Brain-Based Biotypes of Psychiatric Vulnerability in the Acute Aftermath of Trauma

OBJECTIVE

Major negative life events, such as trauma exposure, can play a key role in igniting or exacerbating psychopathology. However, few disorders are diagnosed with respect to precipitating events, and the role of these events in the unfolding of new psychopathology is not well understood. The authors conducted a multisite transdiagnostic longitudinal study of trauma exposure and related mental health outcomes to identify neurobiological predictors of risk, resilience, and different symptom presentations.

METHODS

A total of 146 participants (discovery cohort: N=69; internal replication cohort: N=77) were recruited from emergency departments within 72 hours of a trauma and followed for the next 6 months with a survey, MRI, and physiological assessments.

RESULTS

Task-based functional MRI 2 weeks after a motor vehicle collision identified four clusters of individuals based on profiles of neural activity reflecting threat reactivity, reward reactivity, and inhibitory engagement. Three clusters were replicated in an independent sample with a variety of trauma types. The clusters showed different longitudinal patterns of posttrauma symptoms.

CONCLUSIONS

These findings provide a novel characterization of heterogeneous stress responses shortly after trauma exposure, identifying potential neuroimaging-based biotypes of trauma resilience and psychopathology.

Basal forebrain cholinergic system in the dementias: Vulnerability, resilience, and resistance

The basal forebrain cholinergic neurons (BFCN) provide the primary source of cholinergic innervation of the human cerebral cortex. They are involved in the cognitive processes of learning, memory, and attention. These neurons are differentially vulnerable in various neuropathologic entities that cause dementia. This review summarizes the relevance to BFCN of neuropathologic markers associated with dementias, including the plaques and tangles of Alzheimer's disease (AD), the Lewy bodies of diffuse Lewy body disease, the tauopathy of frontotemporal lobar degeneration (FTLD-TAU) and the TDP-43 proteinopathy of FTLD-TDP. Each of these proteinopathies has a different relationship to BFCN and their corticofugal axons. Available evidence points to early and substantial degeneration of the BFCN in AD and diffuse Lewy body disease. In AD, the major neurodegenerative correlate is accumulation of phosphotau in neurofibrillary tangles. However, these neurons are less vulnerable to the tauopathy of FTLD. An intriguing finding is that the intracellular tau of AD causes destruction of the BFCN, whereas that of FTLD does not. This observation has profound implications for exploring the impact of different species of tauopathy on neuronal survival. The proteinopathy of FTLD-TDP shows virtually no abnormal inclusions within the BFCN. Thus, the BFCN are highly vulnerable to the neurodegenerative effects of tauopathy in AD, resilient to the neurodegenerative effect of tauopathy in FTLD and apparently resistant to the emergence of proteinopathy in FTLD-TDP and perhaps also in Pick's disease. Investigations are beginning to shed light on the potential mechanisms of this differential vulnerability and their implications for therapeutic intervention.

Cancer survivors' perceived vulnerability to COVID-19 and impacts on cognitive, affective, and behavioral responses to the pandemic

STUDY OBJECTIVES

Given the uncertainty COVID-19 has caused for individuals with prior medical conditions, we examined the extent to which cancer survivors consider themselves at risk for the global COVID-19 pandemic (henceforth COVID), both in general and due to their cancer history. Additionally, we evaluated whether perceived vulnerability to COVID among cancer survivors predicts their cognitive/affective and behavioral responses to the pandemic.

DESIGN/SAMPLE

Cancer survivors who completed primary cancer treatment (median months since treatment = 33.00) and were enrolled in prior behavioral trials with our research team (N = 146) completed two surveys in May-July 2020 (95.89% retention).

METHODS

Participants rated perceived next-year risk of infection and of dying from COVID. We adapted established scales to assess perceived vulnerability to COVID generally versus as a cancer survivor, catastrophizing about possible COVID symptoms, COVID-related contamination fears, and adherence to COVID prevention behaviors.

FINDINGS

In May 2020, on a 1-100 scale with 0 = no chance and 100 = definitely will occur, cancer survivors reported a chance in the next year of contracting COVID of M = 39.94 (SD = 23.90), and dying from COVID of M = 24.46 (SD = 24.84). Cancer survivors reported somewhat greater vulnerability to COVID compared to same-aged peers, increased contamination fears, and high adherence to COVID prevention measures. Similar findings emerged six weeks later, suggesting stability over time. In simple linear regression models, both general and cancer survivor-specific perceived COVID vulnerability predicted COVID symptom catastrophizing and contamination fears; in multivariable models, only general vulnerability remained a significant predictor. General perceived vulnerability and contamination fears predicted greater adherence to COVID prevention behaviors.

CONCLUSIONS

Cancer survivors perceived elevated vulnerability to COVID even years after treatment, which predicted adherence to COVID prevention behaviors. Future research should identify the optimal balance between supporting cancer survivors' concerns and minimizing negative impacts on quality of life.

Dynamic longitudinal behavior in animals exposed to chronic social defeat stress

Chronic social defeat (CSD) can lead to impairments in social interaction and other behaviors that are supposed to model features of major depressive disorder (MDD). Not all animals subjected to CSD, however, develop these impairments, and maintained social interaction in some animals is widely used as a model for resilience to stress-induced mental dysfunctions. So far, animals have mainly been studied shortly (24 hours and 7 days) after CSD exposure and longitudinal development of behavioral phenotypes in individual animals has been mostly neglected. We have analyzed social interaction and novel object recognition behavior of stressed mice at different time points after CSD and have found very dynamic courses of behavior of individual animals. Instead of the two groups, resilient or susceptible, that are found at early time points our data suggest four groups with (i, ii) animals behaving resilient or susceptible at early and late time points, respectively (iii) animals that start susceptible and recover with time or (iv) animals that are resilient at early time points but develop vulnerability later on.

Family history of psoriasis, psychological stressors, and tobacco use are associated with the development of tumor necrosis factor-α inhibitor-induced psoriasis: A case-control study

BACKGROUND

Tumor necrosis factor-α inhibitor-induced psoriasis (TNFI psoriasis) is a paradoxical reaction characterized by development of a psoriasiform rash that mimics psoriasis vulgaris. Temporal onset variability and low incidence rates suggest that underlying risk factors or outside triggers have a role in TNFI psoriasis initiation.

OBJECTIVES

We aimed to identify underlying risk factors and outside triggers associated with TNFI psoriasis onset.

METHODS

This case-control study included 97 patients at a tertiary care center between 2003 and 2013 who developed TNFI psoriasis. Ninety-seven control patients were matched to age, sex, disease, TNF-α inhibitor, and length of time on treatment before TNFI psoriasis onset. Patient medical records were reviewed ≥6 months immediately preceding TNFI psoriasis onset (similar equivalent time point for matched controls) for information about potential risk factors and outside factors categorized as: (1) serologic abnormalities, (2) acute events, and (3) social factors.

RESULTS

Compared with those of matched controls, odds ratios (ORs) were significantly higher in the TNFI psoriasis group for psoriasis family history (OR, 16.0) and acute psychological stressors (OR, 3.14) and marginally associated with tobacco use (OR, 1.76).

CONCLUSIONS

Our results suggest that psoriasis family history, psychological stressors, and tobacco use might be risk factors for developing TNFI psoriasis. Performing detailed patient histories when considering TNFI therapy may be useful in identifying patients at risk for TNFI-psoriasis.

A typology of beliefs and misperceptions about the influenza disease and vaccine among older adults in Singapore

Access to the influenza vaccine pose little barriers in developed countries such as Singapore and vaccination against influenza is highly recommended for at-risk populations including older adults. However, vaccination rates are much lower than recommended despite the significant morbidity and mortality associated with the disease among this vulnerable population. Given timely goals to increase vaccine acceptance and uptake, we explored Singaporean older adults’ misperceptions about influenza disease and vaccine. Qualitative semi-structured interviews were conducted among 76 Singaporean adults aged 65 and above with no focus on a specific area in Singapore. Data were analyzed with grounded theory methods to understand participants’ attitudes, perceptions, and knowledge. We developed in vivo codes that reflect the verbiage used by participants and exhaustively catalogued themes through a constant comparison coding method. Focusing specifically on older adults’ misperceptions, seven main themes about influenza disease or vaccine emerged from our data analysis: familiarity with influenza, misperceptions about influenza, personal susceptibility to influenza, familiarity with the influenza vaccine, misperceptions about the influenza vaccine, misperceptions about influenza vaccine usage, and opinions about and barriers to influenza vaccine uptake. Notably, there is a lack of adequate knowledge and motivation in vaccinating against influenza among older adults in Singapore. Health communication needs to be more tailored toward older adults’ message processing systems and engage health professionals’ involvement in addressing the influenza disease and vaccine misperceptions identified in this study.

Non-compliance to Mass Drug Administration Associated with the Low Perception of the Community Members About their Susceptibility to Lymphatic Filariasis in Ankobra, Ghana

BACKGROUND

Lymphatic filariasis (LF) is a parasitic disease that has been targeted for elimination through the Mass Drug Administration (MDA.) Although the MDA started in the Ankobra community in Ghana in 2000, LF prevalence as reported in 2014 was relatively high (4.5%). Non-compliance to the MDA has been associated with the persistent LF prevalence in endemic regions.

OBJECTIVE

This study determined the factors associated with the non-compliance to the MDA among patients living in the Ankobra community, Ghana.

METHODS

A cross-sectional study using a one-stage cluster sampling method was used to collect data between June and July, 2017 in Ankobra. Questionnaires were used to collect data from health workers, the MDA drug distributors and study participants in Ankobra. Data analysis was performed using STATA 14. Logistic regression was used to measure the degree of association between the dependent (non-compliance) and independent variables. Non-compliance rate was defined as the percentage of individuals who self-reported that they did not actually swallow the drugs provided during the MDA.

RESULTS

The MDA coverage and non-compliance rates were 73.5% (147/200) and 33.33% (49/147) respectively. The main reason for non-compliance was fear of drug adverse events (75.51%, 37/49). Thought of "not being susceptible to LF" was significantly associated with the non-compliance (aOR= 2.83, [CI= 1.15, 6.98]).

CONCLUSION

Health education about the susceptibility of residents getting LF disease in endemic community must be intensified to improve compliance to MDA medication ingestion and thus meet the Global Elimination of Lymphatic Filariasis by 2020.

Biopsychosocial Influences on Shoulder Pain: Analyzing the Temporal Ordering of Postoperative Recovery

Shoulder surgery is a primary intervention for shoulder pain, yet many individuals experience persistent postoperative pain. Previously, we found individuals categorized as having a high-risk phenotype (comprised of COMT variation and pain catastrophizing) had approximately double the chance of not reaching a 12-month pain recovery criterion. As a means to better understand the development of persistent postoperative shoulder pain, this study advanced our previous work by examining temporal ordering of postoperative shoulder recovery based on potential mediating factors, and expansion of outcomes to include movement-evoked pain and shoulder active range of motion. Before surgery, individuals were categorized as either high-risk (high pain catastrophizing, COMT-genotype linked to low enzyme activity [n = 41]) or low-risk (low pain catastrophizing, COMT-genotype linked to normal enzyme activity [n = 107]). We then compared potential mediating variables at 3, 6, and 12 months postoperatively 1) endogenous pain modulation defined by a conditioned pain modulation paradigm; and 2) and emotion factors such as anxiety, fear of movement, and depressive symptoms. At 3 months, the high-risk subgroup had higher fear and movement-evoked pain, and causal mediation analysis confirmed the direct effect of risk subgroup on 12-month movement evoked pain. However, baseline to 12-month change in depressive symptoms were found to mediate 53% of the total effect of risk subgroup on 12-month movement-evoked pain. This study introduces potential temporal components and relationships to the development of persistent postoperative shoulder pain, which future studies will confirm and assess for potential therapeutic targets. PERSPECTIVE: This study expands upon postoperative shoulder recovery measures to include movement-evoked pain and depressive symptoms, and provides preliminary indication of temporal ordering to postoperative shoulder recovery for a preidentified high-risk subgroup. Future studies will distinguish temporal components of shoulder surgery that may optimize treatment targets of postoperative recovery.

Heart rate variability in middle-aged adults: Use of Sasang typology to distinguish individuals susceptible to stress

While stress is known to cause many diseases, there is no established method to determine individuals vulnerable to stress. Sasang typology categorizes humans into four Sasang types (So-Eum, Tae-Eum, So-Yang, and Tae-Yang), which have unique pathophysiologies because of their differential susceptibilities to specific stimuli, including stress. The purpose of this study was to determine if Sasang typology can be used identify individuals who are vulnerable to stress by evaluation of heart rate variability (HRV).This was a cross-sectional study. A total of 399 healthy men and women aged 30 to 49 years were recruited. Physical examinations for stress included HRV measurement and blood tests. The subjects also completed questionnaires about psychological stress, self-awareness, and lifestyle. HRV was analyzed using frequency-domain analysis. Subjects were divided into So-Eum (SE) and non-So-Eum (non-SE) groups according to their diagnosis.The weight and body mass index in the SE group were significantly lower than those in the non-SE group (both, P = .000). There were no significant between-group differences in any other demographic variables. In HRV analysis, the normalized high frequency (nHF) was higher (P = .008) while the normalized low frequency (nLF; P = .008) and LF:HF ratio (LF/HF; P = .002) were lower in the SE group than in the non-SE group.Although there was no difference in variables affecting HRV, HRV values were significantly different between groups. The LF/HF value for the SE group was at the lower limit of the normal range, although there were no associated clinical problems. These findings suggest that individuals with the SE type are more susceptible to stress than those with the other types. Thus, middle-aged individuals who are vulnerable to stress can be identified using Sasang typology.

Early-life epigenetic changes along the corticotropin-releasing hormone (CRH) gene influence resilience or vulnerability to heat stress later in life

Stressful events in early life might lead to stress resilience or vulnerability, depending on an adjustable stress-response set-point, which can be altered during postnatal sensory development and involves epigenetic regulation of corticotropin-releasing hormone (CRH). During the critical developmental period of thermal-control establishment in 3-day-old chicks, heat stress was found to affect both body temperature and expression of CRH in the hypothalamic paraventricular nucleus. Both increased during heat challenge in vulnerable chicks, whereas they decreased in resilient chicks. Our aim was to elucidate the epigenetic mechanism underlying the regulation of stress resilience or vulnerability. Accordingly, DNA CpG methylation (5mC) and hydroxymethylation (5hmC) at the CRH intron, which we found to serve as a repressor element, displayed low 5mc% alongside high 5hmc% in resilient chicks, and high 5mc% with low 5hmc% in vulnerable ones. RE1-silencing transcription factor (REST), which has a binding site on this intron, bound abundantly during acute heat stress and was nearly absent during moderate stress, restricting repression by the repressor element, and thus activating CRH gene transcription. Furthermore, REST assembled into a protein complex with TET3, which bound directly to the CRH gene. Finally, the adjacent histone recruited the histone acetylation enzyme GCN5 to this complex, which increased H3K27ac during harsh, but not moderate heat conditioning. We conclude that an epigenetic mechanism involving both post-translational histone modification and DNA methylation in a regulatory segment of CRH is involved in determining a resilient or vulnerable response to stress later in life.

Metabolic Reprogramming in Astrocytes Distinguishes Region-Specific Neuronal Susceptibility in Huntington Mice

The basis for region-specific neuronal toxicity in Huntington disease is unknown. Here, we show that region-specific neuronal vulnerability is a substrate-driven response in astrocytes. Glucose is low in HdhQ(150/150) animals, and astrocytes in each brain region adapt by metabolically reprogramming their mitochondria to use endogenous, non-glycolytic metabolites as an alternative fuel. Each region is characterized by distinct metabolic pools, and astrocytes adapt accordingly. The vulnerable striatum is enriched in fatty acids, and mitochondria reprogram by oxidizing them as an energy source but at the cost of escalating reactive oxygen species (ROS)-induced damage. The cerebellum is replete with amino acids, which are precursors for glucose regeneration through the pentose phosphate shunt or gluconeogenesis pathways. ROS is not elevated, and this region sustains little damage. While mhtt expression imposes disease stress throughout the brain, sensitivity or resistance arises from an adaptive stress response, which is inherently region specific. Metabolic reprogramming may have relevance to other diseases.

Is susceptibility to E-cigarettes among youth associated with tobacco and other substance use behaviors one year later? Results from the PATH study

E-cigarettes are the most commonly used tobacco product among youth. In addition to harm potential, e-cigarette use is associated with initiating cigarette smoking. Limited research exists whether susceptibility to e-cigarette use is a risk factor for future tobacco and other substance use initiation. This study examined associations between baseline e-cigarette susceptibility and initiation and past 30-day use of e-cigarettes and cigarettes as well as initiation of marijuana and alcohol one year later, after adjusting for other risk factors and sociodemographic confounders. The study sample consisted of 5156 nationally representative youth (12-17 years) who completed both waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health (PATH) study and were never users of tobacco, marijuana, and alcohol in Wave 1. Youth who were susceptible to e-cigarettes had increased odds of initiating e-cigarettes (adjusted OR: 2.22, 95% CI: 1.55-3.18), marijuana (aOR: 1.66, 95% CI: 1.12-2.46), and alcohol (aOR: 1.61, 95% CI: 1.26-2.06) between waves, as well as past reporting 30-day e-cigarette use (aOR: 3.64, 95% CI: 1.93-6.89) in Wave 2. Additionally, cigarette susceptibility, but not e-cigarette susceptibility, was associated with cigarette initiation (aOR: 3.36, 95% CI: 1.95-5.82) and past 30-day use (aOR: 2.83, 95% CI: 1.34-5.97). Prevention policies, as well as future research, could target youth susceptible to e-cigarettes to reduce the current trends on the use of these alternative tobacco products. Such efforts may also reduce the use of cigarettes and other substances.

The interplay between externalizing disorders polygenic risk scores and contextual factors on the development of marijuana use disorders

Externalizing disorders have been extensively linked to substance use problems. However, less is known about whether genetic factors underpinning externalizing disorders and environmental features interact to predict substance use disorders (i.e., marijuana abuse and dependence) among urban African Americans. We examined whether polygenic risk scores (PRS) for conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD) interacted with contextual factors (i.e., parental monitoring, community disadvantage) to influence risk for marijuana use disorders in a sample of African American youth. Participants (N=1,050; 44.2% male) were initially recruited for an elementary school-based universal prevention trial in a Mid-Atlantic city and followed through age 20. Participants reported on their parental monitoring in sixth grade and whether they were diagnosed with marijuana abuse or dependence at age 20. Blood or saliva samples were genotyped using the Affymetrix 6.0 microarrays. The CD and ADHD PRS were created based on genome-wide association studies conducted by Dick et al. (2010) and Demontis et al. (2017), respectively. Community disadvantage was calculated based on census data when participants were in sixth grade. There was an interaction between the CD PRS and community disadvantage such that a higher CD PRS was associated with greater risk for a marijuana use disorder at higher levels of neighborhood disadvantage. This finding should be interpreted with caution owing to the number of significance tests performed. Implications for etiological models and future research directions are presented.

Bold personality makes domestic dogs entering a shelter less vulnerable to diseases

It is widely recognised that for vertebrate species, personalities vary along an axis with extremes represented by ‘proactive’ and ‘reactive‘ individuals. The aim of this study was to verify whether there is a relationship between personality and disease vulnerability in domestic dogs (Canis familiaris) exposed to an intensely stressful situation such as entering a shelter. Twenty-eight shelter dogs participated in the study. The ethogram consisted of approximately 100 behavioural patterns. Behavioural observations of dogs in their new environment, a Novel Object and a T-maze test were used to evaluate the personality of the dogs captured as strays and entering the shelter. A blood sample from each dog was obtained at admission into the shelter and after a month to evaluate their immunological state. Based on PCA analyses of observational combined with experimental data, the dogs were ordered along the boldness-shyness axis, with the first being the boldest. Excluding one (the 6th), the first 10 dogs showed an improved health status: absence of disease symptoms during the 30 days of monitoring and improved immunological parameters; the opposite was found for shy dogs. The results of this research seem to confirm findings in other vertebrate species, i.e., bold and shy dog vulnerability to diseases might be different, especially when they must cope with a stressful and highly infectious environment such as a dog shelter.

Personality and Lung Function in Older Adults

OBJECTIVES

Lung disease is a leading cause of disability and death among older adults. We examine whether personality traits are associated with lung function and shortness of breath (dyspnea) in a national cohort with and without chronic obstructive pulmonary disease (COPD).

METHOD

Participants (N = 12,670) from the Health and Retirement Study were tested for peak expiratory flow (PEF) and completed measures of personality, health behaviors, and a medical history.

RESULTS

High neuroticism and low extraversion, openness, agreeableness, and conscientiousness were associated with lower PEF, and higher likelihood of COPD and dyspnea. Conscientiousness had the strongest and most consistent associations, including lower risk of PEF less than 80% of the predicted value (OR = 0.67; 0.62-0.73) and dyspnea (OR = 0.52; 0.47-0.57). Although attenuated, the associations remained significant when accounting for smoking, physical activity, and chronic diseases including cardiovascular and psychiatric disorders. The associations between personality and PEF or dyspnea were similar among those with or without COPD, suggesting that psychological links to lung function are not disease dependent. In longitudinal analyses, high neuroticism (β = -0.019) and low conscientiousness (β = 0.027) predicted steeper declines in PEF.

DISCUSSION

A vulnerable personality profile is common among individuals with limited lung function and COPD, predicts shortness of breath and worsening lung function.

Factors associated with the uptake of seasonal influenza vaccination in older and younger adults: a large, population-based survey in Beijing, China

OBJECTIVES

The present study aimed to estimate the influenza vaccination coverage rate in Beijing, China, and identify its determinants in older and younger adults.

METHODS

A survey was conducted among Chinese adults using a self-administered, anonymous questionnaire in May-June 2015. The main outcome was seasonal influenza vaccination uptake. Multivariate logistic regression models were performed to identify factors associated with uptake.

RESULTS

A total of 7106 participants completed the questionnaire. The overall coverage rate was 20.6% (95% CI 19.7% to 21.5%) in the 2014/2015 influenza season. Lower education (older adults: OR 1.6; 95% CI 1.2 to 2.1; younger adults: OR 1.9; 95% CI 1.4 to 2.6), having a chronic illness (older adults: OR 1.9; 95% CI 1.5 to 2.4; younger adults: OR 1.4; 95% CI 1.2 to 1.7) and recommendations from healthcare workers (older adults: OR 5.4; 95% CI 3.9 to 7.4; younger adults: OR 4.5; 95% CI 3.7 to 5.4) were positively associated with uptake; perceived side effects of vaccination had a negative impact (older adults: OR 0.6; 95% CI 0.4 to 0.7; younger adults: OR 0.8; 95% CI 0.7 to 1.0). Perceived susceptibility to influenza (OR 1.5; 95% CI 1.2 to 2.0) and awareness of the free influenza vaccine policy (OR 1.9; 95% CI 1.2 to 2.9) were only associated with vaccine uptake in older adults, while perceived effectiveness of vaccination (OR 2.2; 95% CI 1.7 to 2.8) was only a predictor for younger adults. Older adults were more likely to receive recommendations from healthcare professionals and perceive the severity of seasonal influenza, and less likely to worry about side effects of vaccination.

CONCLUSION

The influenza vaccination coverage rate was relatively low in Beijing. Apart from free vaccinations for older adults, age disparity in the rate between older and younger adults (48.7% vs 16.0%) may be explained by differing professional recommendations and public perceptions. Vaccination campaigns targeting increasing professional recommendations and public perceptions should be implemented in the coming years.

Human papillomavirus (HPV) vaccine knowledge, attitudes, and uptake in college students: Implications from the Precaution Adoption Process Model

The purpose of this study was to examine human papillomavirus (HPV) and HPV vaccine knowledge, attitudes, and uptake in college students and to identify factors associated with vaccination status utilizing the Precaution Adoption Process Model (PAPM). The sample included 383 undergraduates from a public university who participated in February and March 2015. Students were emailed an anonymous online survey assessing knowledge, attitudes, and perceptions related to HPV and HPV vaccination, as well as their stage in the PAPM regarding vaccination completion. Significantly more females (47.3%) than males (15.8%) were vaccinated. While most students had basic knowledge of HPV, they had low perceptions of their susceptibility to contract HPV. Most unvaccinated students were in the early stages of decision-making related to vaccination. Campus health centers have an opportunity to increase HPV vaccination rates. This study indicates that students need prompts from providers, as well as education regarding susceptibility to HPV.

Invited Commentary: Cassel's "The Contribution of the Social Environment to Host Resistance"-A Modern Classic

John Cassel's 1976 paper "The Contribution of the Social Environment to Host Resistance" (Am J Epidemiol. 1976;104(2):107-123) is widely regarded as a classic in epidemiology. He makes the compelling argument that the quality of a person's social relationships, that is, the degree to which her relationships are more stressful than supportive (or vice versa) influences her susceptibility to disease independent of genetic endowment, diet, physical activity, etc. Cassel's provocative thesis was anchored in a cogent synthesis of findings from animal experiments and observational studies on diverse human populations. Beginning in the late 1970s, the paper stimulated an explosion of epidemiologic research on social support and human health. Beyond advancing epidemiologic theory, Cassel showed how findings from various epidemiologic study designs could be marshalled to build a persuasive causal argument that impaired social bonds increase the risk of premature disease and death. The paper also foreshadowed core ideas of later theoretical constructs, such as weathering and allostatic load, regarding the power of chronic environmental stressors to accelerate biological aging across multiple organ systems. Cassel's assessment of the research and practice implications of his conclusions has remarkable contemporary resonance for the field of epidemiology.

Resilience to adversity and the early origins of disease

For the past quarter century, scientists at the Center for Family Research at the University of Georgia have conducted research designed to promote understanding of normative developmental trajectories among low socioeconomic status African American children, youths, and young adults. In this paper, we describe a recent expansion of this research program using longitudinal, epidemiological studies and randomized prevention trials to test hypotheses about the origins of disease among rural African American youths. The contributions of economic hardship, downward mobility, neighborhood poverty, and racial discrimination to allostatic load and epigenetic aging are illustrated. The health benefits of supportive family relationships in protecting youths from these challenges are also illustrated. A cautionary set of studies is presented showing that some psychosocially resilient youths demonstrate high allostatic loads and accelerated epigenetic aging, suggesting that, for some, "resilience is just skin deep." Finally, we end on an optimistic note by demonstrating that family-centered prevention programs can have health benefits by reducing inflammation, helping to preserve telomere length, and inhibiting epigenetic aging.

Peer Victimization and Harsh Parenting Predict Cognitive Diatheses for Depression in Children and Adolescents

The current study examined peer victimization and harsh parenting as longitudinal predictors of broadband and narrowband cognitions associated with the etiology of depression in children and adolescents. The sample consisted of 214 elementary and middle school students. At the start of the study, their average age was 12.2 years (SD = 1.0). The sex ratio was 112 girls to 102 boys. The sample was ethnically diverse (58.9% Caucasian, 34.1% African American, 10.7% Hispanic, 3.3% Asian, and 5.2% other). Children and their parents completed measures of peer victimization and harsh parenting. At two waves 1 year apart, children also completed questionnaire measures of negative and positive broadband cognitive style (e.g., personal failure, global self-worth) and narrowband self-perceptions (e.g., perceived social threat, social acceptance). Every Wave 2 cognitive variable was predicted by peer victimization or harsh parenting or both, even after controlling for a Wave 1 measure of the same cognitive variable. Peer victimization more consistently predicted narrowband social/interpersonal cognitions, whereas harsh parenting more consistently predicted broadband positive and negative cognitions. Furthermore, controlling for positive and negative self-cognitions eliminated a statistically significant effect of harsh parenting and peer victimization on depressive symptoms. Support emerged for the social learning of negative self-cognitions. Support also emerged for negative self-cognitions as a mediator of depressive symptoms. Implications for theory and practice are discussed.

The Importance of a Biopsychosocial Approach in Melanoma ResearchExperiences from a Single-center Multidisciplinary Melanoma Working Group in Middle-Europe

The biopsychosocial model represents a very important theoretical framework developed in the 21th century. According to a body mind unity theory, it postulates that research must focus not only on biomedical but also on other aspects in order to understand complex interactions occurring on different system levels. With regard to the occurrence of melanoma, both immunologic surveillance and a lack of cancerogenic factors are crucial in the suppression of tumor development. In addition, a reduction in mental stress (employing effective strategies for coping with stress) in cases of malignant disease seems to prolong life. Focusing on these theories, examples of studies that followed an interdisciplinary, biopsychosocial approach to melanoma research conducted at one center are given to emphasize the multi-dimensional and interdisciplinary aspects of the biopsychosocial model.

Barriers to prevention of cervical cancer in the city of Porto Velho, Rondônia, Brazil

OBJECTIVE

Identify the related factors with the no adhesion of women in preventive practices of cervical cancer (CC), in a coverage area of a Family Health Team in the city of Porto Velho (Rondônia, Brazil).

METHODS

Descriptive, cross-sectional study held in 2013. It was applied a questionnaire containing questions related to the health belief model (HBM) of the instrument "Champion's Health Belief Model Scale", validated and culturally adapted to Brazil, to 286 women.

RESULTS

87.7% of women state that they have been submitted to prevention of CC; Regarding the parameters of the HBM, it was found that 74.5% of the women had low scores for the perception of susceptibility to the disease; equal percentage of women had an moderate perception of severity; 52.8% have an moderate perception of the benefits gained from the examination of prevention; and 51.4% have moderate perception of barriers to perform the same test.

CONCLUSION

the process involving the prevention of CC involves the supply of services and availability of skilled professionals. However, the adoption of preventive behavior depends not only on external factors, but also own subjective factors to women.

School bullying and susceptibility to smoking among never-tried cigarette smoking students

INTRODUCTION

Bullying involvement has been linked with substance use; however, less is known about its relationship with pre-initiation stages of adolescent cigarette smoking behavior. This study examined the association between bullying involvement and smoking susceptibility among never tried or experimented with cigarette smoking students. Susceptibility to cigarette smoking in adolescence is a strong predictor of subsequent smoking initiation.

METHODS

A cross-sectional data on Canadian adolescent and youth were drawn from the 2012/2013 Youth Smoking Survey (n=28,843). Logistic regression analysis was used to examine the association between bullying and smoking susceptibility among never-smoking students.

RESULTS

About 21% self-reported involvement in bullying (as a bully, victim or both). Middle school students (grades 6-8) reported more involvement in bullying (24%) than those in grades 9-12 (16%). The multivariable analyses showed that the association between bullying and smoking susceptibility was significantly different by grade level. Middle school students involved in bullying had higher odds of smoking susceptibility compared to uninvolved students (bully, adjusted odds ratio [AOR]=2.54, 95% CI=1.73-3.74; victim, AOR=1.29, 95% CI=1.11-1.48; bully-victim, AOR=2.19, 95% CI=1.75-2.74). There were no significant associations between all subgroups of bullying and smoking susceptibility for grades 9-12 students.

CONCLUSIONS

Students involved in bullying were more susceptible to smoking, although patterns of association varied by grade level. In particular, the findings highlight that non-smoking middle school students involved in bullying were susceptible to future smoking.

Differential Susceptibility of the Developing Brain to Contextual Adversity and Stress

A swiftly growing volume of literature, comprising both human and animal studies and employing both observational and experimental designs, has documented striking individual differences in neurobiological sensitivities to environmental circumstances within subgroups of study samples. This differential susceptibility to social and physical environments operates bidirectionally, in both adverse and beneficial contexts, and results in a minority subpopulation with remarkably poor or unusually positive trajectories of health and development, contingent upon the character of environmental conditions. Differences in contextual susceptibility appear to emerge in early development, as the interactive and adaptive product of genetic and environmental attributes. This paper surveys what is currently known of the mechanisms or mediators of differential susceptibility, at the levels of temperament and behavior, physiological systems, brain circuitry and neuronal function, and genetic and epigenetic variation. It concludes with the assertion that differential susceptibility is inherently grounded within processes of biological moderation, the complexities of which are at present only partially understood.

Talking About Type 2 Diabetes: Family Communication From the Perspective of At-Risk Relatives

PURPOSE

The purpose of this study was to describe type 2 diabetes (T2DM) communication and risk reduction recommendations from the perspective of family members at risk for T2DM based on family history.

METHODS

Semistructured qualitative interviews were conducted with 33 individuals with a first-degree relative with T2DM. Participants were recruited from the community and a previous pharmacogenetics study. Deductive and inductive codes were applied to the transcripts.

RESULTS

Conversations with family members with and without T2DM focused on symptoms and disease management of the family member with T2DM. With at-risk relatives, conversations also focused on prevention. Lack of perceived relevance to family members without T2DM was a barrier to communication. Recommendations to facilitate communication included education of an at-risk family member to increase awareness of risk, followed by sharing of learned information with others.

CONCLUSION

Efforts are needed to increase awareness and improve communication about T2DM risk factors, familial risk, and risk reduction behaviors within families with a family history of T2DM. Family members with and without T2DM should be encouraged to communicate with their relatives about T2DM and the risk to family members. Identification of family members who can facilitate communication, education, and modeling of healthy behaviors may increase awareness and motivate at-risk individuals to engage in risk-reducing behaviors.

Parsing susceptibility and severity dimensions of health risk perceptions

Risk perceptions, an important determinant of positive behavioral change, are often conceptualized as an additive or multiplicative index of two concepts: susceptibility to and severity of a health risk. Susceptibility is the possibility of experiencing a health risk, whereas severity is its seriousness or harmfulness. This article challenged the current theorization of risk perceptions. To demonstrate the differential perceptions of susceptibility and severity, two self-report studies (N = 70, each) and one reaction time study (N = 476) provided data on 50 health conditions that varied on several risk characteristics (e.g., prevalence, personal experience). Results showed that susceptibility and severity were two distinct, inversely related concepts. Perceived susceptibility and severity varied by risk characteristics, mainly prevalence (i.e., how common a health risk was perceived to be). Self-report data showed that a progressive increase in perceptions of a health risk prevalence rates was associated with an increase in susceptibility and a decrease in severity (and vice versa). Reaction-time data mirrored this pattern and showed these differential perceptions of susceptibility and severity were highly accessible, as evident by fast reaction times. Several individual differences (e.g., optimism) emerged as significant predictors of risk perceptions and their accessibility. Theoretical and practical implications are discussed.

The relationship between tooth loss and psychological factors

OBJECTIVES

Limited evidence is available regarding mutual interactions between psychological factors and tooth loss. This study aimed to investigate the association between these two issues.

METHOD

In this 2011 cross-sectional study we obtained data from 4,585 adults who had completed information in 20 counties across Isfahan province, Iran, regarding tooth loss and psychological factors (depression, anxiety and stress level). To analyse the data ANOVA and multiple ordinal regression were applied.

RESULTS

After adjusting socio demographic factors, the association between depression (OR 1.23; 95% CI = 1.01,1.49), anxiety (OR 1.19; 95% CI = 1.03,1.38), and high stress level (OR 95% CI = 1.19; 1.01,1.39) remained significant.

CONCLUSION

We confirm the interaction between psychological factors and tooth loss, but recommend further studies on a national Iranian population.

Intention to undergo colonoscopy screening among relatives of colorectal cancer cases: a theory-based model

BACKGROUND

It is recommended that persons having familial risk of colorectal cancer begin regular colonoscopy screening at an earlier age than those in the general population. However, many individuals at increased risk do not adhere to these screening recommendations.

PURPOSE

The goal of this study was to examine cognitive, affective, social, and behavioral motivators of colonoscopy intention among individuals at increased risk of familial colorectal cancer.

METHODS

Relatives of colorectal cancer cases (N = 481) eligible for colonoscopy screening completed a survey assessing constructs from several theoretical frameworks including fear appeal theories.

RESULTS

Structural equation modeling indicated that perceived colorectal cancer risk, past colonoscopy, fear of colorectal cancer, support from family and friends, and health-care provider recommendation were determinants of colonoscopy intention.

CONCLUSIONS

Future interventions to promote colonoscopy in this increased risk population should target the factors we identified as motivators. (ClinicalTrials.gov number NCT01274143).

Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility

BACKGROUND

Depression, anxiety, and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders.

METHODS AND RESULTS

Participants were 1 107 524 Swedish men conscripted at a mean age of 18.3 years. Mental disorders were assessed by psychiatric interview on conscription, and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. An increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.62) (depressive disorders) to 1.90 (1.58, 2.38) (alcohol-related disorders). [corrected]. The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24-1.80) (schizophrenia) to 2.82 (2.53-3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes mellitus, and blood pressure measured at conscription, but they were partially attenuated by the adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position.

CONCLUSIONS

Increased risk of incident CHD is present across a range of mental disorders and is observable when the disorders are diagnosed at a young age.

Cognitive decline and cardiometabolic risk among Hispanic and non-Hispanic white adults in the San Luis Valley Health and Aging Study

Cardiometabolic risk factors, including hypertension, dyslipidemia, central obesity, insulin resistance and diabetes are linked to cognitive impairment. The Hispanic population appears to be differentially affected by both cardiometabolic risk factors and cognitive impairment. We sought to determine whether ethnic differences in cognitive impairment in long-resident southwestern US elders was explained by the presence of cardiometabolic risk factors, and to explore patterns of cognitive decline over time. We performed a secondary analysis of data collected on 378 Hispanic and 409 non-Hispanic white adult participants in a longitudinal study of community-dwelling elderly in southern Colorado. Measures of cardiometabolic risk included waist circumference, blood pressure, diagnosis of diabetes, and random blood glucose. Cognitive measures included the Mini-Mental State Exam (MMSE) and the behavioral dyscontrol scale (a measure of executive cognitive function), at baseline and after an average of 22 months. Subjects were also administered the Center for Epidemiologic Studies Depression Scale, and the Coronary Artery Risk Development in Young Adults 1-Year Activity Recall. At baseline, Hispanic elders had a greater number of cardiometabolic risk factors and lower MMSE and behavioral dyscontrol scale scores than non-Hispanic whites. Hispanic ethnicity was associated with a greater likelihood of decline in general cognitive function, but not executive cognitive function, after adjusting for age and education. This differential decline was not explained by either individual or total number of baseline cardiometabolic risk factors, depression, or physical activity. A borderline increased risk of decline in general cognitive function was seen in sedentary individuals (P = 0.05).

[Psychological gender in clinical depression. Preliminary study]

AIM

Psychosocial and social theories of mood disorders indicate that factors connected with women's gender roles could create a higher risk of depression. The fact that social role is an important factor associated with depressive disorders suggests that not only a biological but also a psychological gender influences the vulnerability to depression.

METHOD

Gender schema theory was applied to investigate a role of femininity in depressive disorders. It was predicted that patients who identify themselves with the traditional feminine gender role will be more depressed than androgynous and undifferentiated patients or individuals with high level of masculinity. Sixty one patients suffering from affective disorder participated in this research. The Polish adaptation of Bem Sex - Role Inventory and Beck Depression Inventory were used to investigate the association between psychological gender and symptoms of depression.

RESULTS

The results indicated that there is a significant connection between the type of psychological gender and the level of depression. The highest level of depression was shown by undifferentiated patients, femininity was also found to be associated with a great number of depressive symptoms. These findings also suggest that androgynous individuals and patients with a high level of masculinity tend to be less depressed.

CONCLUSIONS

Psychological gender is an important factor which interacts to create a higher depression risk in men and women.

Animal models of stress vulnerability and resilience in translational research

Stress has been identified as a key risk factor for a multitude of human pathologies. However, stress by itself is often not sufficient to induce a disease, as a large contribution comes from an individual's genetic background. Therefore, many stress models have been created to investigate this so-called gene-environment interaction for different diseases. Recently, evidence has been accumulating to indicate that not only the exposure to stress, but also the vulnerability to such an exposure can have a significant impact on the development of disease. Herein we review recent animal models of stress vulnerability and resilience, with special attention devoted to the readout parameters and the potential for translatability of the results.

Threat, efficacy, and uncertainty in the first 5 months of national print and electronic news coverage of the H1N1 virus

The authors conducted a content analysis, investigating the first 5 months of national print and electronic news coverage of the H1N1 virus. They collected all stories about H1N1 appearing in 6 national news outlets between April and September 2009. Of these stories meeting the analysis criteria, the authors randomly selected 200 for inclusion. Using models of fear appeal message processing, this study investigated the nature and prevalence of threat and efficacy messages in news coverage of the virus. Such models have traditionally been applied to strategic health message contexts (e.g., campaigns) rather than to health news coverage. Results suggest that most stories made reference to the threat of the H1N1 virus, sometimes overemphasizing and sensationalizing virus-related death. With regard to efficacy, approximately half mentioned actions individuals or organizations/communities could take to protect themselves from the virus, but almost none provided evidence that such methods are effective, and some explicitly questioned their effectiveness. In addition, a number of stories referenced uncertainty about the threat of the virus (38%) and/or solutions to the potential threat (18%). The authors discuss the implications from the perspective of fear appeal message processing models.

The familial association of tourette's disorder and ADHD: the impact of OCD symptoms

Tourette's disorder (TD) frequently co-occurs with attention-deficit/hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). While the relationship between TD and OCD suggests that they share etiological factors, the exact relationship between TD and ADHD is less clear. The goal of the current analyses was to understand better the familial relationship between DSM-IV ADHD and TD. Direct interview diagnostic data from a case-control study of 692 relatives of 75 comorbid TD and ADHD (TD + ADHD), 74 TD without ADHD (TD Only), 41 ADHD without TD (ADHD Only), and 49 control probands were analyzed. Hierarchical loglinear modeling was used to explore association patterns between TD, ADHD, and OCD or sub-clinical OCD (OCD/OCDsub) diagnoses among the 190 affected probands and their 538 relatives. The presence of OCD or OCDsub diagnosis in a proband was associated with a significantly increased risk of comorbid TD + ADHD in his/her relatives. The finding of an association between TD, ADHD and a proband OCD/OCDsub diagnosis was unexpected. The current results suggest that TD, ADHD, and OCD symptoms have overlapping neurobiology when occurring in families of TD and/or ADHD probands.

Identifying key features of early stressful experiences that produce stress vulnerability and resilience in primates

This article examines the complex role of early stressful experiences in producing both vulnerability and resilience to later stress-related psychopathology in a variety of primate models of human development. Two types of models are reviewed: Parental Separation Models (e.g., isolate-rearing, peer-rearing, parental separations, and stress inoculation) and Maternal Behavior Models (e.g., foraging demands, variation in maternal style, and maternal abuse). Based on empirical evidence, it is argued that early life stress exposure does not increase adult vulnerability to stress-related psychopathology as a linear function, as is generally believed, but instead reflects a quadratic function. Features of early stress exposure including the type, duration, frequency, ecological validity, sensory modality, and developmental timing, within and between species, are identified to better understand how early stressful experiences alter neurobiological systems to produce such diverse developmental outcomes. This article concludes by identifying gaps in our current knowledge, providing directions for future research, and discussing the translational implications of these primate models for human development and psychopathology.

Adaptive significance of natural variations in maternal care in rats: a translational perspective

A wealth of data from the last fifty years documents the potency of early life experiences including maternal care on developing offspring. A majority of this research has focused on the developing stress axis and stress-sensitive behaviors in hopes of identifying factors impacting resilience and risk-sensitivity. The power of early life experience to shape later development is profound and has the potential to increase fitness of individuals for their environments. Current findings in a rat maternal care paradigm highlight the complex and dynamic relation between early experiences and a variety of outcomes. In this review we propose adaptive hypotheses for alternate maternal strategies and resulting offspring phenotypes, and suggest means of distinguishing between these hypotheses. We also provide evidence underscoring the critical role of context in interpreting the adaptive significance of early experiences. If our goal is to identify risk-factors relevant to humans, we must better explore the role of the social and physical environment in our basic animal models.

[Positive life events and mood disorders: longitudinal evidence for a chaotic life-course hypothesis]

BACKGROUND

In psychiatric research it is often assumed that detrimental effects of negative life events on mental health can be buffered by a number of positive life events. However, there is no convincing empirical evidence that this assumption is correct; it can even be argued that positive life events act as additional stressors rather than as buffers, leading to a continuation of a chaotic life course and an increase in the risk of affective disorders.

AIM

To find out whether positive life events were associated with a higher risk of the occurrence of mood disorders and whether such an association could be explained by a number of negative life events that individuals had experienced.

METHOD

We used data from 4,796 adults, aged 18-64, collected at two measurement moments (i.e. 1997 and 1999) of NEMESIS, a Dutch prospective-epidemiological study. As a basis for our measurements we used dsm-iii-r diagnoses of major depressive disorders and dysthymia and the Life Events and Difficulties Schedules LEDS.

RESULTS

A multivariate (MPlus) path analysis demonstrated that positive life events were not, in themselves, significantly predictive of affective disorders. Positive life events were only related to the risk of mood disorders when they co-occurred with a high number of negative life events.

CONCLUSIONS

In accordance with a chaotic life-course hypothesis, positive events were not found to buffer the detrimental impact of negative life events, but when they are part of an erratic course of life they can pose an extra threat to an individual’s mental health.

Positive life events and mood disorders: longitudinal evidence for an erratic lifecourse hypothesis

BACKGROUND

An unresolved issue in psychiatry research concerns the assumption that detrimental effects of negative life events on mental health may be buffered by a multitude of positive life events. However, there is clear lack of empirical evidence for this assumption, and one may even argue that positive life events act as additional stressors and thus increase (and not decrease) the risk for affective disorders.

METHODS

Data were used from 4796 adults aged 18-64, who participated in 2 waves (i.e., 1997 and 1999) of NEMESIS, a prospective-epidemiological study. Measures were based on diagnoses of DSM-III-R mood disorders, and a life events questionnaire employed in the NEMESIS study.

RESULTS

Although the prevalence of mood disorders correlated positively with both the number of negative and positive life events experienced, a multivariate path analysis (Mplus) demonstrated that only negative life events longitudinally predicted mood disorders. Positive life events predicted subsequent mood disorders only when in the same time period a high number of negative events were experienced.

CONCLUSIONS

Positive life events do not buffer the detrimental impact of negative ones, but instead may function as additional stressor, in the context of highly erratic life course patterns that may be typical for depressed individuals.

Restraint stress fails to render C57BL/6 mice susceptible to Theiler's virus-induced demyelination

OBJECTIVES

Multiple sclerosis is a degenerative disease of the CNS with a pathology consistent with immunological mediation. Although its cause is unknown, multiple factors are thought to influence both the onset and exacerbation of the disease, including both genetic background as well as environmental factors.

METHODS

We are interested in the effect of psychological stress on the onset and exacerbation of Theiler's virus-induced demyelinating disease (TVID), a murine model of MS in which viral persistence facilitates demyelination. In the current study, we determined whether chronic restraint stress (RS)-induced immunosuppression could result in the establishment of a persistent CNS infection in the normally TVID-resistant C57BL/6 mouse strain, resulting in demyelination.

RESULTS

Our data indicated that RS repeated over the course of 7 days was not sufficient to cause decreases in virus-specific adaptive immunity, and did not significantly alter CNS viral levels. Furthermore, chronic repeated RS lasting until 4 weeks after infection altered neither the development of virus-specific IgG nor motor function determined by Rotarod analysis. In addition, histological analysis of the CNS of stressed mice indicated no inflammation or demyelination on day 193 after infection.

CONCLUSION

These results suggest that stress alone is not sufficient to overcome genetic resistance to TVID in the C57BL/6 mouse strain.

Gender differences in the longitudinal structure of cognitive diatheses for depression in children and adolescents

In a school-based, four-wave, longitudinal study, children (grades 4-7) and young adolescents (grades 6-9) completed questionnaires measuring depressive symptoms and depressive cognitions, including positive and negative cognitions on the Cognitive Triad Inventory for Children (CTI-C; Kaslow, Stark, Printz, Livingston, & Tsai, 1992) and self-perceived competence on the Self-Perception Profile for Children (SPPC; Harter, 1985). Application of the Trait-State-Occasion model (Cole, Martin, & Steiger, 2005) revealed the existence of a time-invariant trait factor and a set of time-varying occasion factors. Gender differences emerged, indicating that some cognitive diatheses were more trait-like for girls than for boys (i.e., positive and negative cognitions on the CTI-C; self-perceived physical appearance and global self-worth on the SPPC). Implications focus on the emergent gender difference in depression, the design of longitudinal studies, and clinical decisions about the implementation of prevention versus intervention programs.

Understanding the ‘miserable minority’: a diasthesis-stress paradigm for post-concussional syndrome

Opinions about persisting post-concussional symptoms after minor traumatic brain injury still reflect a polarization of views around the sterile debate concerning the psychological vs organic origins of symptoms. Reviews of the experimental literature do not always integrate the often diverse perspectives that explain persisting symptoms of concussion. As a result, the disorder is still poorly understood. In this review, a diasthesis-stress paradigm examines the interaction between physiological and psychological factors that generate and maintain post-concussional symptoms. Motivational factors and different coping strategies are considered to explain why some people are at risk of developing a post-concussional syndrome. The early iatrogenic potential of GPs and hospital doctors who may create insecurity or reinforce illness perceptions is considered. Finally, the rationale and effectiveness of interventions that ameliorate the impact of early post-concussional symptoms is reviewed to see if prevention of the post-concussional syndrome is more effective than cure.

Laboratory test of a novel structural model of anxiety sensitivity and panic vulnerability

The current study evaluated a novel latent structural model of anxiety sensitivity (AS) in relation to panic vulnerability among a sample of young adults (N=216). AS was measured using the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), and panic vulnerability was indexed by panic attack responding to a single administration of a 4-minute, 10% CO(2) challenge. As predicted, vulnerability for panic attack responding to biological challenge was associated with dichotomous individual differences between taxonic AS classes and continuous within-taxon class individual differences in AS physical concerns. Findings supported the AS taxonic-dimensional hypothesis of AS latent structure and panic vulnerability. These findings are discussed in terms of their theoretical and clinical implications.

Novel environmental response and heroin-dependent susceptibility in Sprague-Dawley rats

OBJECTIVE

To establish models of different susceptibility of heroin-induced conditioned place preference (CPP) in rats and investigate the relation between novel environmental response and heroin-dependent susceptibility.

METHODS

After an open-field test, 70 male Sprague-Dawley rats were classified into 2 groups according to the numerical value of heroin-induced CPP, each accounting for 30%. The correlation between open-field test and CPP was analyzed.

RESULTS

CPP value was much higher than pre-test scores in the rats after exposure to heroin (P<0.01). Compared with the low-CPP group, the high-CPP group had much higher scores in open-field test (P<0.01). The deviation of resident time at natural preference side tested and pre-tested had positive correlation with open-field test (P<0.05).

CONCLUSION

Heroin-induced CPP model of different susceptibilities could be successfully established by chronic heroin exposure. The novel environmental response is a reliable predictor for its vulnerability to develop heroin dependence.

Affective personality as cognitive-emotional presymptom profiles regulatory for self-reported health predispositions

Three studies that examined the links between affective personality, as constructed from responses to the Positive Affect (PA) and Negative Affect (NA) Scale (PANAS), and individuals' self-report of self-esteem, intrinsic motivation and Beck's Depression Inventory (BDI) depression in high school students and persons in working occupations are described. Self-report estimations of several other neuropsychiatric and psychosocial variables including, the Uppsala Sleep Inventory (USI), the Hospital Anxiety and Depression (HAD) test, Dispositional optimism, Locus of control, the Subjective Stress Experience test (SSE) and the Stress-Energy (SE) test, were also derived. Marked effects due to affective personality type upon somatic and psychological stress, anxiety and depression, self-esteem, internal and external locus of control, optimism, stress and energy, intrinsic motivation, external regulation, identified regulation, major sleep problems, problems falling asleep, and psychophysiological problems were observed; levels of self-esteem, self-motivation and BDI-depression all produced substantial effects on health and well-being. Regression analyses indicated PA was predicted by dispositional optimism (thrice), energy (thrice), and intrinsic motivation, and counter predicted by depression (twice) and stress (twice); and NA by anxiety (twice), stress (twice), psychological stress, identified regulation, BDI depression and psychophysiological problems, and counter predicted by internal locus of control and self-esteem. BDI-depression was predicted by negative affect, major sleep problems and psychophysiological problems (Study III), self-esteem by dispositional optimism and energy, and counter predicted by anxiety, depression and stress (Study I), and intrinsic motivation by dispositional optimism, energy, PA and self-esteem (Study II). These convergent findings are interpreted from a perspective of the cognitive-emotional expressions underlying behavioural or presymptomatic profiles presenting predispositions for health or ill health.

"Couldn't you have done just as well without the screening?". A qualitative study of benefits from screening as perceived by people without a high cardiovascular risk score

OBJECTIVE

To explore how individuals whose health screening does not reveal a high cardiovascular risk score (CRS) interpret and respond to this result.

DESIGN

Qualitative semi-structured interviews. Purposeful sampling reflected variations in age, gender, and self-rated health within the sample. Analysis and interpretation were informed by the Health Belief Model concerning individuals' cues to act when told there is a health threat, and by Hollnagel and Malterud's theories about personal self-assessed health resources.

SETTING

Participants were recruited among participants without a high cardiovascular risk score in a Danish health-screening project.

SUBJECTS

Seven men and 15 women aged 36-50 years with a low or moderate cardiovascular risk score.

RESULTS

The screening confirmed the participants' feeling of being in good health and they put emphasis on this acquired peace of mind. Participants used the results to eliminate worries and confirm their lifestyle up to now but were aware that the results gave no guarantee that there was nothing the matter elsewhere. Some paid a price for the reassurance since they had to undergo further examinations, had unfulfilled expectations, or were irritated at not being left in peace with their reassurance.

CONCLUSION

Screened individuals who were shown not to have a high risk score appear to be reassured and confirmed in their own feeling of being healthy, and to be aware of the limitations of the screening. Consideration should be given to the possible risk of creating either insecurity or over-complacency through population screening.

Further examination of the relationship between anxiety sensitivity and depression: the mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed

This study examined the role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed in the relationship between anxiety sensitivity (AS) and depressive symptom severity. A sample of 391 undergraduate students completed a series of questionnaires assessing the constructs of interest. Results provided support for a model where experiential avoidance and difficulties engaging in goal-directed behavior mediate the relationship between the AS dimensions of fear of cognitive dyscontrol and fear of publicly observable anxiety reactions and depressive symptom severity. The ability of this model to distinguish participants (N=53) reporting clinical levels of depression from those without (N=53) was then examined. The model was found to reliably distinguish between participants with and without clinical levels of depression. However, only experiential avoidance was a significant mediator. Implications for research on the role of AS in depression vulnerability and treatment are discussed.