Sibon I, Capuron L, Couffinhal T. High sensitivity C reactive protein, fibrinogen levels and the onset of major depressive disorder in post-acute coronary syndrome. BMC Cardiovasc Disord 2015; 15:23. [PMID: 25888123 PMCID: PMC4436867 DOI: 10.1186/s12872-015-0015-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/27/2015] [Indexed: 11/28/2022] Open
Abstract
Background Major depression disorder (MDD) is a common condition in patients suffering from acute coronary syndrome (ACS), and depression is a risk factor for mortality following an ACS. Growing evidence suggests that there is an intricate interplay between atherosclerosis, inflammation and depression. The aim of this study was to investigate the role of atherosclerosis-induced inflammation in the mediation of MDD. Methods 87 patients without depression were recruited at the time of an ACS, evaluated at 3 and 7 days and followed at 1, 3 and 9 months for the occurrence of a MDD as assessed by structured interviews (MINI). At each time point, they were monitored for inflammatory markers (high sensitivity C Reactive Protein {hsCRP} and fibrinogen), cardiovascular risk factors and atherosclerosis burden. Association between possible predictive characteristics and depression was assessed using a multivariable logistic regression model. Results The overall incidence of MDD, in this population, was 28.7% [95% CI: 19.5 – 39.4] during the 9-month follow up period. Elevated hsCRP was not associated with depression onset after an ACS (adjusted OR: 1.07 [0.77 - 1.48]; p = 0.70), and similarly no association was found with fibrinogen. Furthermore, we found no association between hsCRP, fibrinogen or atherosclerosis burden at any time-point, and the occurrence of a MDD (or HDRS-17 and MADRS). The only factor associated with depression occurrence after an ACS was a previous personal history of depression (adjusted OR: 11.02 [2.74 to 44.34]; p = 0.0007). Conclusions The present study shows that after an ACS, patients treated with optimal medications could have a MDD independent of elevated hsCRP or fibrinogen levels. Personal history of depression may be a good marker to select patients who should be screened for depression after an ACS. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0015-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marianne Lafitte
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France.
| | - Sandrine Tastet
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France.
| | - Paul Perez
- CHU de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, F-33000, Bordeaux, France.
| | - Marie-Aimée Serisé
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France.
| | - Anne-Sophie Grandoulier
- CHU de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, F-33000, Bordeaux, France.
| | - Bruno Aouizerate
- CHU de Bordeaux, Pôle Universitaire de Psychiatrie, F-33000, Bordeaux, France.
| | - Igor Sibon
- CHU de Bordeaux, Unité Neurovasculaire, F-33000, Bordeaux, France.
| | - Lucile Capuron
- INRA, Nutrition et Neurobiologie intégrée, UMR 1286, F-33000, Bordeaux, France.
| | - Thierry Couffinhal
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France. .,Univ. Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600, Pessac, France. .,INSERM, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600, Pessac, France.
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Ren Y, Yang H, Browning C, Thomas S, Liu M. Performance of screening tools in detecting major depressive disorder among patients with coronary heart disease: a systematic review. Med Sci Monit 2015; 21:646-53. [PMID: 25725615 PMCID: PMC4354444 DOI: 10.12659/msm.892537] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Eligible studies published before 31 Dec 2013 were identified from the following databases: Ovid Medline, EMBASE, PsycINFO, Scopus, Cochrane Library, CINAHL Plus, and Web of Science. MATERIAL AND METHODS Eligible studies published before 31, Dec 2013 were identified from the following databases: Ovid Medline, EMBASE, psycINFO, Scopus, Cochrane Library, CINAHL Plus, and Web of Science. RESULTS Eight studies aiming to identify MDD in CHD patients were included, and there were 10 self-reporting questionnaires (such as PHQ-2, PHQ-9, PHQ categorical algorithm, HADS-D, BDI, BDI-II, BDI-II-cog, CES-D, SCL-90, 2 simple yes/no items) and 1 observer rating scale (Ham-D). For MDD alone, the sensitivity and specificity of various screening tools at the validity and optimal cut-off point varied from 0.34 [0.19, 0.52] to 0.96 [0.78, 1.00] and 0.69 [0.65, 0.73] to 0.97 [0.93, 0.99]. Results showed PHQ-9 (≥10), BDI-II (³14 or ≥16), and HADS-D (≥5 or ≥4) were widely used for screening MDD in CHD patients. CONCLUSIONS There is no consensus on the optimal screening tool for MDD in CHD patients. When evaluating the performance of a screening tool, balancing the high sensitivity and negative predictive value (NPV) between specificity and positive predictive value (PPV) for screening or diagnostic purpose should be considered. After screening, further diagnosis, appropriate management, and necessary referral may also improve cardiovascular outcomes.
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Affiliation(s)
- Yanping Ren
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Hui Yang
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Colette Browning
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Shane Thomas
- School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Meiyan Liu
- Department of Cardiology, Affiliated Beijing Anzhen Hospital of Capital Medical University, Beijing, China (mainland)
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A comparison of the health status and psychological distress of partners of patients with a left ventricular assist device versus an implantable cardioverter defibrillator: A preliminary study. Heart Lung 2015; 44:27-32. [DOI: 10.1016/j.hrtlng.2014.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/16/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
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Mazereeuw G, Herrmann N, Xu H, Blanchard AP, Figeys D, Oh PI, Bennett SA, Lanctôt KL. Platelet activating factors are associated with depressive symptoms in coronary artery disease patients: a hypothesis-generating study. Neuropsychiatr Dis Treat 2015; 11:2309-14. [PMID: 26379437 PMCID: PMC4567245 DOI: 10.2147/ndt.s87111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Depression is a frequent complication of coronary artery disease (CAD) with an unknown etiology. Platelet activating factor (PAF) lipids, which are associated with CAD, have recently been linked with novel proposed etiopathological mechanisms for depression such as inflammation, oxidative/nitrosative stress, and vascular endothelial dysfunction. METHODS AND RESULTS This hypothesis-generating study investigated the relationships between various PAF species and depressive symptoms in 26 CAD patients (age: 60.6±9.2 years, 69% male, mean Hamilton Depression Rating Scale [HAM-D] score: 11.8±5.2, HAM-D range: 3-20). Plasma PAF analyses were performed using high performance liquid chromatography electrospray ionization mass spectrometry in precursor ion scan. Significant associations between depressive symptom severity (HAM-D score) and a greater plasma abundance of the PAFs phosphocholine (PC) PC(O-12:0/2:0) (r=0.49, P=0.01), PC(O-14:1/2:0) (r=0.43, P=0.03), PC(O-17:3/2:0) (r=0.44, P=0.04), and PC(O-18:3/2:0) (r=0.50, P=0.01) were observed. Associations between those PAFs and HAM-D score persisted after adjusting for age and sex. CONCLUSION These preliminary findings support the exploration of the PAF lipidome for depressive symptom biomarkers in CAD patients. Patients were recruited as part of the following clinical trial: NCT00981383.
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Affiliation(s)
- Graham Mazereeuw
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada ; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada ; CIHR Training Program in Neurodegenerative Lipidomics, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada ; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hongbin Xu
- Ottawa Institute of Systems Biology and Neural Regeneration Laboratory, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada ; CIHR Training Program in Neurodegenerative Lipidomics, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Alexandre P Blanchard
- Ottawa Institute of Systems Biology and Neural Regeneration Laboratory, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada ; CIHR Training Program in Neurodegenerative Lipidomics, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Figeys
- Ottawa Institute of Systems Biology and Neural Regeneration Laboratory, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada ; CIHR Training Program in Neurodegenerative Lipidomics, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Paul I Oh
- UHN Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Steffany Al Bennett
- Ottawa Institute of Systems Biology and Neural Regeneration Laboratory, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada ; CIHR Training Program in Neurodegenerative Lipidomics, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada
| | - Krista L Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada ; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada ; CIHR Training Program in Neurodegenerative Lipidomics, Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON, Canada ; Department of Psychiatry, University of Toronto, Toronto, ON, Canada ; UHN Toronto Rehabilitation Institute, Toronto, ON, Canada
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van Zuiden M, Kavelaars A, Vermetten E, Olff M, Geuze E, Heijnen C. Pre-deployment differences in glucocorticoid sensitivity of leukocytes in soldiers developing symptoms of PTSD, depression or fatigue persist after return from military deployment. Psychoneuroendocrinology 2015; 51:513-24. [PMID: 25277845 DOI: 10.1016/j.psyneuen.2014.09.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/17/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022]
Abstract
Deployed soldiers are at risk of developing stress-related conditions, including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and severe fatigue. We previously observed condition- and cell-specific differences in sensitivity of immune cells for regulation by glucocorticoids (GCs) pre-deployment between male soldiers with and without subsequent development of high levels of these stress-related symptoms. Here we investigated whether these pre-deployment dysregulations in GC-sensitivity of immune cells persisted after return from military deployment. In a prospective, longitudinal study including 721 male and female soldiers, the in vitro GC-sensitivity of monocytes and T-cells was assessed prior to deployment and one and six months post-deployment. Differences in the longitudinal course of sensitivity for regulation by dexamethasone (DEX) of LPS-stimulated TNF-α production and PHA-stimulated T-cell proliferation between soldiers with and without subsequent symptom development were investigated using linear mixed models. Within the whole group, DEX-sensitivity of monocytes was significantly decreased at six months post-deployment compared to the assessments pre-deployment and one month post-deployment. The DEX-sensitivity of T-cells did not significantly change over time. Participants developing high levels of PTSD symptoms showed high DEX-sensitivity of T-cells, while participants developing high levels of depressive symptoms showed low DEX-sensitivity of T-cells before deployment that persisted at the two time points after return. In addition, participants developing severe fatigue had low DEX-sensitivity of monocytes at all assessments. Our finding that the previously observed pre-deployment group differences in peripheral GC-sensitivity persisted until at least six months after return indicates that in vitro GC-sensitivity of T-cells and monocytes may represent a persistent biological vulnerability factor for development of stress-related conditions PTSD, depression and fatigue.
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Affiliation(s)
- Mirjam van Zuiden
- Center for Psychotrauma, Department of Psychiatry, Anxiety Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Annemieke Kavelaars
- Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Eric Vermetten
- Research Centre Military Mental Health, Ministry of Defense, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Miranda Olff
- Center for Psychotrauma, Department of Psychiatry, Anxiety Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - Elbert Geuze
- Research Centre Military Mental Health, Ministry of Defense, Utrecht, The Netherlands; Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cobi Heijnen
- Neuroimmunology Laboratory, Department of Symptom Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA; Laboratory of Neuroimmunology and Developmental Origins of Disease (NIDOD), University Medical Center Utrecht, Utrecht, The Netherlands
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de Jong AEE, Bremer M, Hofland HWC, Schuurmans MJ, Middelkoop E, van Loey NEE. The visual analogue thermometer and the graphic numeric rating scale: a comparison of self-report instruments for pain measurement in adults with burns. Burns 2014; 41:333-40. [PMID: 25262546 DOI: 10.1016/j.burns.2014.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/16/2014] [Accepted: 07/05/2014] [Indexed: 10/24/2022]
Abstract
To evaluate the adequacy of pain management in burn care, pain measurement is essential. The visual analogue thermometer (VAT) and graphic numeric rating scale (GNRS) are frequently used self-report instruments for burn pain. To legitimise their interchangeable use in research and practice, we aimed to compare self-reports obtained by the VAT and GNRS, the ability of the scales to differentiate background from procedural pain, and to compare potential cutpoints. Adults with acute burns (N=319) participated in the study (67% male, mean age 40.3 years (SD 16), mean TBSA 9.9% (SD 10.4). Correlation coefficients between VAT and GNRS were 0.64 and 0.55 for, respectively, morning and afternoon background pain and 0.51 for procedural pain (p<0.01). VAT scores were lower than GNRS scores for all pain types (p<0.01). Both scales could differentiate background from procedural pain: procedural pain was higher (p<0.01). The standardized response mean was moderate (0.518 for VAT and 0.571 for GNRS). Self-reported thresholds for 'unacceptable pain' by GNRS were higher than by VAT (p<0.001). ROC analyses showed that the highest sensitivity was reached for pain score 2 for both scales. The results suggest that the instruments cannot be used interchangeably without taking their differences into account.
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Affiliation(s)
- A E E de Jong
- Burn Centre, Red Cross Hospital, Beverwijk, The Netherlands; Association of Dutch Burn Centres, Beverwijk, The Netherlands.
| | - M Bremer
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Burn Centre, Martini Hospital, Groningen, The Netherlands
| | - H W C Hofland
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Burn Centre, Maasstad Hospital, Rotterdam, The Netherlands
| | - M J Schuurmans
- Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Middelkoop
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N E E van Loey
- Association of Dutch Burn Centres, Beverwijk, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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Poor social support is associated with increases in depression but not anxiety over 2 years in heart failure outpatients. J Cardiovasc Nurs 2014; 29:20-8. [PMID: 23321780 DOI: 10.1097/jcn.0b013e318276fa07] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Heart failure (HF) is a major health problem in the United States, affecting 5.7 million American adults. Psychosocial distress, in particular depression, contributes to morbidity and mortality in patients with HF. Little is known about the interrelationship among disease severity, social support, and depression. OBJECTIVE The aim of this study was to examine the contributions of social support and disease severity to longitudinal changes in depression and anxiety of outpatients with HF. METHODS Patients (N = 108) enrolled in the Psychosocial Factors Outcome Study completed the Beck Depression Inventory-II, the State Trait Anxiety Inventory, and the Social Support Questionnaire-6 at study entry and every 6 months for up to 2 years. RESULTS At baseline, 30% of the patients were depressed and 42% were anxious. Social support amount contributed to changes in depression (P = .044) but not anxiety (P = .856). Depression increased over time for patients who had lower initial social support amount. Depression did not increase for those with higher initial social support amount. Neither New York Heart Association class nor treatment group (placebo or implantable cardioverter defibrillator) interacted with time to predict depression, which indicates that changes in depression were parallel for patients with New York Heart Association class II and class III HF and for those who received implantable cardioverter defibrillators and those who did not. Assessment of patients with HF should include depression and social support. Interventions to enhance social support among patients with HF who have low social support may help alleviate the development of depression. CONCLUSIONS Reducing psychological distress and increasing social support may improve health outcomes among HF outpatients. It is important for studies of HF to include assessment of depression, anxiety, and social support and evaluate their contributions to health outcomes.
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Wang W, Chow A, Thompson DR, Koh K, Kowitlawakul Y, He HG. Predictors of Health-Related Quality of Life Among Patients With Myocardial Infarction. West J Nurs Res 2014; 38:43-56. [DOI: 10.1177/0193945914546201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This cross-sectional correlational study aimed to examine health-related quality of life (HRQoL) and its predictors among patients with myocardial infarction (MI). One hundred and twenty-eight outpatients with MI were recruited from a university hospital. The 12-item Short-Form Health Survey version 2, Myocardial Infarction Dimensional Assessment Scale (MIDAS), and Hospital Anxiety and Depression Scale (HADS) were used to measure the study variables. Compared with the findings of similar studies of patients with MI, this sample, despite having significant coronary risk factors, reported generally better HRQoL. Predictors of physical HRQoL included low monthly household income, whereas predictors of mental HRQoL included ex-smoker, alcohol use, hypertension, anxiety, and depression. Special attention may need to be given to those people with a low income level, who are ex-smokers, use alcohol, or have hypertension, anxiety, or depression.
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Affiliation(s)
- Wenru Wang
- National University of Singapore, Singapore
| | | | - David R. Thompson
- Australian Catholic University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Karen Koh
- National University Hospital, Singapore
| | | | - Hong-Gu He
- National University of Singapore, Singapore
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