The structure of affective symptomatology in older adults with osteoarthritis

OBJECTIVE

To examine the structure of symptoms of affective disorder among older adults with a chronic health problem (osteoarthritis) and to explore cross-sectional and longitudinal associations of obtained affective symptom clusters with key health outcomes (pain, functional disability, perceived health).

METHODS

One-year longitudinal study of older adults with diagnosed osteoarthritis of the knee. Symptoms of DSM depression and anxiety were assessed in a research diagnostic interview by using a DSM-IV symptom checklist; self-reports captured demographic characteristics, objective health, pain, disability, and perceived health. Confirmatory factor analysis tested comparability of affective symptom structure in this sample to findings of previous research; ordinary least squares regression examined cross-sectional and longitudinal associations of affective symptoms with health outcomes, controlling for demographics and objective health.

RESULTS

The current sample displayed an affective symptom structure comparable with that observed in previous research, with symptoms clustering into depressed mood (DM), somatic symptoms (SS), and psychic anxiety (PA) factors. DM was cross-sectionally associated with pain and disability and marginally with perceived health; SS predicted current pain and perceived health. Only DM predicted 1 year change in disability and perceived health (but not pain).

CONCLUSIONS

This research confirms the role of SS of distress in fueling disability and perceived ill health among older adults who are chronically ill. However, it is DM that drives changes in perceived health and functional ability.

Salience of positive and negative affect in the recognition of depression among elderly persons

Generally, depression is thought of in terms of negative affect However, in the following paper, the contribution of positive affect (PA), as well as negative affect (NA), is demonstrated in the recognition of clinically significant depression. Affect and depression data were collected from 554 residents of a large, urban geriatric center. Statistical analyses demonstrated that both PA and NA were correlated with depression and measures of frailty, and that low PA and high NA were risk factors for depression 1 year later. Results suggest that low PA, or anhedonia, may be particularly important in diagnosing depression among older persons who may not readily report depressive symptoms such as sadness.

Pain, disability, and depression in osteoarthritis: effects of race and sex

OBJECTIVES

A cross-sectional study examined how race and sex affect associations among osteoarthritis (OA) pain, disability, and depression in 363 older adults with diagnosed knee OA.

METHOD

African American (Black; N = 94) and non-Hispanic White (White; N = 269) men and women self-reported pain, disability, depressive symptoms, arthritis history, general health, and demographic information.

RESULTS

Women experienced greater pain and marginally greater disability than men; African Americans reported greater disability and marginally greater pain than non-Hispanic Whites. These effects varied with education, health, and arthritis history. In ordinary least squares regression analyses, race and pain independently predicted depression. Significant interactions of race, sex, and disability were driven by a lack of relationship between depression and disability among African American men.

DISCUSSION

Race and sex influence affective response to OA pain and disability in complex ways, with African American men showing paradoxical effects. Further research is needed to elucidate mechanisms of this moderation effect.

Factors influencing delay in seeking treatment for acute ischemic symptoms among lower income, urban women

OBJECTIVE

We examined factors associated with delay in seeking emergency medical attention for acute ischemic symptoms in a sample of predominantly African American women.

METHOD

Female patients who presented with symptoms of acute myocardial infarction (AMI) were interviewed. Qualitative and quantitative methods were used to examine barriers associated with delay.

RESULTS

The mean hours of delay were 20.4 (median = 4.5 hours). Sixty-nine percent of the patients delayed 1 hour or more. These delays were associated with younger age, African American ethnicity, poorer self-rated health, and the belief that one could not personally ever have an AMI. In a multiple logistic regression model, the belief that one could not ever have an AMI significantly increased the odds of delay compared with other patient characteristics.

CONCLUSION

The results indicate that efforts should be made to increase women's awareness of personal risk for AMI and the need for development of cognitive representations of AMI.

Necessary and Discretionary Activities in Knee Osteoarthritis: Do They Mediate the Pain–Depression Relationship?

OBJECTIVE

This study examined direct vs indirect associations of pain and physical function with depression in 369 older adults with osteoarthritis (OA) of the knee. A key focus was the distinction of functional disability in necessary tasks (basic and instrumental activities of daily living) from discretionary, leisure activities.

DESIGN

A naturalistic longitudinal study examined effects of demographic variables, indicators of arthritis status, general health, pain, and several measures of functional disability upon depressive symptoms at baseline and 1 year later.

SETTING AND PATIENTS

Participants with diagnosed knee OA were recruited from rheumatological and general geriatric outpatient clinics, as well as public service announcements.

OUTCOME MEASURE

Depressive symptoms, measured with the Center for Epidemiologic Studies Depression scale.

RESULTS

At baseline, the relationships of depression with functional disability and activity limitation were wholly mediated by pain. In contrast, activity participation was independently linked with depression, even controlling health and demographic variables. A 1-year follow-up revealed that depressive symptoms increased with increasing health problems, and with reduction in activity participation over time. Having and retaining favorite pastimes were also associated with reduced depressive symptomatology at baseline and follow-up, respectively.

CONCLUSIONS

These data highlight the disease-specific nature of paths among depression, pain, and disability, and the importance of considering discretionary as well as necessary activities in evaluating effects of pain upon quality of life.

Effects of Pain on Functioning and Well-Being in Older Adults With Osteoarthritis of the Knee

The effects of pain on functioning and well-being were examined in 367 older adults with osteoarthritis (OA) of the knee. The relationship of OA-related pain to depressive symptoms and perceived health was hypothesized to be direct as well as mediated by physical and social functioning. Results showed that OA-related pain was related to poorer physical and social functioning, had a direct effect on depressive symptoms, and direct and indirect effects on perceived health. Lower social functioning was related to more depressive symptoms, and both lower social and physical functioning predicted worse perceived health. Thus, distinguishing between physical and social functioning when examining the costs of OA-related pain is useful. Moreover, existing pain-psychological well-being models can be generalized to perceived health.

Similarities and differences in depression among black and white nursing home residents

The authors examined racial similarities and differences in depressive symptomatology, diagnosis, and the predictors of depression in four independent nursing homes, conducting analyses across all sites and separately for the nursing home with the greatest racial balance (NH4). All-site data indicated that white residents showed more depression than black residents. There were no racial differences in the depression diagnosis derived from a structured interview of DSM-III-R. At NH4, there were no statistically significant racial differences in any of the measures of depression. Across sites, functional disability was the strongest predictor of both Geriatric Depression Scale (GDS) and DSM-III-R diagnosis of depression in both blacks and whites. Cognitive impairment and use of antidepressants were predictive of medical chart diagnosis of depression across sites, but not of depression measured by GDS or DSM-III-R criteria. At NH4, functional disability was predictive of GDS depression, but only among whites. Age was not an important predictor of depression. Results indicate the importance of considering the method used to diagnose depression and the necessity of controlling for the nursing home setting when examining racial differences in depression.

Hostility-related differences in the associations between stress-induced physiological reactivity and lipid concentrations in young healthy women

We examined the relations of fasting lipid levels to stress-induced neuroendocrine and cardiovascular responses as a function of hostility in 36 healthy young women. Participants were women who scored above 17 (n = 23) or below 12 (n = 13) on the Cook-Medley Hostility (Ho) Inventory. Lipids were determined following an overnight fast. Individuals participated in a solvable anagram task, which evoked significant physiological responses in all participants. The Ho group by total serum cholesterol (TSC) and the Ho group by low-density lipoprotein (LDL) cholesterol interactions significantly predicted heart rate (HR) and norepinephrine (Ne) responses. For high Ho women, elevations in TSC and LDL cholesterol were associated with smaller HR responses and larger Ne responses. In contrast, for low Ho women, elevations in TSC and LDL cholesterol were associated with larger HR responses and smaller Ne responses. Results also indicated a significant Ho group by TSC to high density lipoprotein (HDL) cholesterol ratio interaction for cortisol. For high Ho women, larger cortisol responses were associated with a greater TSC to HDL cholesterol ratio. For low Ho women, larger cortisol responses were associated with a smaller TSC to HDL cholesterol ratio. Lastly, higher TSC and LDL cholesterol levels were significantly associated with larger epinephrine responses. The findings suggest that stress-induced physiological responses are differentially associated with fasting lipids as a function of hostility in healthy young women.

The relation of hostility to lipids and lipoproteins in women: evidence for the role of antagonistic hostility

We examined the relation of antagonistic, neurotic, and cynical hostility to lipids and lipoproteins in 77 healthy women (aged 18-26) selected for having high (> 17) or low (< 12) scores on the Cook-Medley Hostility (Ho) scale. Fasting lipids were determined during the luteal phase of the menstrual cycle for oral contraceptive (OC) non-users (N = 41), and during pills 15-21 for OC users (N = 36). Factor scores for antagonistic and neurotic hostility were derived from a principal component of the Buss-Durkee Hostility Inventory, Spielberger's Anger Expression, and the NEO-Personality Inventory. High Ho scores were significantly associated with higher cholesterol. Antagonistic hostility significantly predicted cholesterol, low density lipoprotein cholesterol, triglycerides, and the ratio of cholesterol to high density lipoprotein cholesterol, with higher antagonistic hostility scores associated with higher levels. Neurotic hostility did not predict lipids. Results suggest a potential pathophysiological mechanism that may contribute to the association between hostility and coronary heart disease. Moreover, a measure of antagonistic hostility, relative to cynical and neurotic hostility, was the best predictor of lipid levels.

Cardiovascular reactivity among hostile men and women: the effects of sex and anger suppression

This study examined cardiovascular reactivity differences among hostile men and women. Sixty-four individuals (33 women 31 men; M = 19.9 years of age) were selected from a sample of 105 volunteers based on their Cook-Medley Hostility Scale scores (Cook & Medley, 1954; less than or equal to 24). Analyses revealed no significant sex differences in Cook-Medley Hostility scores. At baseline, men had higher mean systolic blood pressure (SBP) level. However, during the Stroop Color-Word Conflict Task (Stroop, 1935), high-hostile men and women exhibited similar cardiovascular responses. Further analyses revealed that cardiovascular responses to the Stroop task were differentially associated with among men and women as a function of anger suppression. For women, anger suppression was positively associated with diastolic blood pressure (DBP) responses and negatively associated with SBP responses. In contrast, anger suppression was negatively associated with DBP changes and not associated with SBP responses for men. The results suggest that personality factors, such as high hostility and anger suppression, may influence the degree to which men and women differ in their cardiovascular responses to interpersonal stressors.

Gender and cardiovascular responses: what is the role of hostility?

Two experiments are reported investigating hostility group by gender effects on heart rate and blood pressure. In experiment 1, 58 males and 59 females were tested with a protocol that included baseline, reaction time with and without harassment, and recovery. In experiment 2, 55 males and 50 females participated in a procedure of baseline, Stroop color--word conflict, anger recall interview, and recovery. Based on Buss-Durkee subscales, genders were divided into high and low neurotic hostility and expressed hostility groups. High expressed hostility was associated with greater diastolic reactivity to all tasks in males, but not in females. Low expressed hostility was associated with greater heart rate and systolic reactivity, specifically during the anger recall interview. High neurotic hostility in males and females was associated with greater diastolic reactivity to the anger task only, while low Neurotic hostility males had higher resting systolic pressures. These results suggest that outward expression of hostility in men may increase their coronary heart disease risk; however, results for both men and women support an association between cardiovascular reactivity and a lack of match between self-reported anger management style and task demands.

Long-term sequelae of childhood sexual abuse: perceived family environment, psychopathology, and dissociation

In this study, 105 abused and nonabused women were examined for patterns of adult psychopathology associated with childhood sexual abuse and to test the extent to which these patterns are independent of other pathogenic properties of the family environment. Clinical and nonclinical Ss completed the Family Environment Scale, the Minnesota Multiphasic Personality Inventory (MMPI), the Rorschach, and the Stanford Hypnotic Susceptibility Scale. Greater nonspecific impairment among abused women may be a consequence, at least in part, of pathogenic family structure rather than sexual abuse per se. However, MMPI and Rorschach responses suggest sexual abuse may render victims especially vulnerable to specific disturbances i involving soma and self. Abuse was associated with greater use of dissociation, but covariance analysis revealed this effect to be accounted for by family pathology. There was no evidence that sexual trauma is associated with hypnotizability.

The relationship of parenting styles and social competency to Type A behavior in children

This study examined parenting styles, Type A behavior in parents and children, and social competence in children. Fifty 1st-6th grade children, parents, and their teachers participated. Type A behavior in parents was associated with a controlling style of parenting, but not with pressuring the child to achieve. Parenting styles of achievement pressure and high control were related to impatient and aggressive behaviors in children, as measured by the MYTH, a teacher-scored Type A behavior instrument. In addition, impatience and aggressiveness in the children were negatively correlated with the child's social competency and ability to function in school. Parenting practices, Type A behavior, and social competency in children may play important roles in the origins of detrimental components of Type A behavior, such as impatience and aggression.