Anxiety, depression, and heart disease in women

In vivo β-adrenergic receptor responsiveness: ethnic differences in the relationship with symptoms of depression and fatigue

BACKGROUND

Depressive symptoms and fatigue frequently overlap in clinical samples and the general population. The link of depressive symptoms and fatigue with increased risk of cardiovascular disease has been partly explained by shared biological mechanisms including sympathetic overactivity. Prolonged sympathetic overactivity downregulates the responsiveness of the β-adrenergic receptor (β-AR), a receptor that mediates several end-organ sympathetic responses.

PURPOSE

The authors studied whether depression and fatigue are related to reduced β-AR responsiveness within the human body (in vivo) in an ethnically diverse sample of African and Caucasian Americans.

METHODS

The chronotropic25 dose (CD25) was used to determine in vivo β-AR responsiveness in 93 healthy participants. Psychometric measures included the Center of Epidemiological Studies-Depression Scale and the Multidimensional Fatigue Symptom Inventory.

RESULTS

Hierarchical regression analyses (adjusted for age, gender, body mass index, blood pressure, smoking, and ethnicity) revealed that mental fatigue was significantly related to reduced β-AR responsiveness (i.e., higher CD25 values) in the whole sample. Moderation analyses indicated significant ethnicity × depression/fatigue interactions. Depressive symptoms, total fatigue, emotional fatigue, mental fatigue, and physical fatigue were related to reduced β-AR responsiveness in Caucasian American but not in African Americans.

CONCLUSIONS

Our findings suggest that symptoms of depression and fatigue are related to decreased in vivo β-AR responsiveness in Caucasian Americans. The lack of this association in African Americans highlights the importance for considering ethnicity as a potential moderator in research focusing on associations between psychological variables and cardiovascular function.

Counselling: filling a gap in general practice

A counsellor worked for 1 year in three practices in a rural area where there was previously no practice-based counselling. The service was evaluated, using a range of methods, in order to inform general practitioners and policy-makers about the demand for counselling, where it fits with other services, its potential value and how to organise and audit the service efficiently. Five kinds of information were collected: administrative data; patients' views; well-being scores; GPs' perceptions of individual patients; and interviews with the counsellor, GPs and other primary care staff by an independent researcher. All the GPs used the service, referring 131 people. The most common reason for referral was 'relationship difficulties'. There were improvements in patients' well-being, self-awareness and coping skills, and high satisfaction among GPs and patients. Communication with other services was seen to improve. The counselling service was found to fill a gap by addressing the needs of a substantial group of patients for whom psychiatric care was inappropriate.

Psychosocial variables, age, and angiographically-determined coronary artery disease in women

The present study explored the relationship between psychosocial measures and the degree of coronary stenosis in a sample of 59 women between the ages of 39 and 84. Coronary occlusion was correlated with elevated cholesterol and marginally correlated with age and was inversely associated with years of education. Based on hierarchical multiple regression, an interview-based measure of hostility was associated with coronary stenosis after controlling for traditional risk factors, and age moderated the hostility-stenosis relationship. Further, a second regression model suggested that trait anxiety was inversely correlated with degree of occlusion, perhaps because low-anxious women are referred for catheterization later in the course of the disease. Contrary to hypotheses, there was no evidence that repression of interview-based hostility or anxiety predicted coronary occlusion. Given the small sample size, results should be considered preliminary. Future studies should explore the degree to which anxiety and hostility are associated with coronary heart disease (CHD) in larger samples of women and the degree to which age moderates the hostility-occlusion association.