A meta-analysis of temperament in axis I psychiatric disorders

This article reports on a meta-analysis of Cloninger's temperament dimensions (novelty seeking, harm avoidance, reward dependence, and persistence) in individuals with lifetime psychiatric disorders compared with controls and on interdisorder comparisons between these disorders. Nine disorders from 75 studies were included in the meta-analyses. The most consistent feature was elevated harm avoidance: compared with the controls, harm avoidance was higher in all diagnostic groups studied except for those with alcohol use disorders. The increase in effect sizes in harm avoidance scores varied from a very large (d = 2.66) in social phobia to a small effect (effect size, d = 0.29) in alcohol use disorders. In other dimensions, differences between cases and controls were relatively small. However, in pairwise comparisons, notable differences also in other dimensions emerged: in novelty seeking, the lowest scores were in social phobia (d = -0.87) and the highest in bulimia nervosa (d = 0.33); in reward dependence, the lowest scores were in schizophrenia (d = -0.36) and the highest in social phobia (d = 0.12); and in persistence, the lowest scores were in social phobia (d = -0.30) and the highest in anorexia nervosa (d = 0.49). The provided data should be taken into account in the future studies on suggestive vulnerability markers for psychiatric morbidity.

Do people whose names begin with "D" really die young?

It has been reported that professional baseball players whose first names begin with the letter "D" tend to die relatively young (E. L. Abel & M. L. Kruger, 2010). However, the statistical evidence for this claim is based on selective data and a statistical test that ignores important confounding influences. A valid test applied to more comprehensive data from the same source does not show a statistically significant relationship between initials and longevity. In addition, data for the years 1960 through 2004 for 6.7 million White, non-Hispanic California decedents do not replicate the claim that D's die young.

Global DNA methylation is associated with insulin resistance: a monozygotic twin study

Insulin resistance (IR), the hallmark of type 2 diabetes, may be under epigenetic control. This study examines the association between global DNA methylation and IR using 84 monozygotic twin pairs. IR was estimated using homeostasis model assessment (HOMA). Global DNA methylation of Alu repeats in peripheral blood leukocytes was quantified by bisulfite pyrosequencing. The association between global DNA methylation and IR was examined using generalized estimating equation (GEE) and within-twin pair analyses, adjusting for potential confounders. Results show that methylation levels at all four CpG sites were individually associated with IR by GEE (all false discovery rate-adjusted P values≤0.026). A 10% increase in mean Alu methylation was associated with an increase of 4.55 units (95% CI 2.38-6.73) in HOMA. Intrapair difference in IR was significantly associated with intrapair difference in global methylation level. A 10% increase in the difference in mean Alu methylation was associated with an increase of 4.54 units (0.34-8.71; P=0.036) in the difference in HOMA. Confirmation of the results by intrapair analyses suggests that genetic factors do not confound the association between global DNA methylation and IR. Exclusion of twins taking diabetes medication (n=17) did not change our results.

Models of intimacy of securely and avoidantly attached young adults: a narrative approach

This study compared models of intimacy implicit in the narratives of young adults (mean age, 25 years) with secure (n = 13) and avoidant (n = 13) attachment styles. Participants completed an open-ended interview in which they described past and present adult love relationships. Content analysis revealed that although secure and avoidant individuals expressed needs for both closeness and distance, the meaning they attached to these needs differed. Narratives of secure individuals were more likely to include themes of caring, idealization, and passion; in contrast, the narratives of avoidant individuals were more likely to contain themes of holding, self-validation, and calmness. Avoidant individuals implicitly endorse an "infant-mother" intimacy model, whereas secure individuals seem to hold a "two-adult" intimacy model.

Alexithymia in adolescents with borderline personality disorder

OBJECTIVE

The aim of this study was to explore the relationship between alexithymia and borderline personality disorder (BPD) in adolescents.

METHODS

The study investigated a sample of 59 consulting or inpatient adolescents with a well-established diagnosis of BPD (SIDP-IV) and a control sample of healthy adolescents individually matched by gender, age and socio-economic status. Alexithymia, depression and trait-anxiety were rated using the Twenty-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory (BDI-II) and the trait-anxiety subscale from the State-Trait Anxiety Inventory (STAI-T), respectively. A confirmatory factorial analysis (CFA) was performed to test the fit of the three-factor structure of the TAS-20 in the adolescent sample (N=140). BPD and control groups were compared on alexithymic scores using ANCOVA analyses controlling for the potential confounding effects of depression and anxiety.

RESULTS

The ratio of the chi-square to its degrees of freedom, the goodness-of-fit index, the adjusted goodness-of-fit index and Steiger's root-mean-square error of approximation had satisfactory values of 1.54; 0.87; 0.83 and 0.058, respectively. The two ANCOVA demonstrated no significant difference for TAS-20 scores. BPD subjects were more alexithymic than healthy subjects but this difference was mainly explained by the levels of depression or anxiety.

LIMITATIONS

Since BPD subjects have high comorbidity with depression or anxiety, longitudinal studies examining the absolute and relative stability of TAS-20 scores are necessary to determine whether alexithymia constitutes a state or a trait in BPD.

CONCLUSIONS

BPD adolescents are characterized by alexithymia, probably of a secondary or state-dependent nature.

Cardiovascular responses to a laboratory stressor in women: Assessing the role of body awareness

Body awareness (BA) is characterised by a general tendency towards awareness and recognition of normal, non-emotive bodily processes and physical sensations. BA considers one's sensitivity towards and belief in how well they can sense, predict, and describe their bodily functions and sensations. This study investigated the role of BA in haemodynamic and anxiety responses to a laboratory stressor. Women (n = 40) completed assessments of BA and state/trait anxiety. Women with low BA displayed higher blood pressure (BP) and heart rate (HR) reactivity in response to the stressor than women with high BA. Delayed HR recovery poststressor was observed in women with low BA. BA was a significant predictor of haemodynamic reactivity over and above trait anxiety. BA effects on state anxiety were not observed. Thus, greater BA is associated with less haemodynamic stress reactivity in women lending further support for the development of BA interventions aimed at stress reduction.

Test anxiety and cardiovascular responses to daily academic stressors

Routine academic events may cause stress and produce temporary elevations in blood pressure. Students who experience test anxiety may be especially prone to cardiovascular activation in response to academic stress. This study drew on self-reported stress and ambulatory blood pressure measurements provided by 99 undergraduate participants (30% men, mean age=21 years) who participated over 4 days. Posture, activity level, recent consumption and the previous same-day reading were considered as covariates in a series of hierarchical linear models. Results indicate elevations in systolic blood pressure at times of acute academic stressors; neither diastolic blood pressure nor heart rate was linked with academic stress. In addition, those participants higher in test anxiety exhibited especially pronounced elevations in systolic blood pressure during times of acute academic stress. This research suggests that everyday academic stressors are linked with temporary increases in blood pressure and that test anxiety may contribute to these elevations. Test anxiety has implications for future academic and job success, and cardiovascular responses to everyday stress may contribute to health problems later in life.

Functional anatomy of ventromedial prefrontal cortex: implications for mood and anxiety disorders

In recent years, an increasing number of neuroimaging studies have sought to identify the brain anomalies associated with mood and anxiety disorders. The results of such studies could have significant implications for the development of novel treatments for these disorders. A challenge currently facing the field is to assimilate the large and growing corpus of imaging data to inform a systems-level model of the neural circuitry underlying the disorders. One prominent theoretical perspective highlights the top-down inhibition of amygdala by ventromedial prefrontal cortex (vmPFC) as a crucial neural mechanism that may be defective in certain mood and anxiety disorders, such as major depression and post-traumatic stress disorder. In this article, we provide a critical review of animal and human data related to this model. In particular, we emphasize the considerable body of research that challenges the veracity (or at least completeness) of the predominant model. We propose a framework for constructing a more comprehensive model of vmPFC function, with the goal of fostering further progress in understanding the neuropathophysiological basis of mood and anxiety disorders.

Correlates of suicide ideation and attempt among youth living in the slums of Kampala

While suicidal behavior is recognized as a growing public health problem world-wide, little is known about the prevalence and risk factors for suicidal behaviors among street and slum youth in Africa, and in Uganda, specifically. The number of youth who live on the streets and in the slums of Kampala appears to be growing rapidly, but their mental health needs have not been documented, which has hampered resource allocation and service implementation. This study of youth, ages 14-24, was conducted in May and June of 2011, to assess the prevalence and correlates of suicidal behavior. Participants (N = 457) were recruited for a 30-minute interviewer-administered survey through eight drop-in centers operated by the Uganda Youth Development Link for youth in need of services. Bivariate and multivariate logistic regression analyses were computed to determine associations between psychosocial correlates and suicide ideation and suicide attempt. Reporting both parents deceased Adj.OR = 2.36; 95% CI: 1.23-4.52), parental neglect due to alcohol use (Adj.OR = 2.09; 95% CI: 1.16-3.77), trading sex for food, shelter or money (Adj.OR = 1.95; 95% CI: 1.09-3.51), sadnesss (Adj.OR = 2.42; 95% CI: 1.20-4.89), loneliness (Adj.OR = 2.67; 95% CI: 1.12-6.40) and expectations of dying prior to age 30 (Adj.OR = 2.54; 95% CI: 1.53-4.23) were significantly associated with suicide ideation in multivariate analyses. Parental neglect due to alcohol use (Adj.OR = 2.04; 95% CI: 1.11-3.76), sadness (Adj.OR = 2.42; 95% CI: 1.30-7.87), and expectations of dying prior to age 30 (Adj.OR = 2.18; 95% CI: 1.25-3.79) were significantly associated with suicide attempt in multivariate analyses. Given the dire circumstances of this vulnerable population, increased services and primary prevention efforts to address the risk factors for suicidal behavior are urgently needed.

Suppression of anger and subsequent pain intensity and behavior among chronic low back pain patients: the role of symptom-specific physiological reactivity

Suppression of anger may be linked to heightened pain report and pain behavior during a subsequent painful event among chronic low back patients, but it is not clear whether these effects are partly accounted for by increased physiological reactivity during suppression. Chronic low back pain patients (N = 58) were assigned to Suppression or No Suppression conditions for a "cooperative" computer maze task during which a confederate harassed them. During baseline and maze task, patients' lower paraspinal and trapezius muscle tension, blood pressure and heart rate were recorded. After the maze task, patients underwent a structured pain behavior task (behaviors were videotaped and coded). Results showed that: (a) Suppression condition patients revealed greater lower paraspinal muscle tension and systolic blood pressure (SBP) increases during maze task than No Suppression patients (previously published results showed that Suppression condition patients exhibited more pain behaviors than No Suppression patients); (b) residualized lower paraspinal and SBP change scores were related significantly to pain behaviors; (c) both lower paraspinal and SBP reactivity significantly mediated the relationship between Condition and frequency of pain behaviors. Results suggest that suppression-induced lower paraspinal muscle tension and SBP increases may link the actual suppression of anger during provocation to signs of clinically relevant pain among chronic low back pain patients.

The neural bases of social pain: evidence for shared representations with physical pain

Experiences of social rejection or loss have been described as some of the most "painful" experiences that we, as humans, face and perhaps for good reason. Because of our prolonged period of immaturity, the social attachment system may have co-opted the pain system, borrowing the pain signal to prevent the detrimental consequences of social separation. This review summarizes a program of research that has explored the idea that experiences of physical pain and social pain rely on shared neural substrates. First, evidence showing that social pain activates pain-related neural regions is reviewed. Then, studies exploring some of the expected consequences of such a physical pain-social pain overlap are summarized. These studies demonstrate that a) individuals who are more sensitive to one kind of pain are also more sensitive to the other and b) factors that increase or decrease one kind of pain alter the other in a similar manner. Finally, what these shared neural substrates mean for our understanding of socially painful experience is discussed.

Untreated prenatal maternal depression and the potential risks to offspring: a review

Research exploring the effects of prenatal maternal depression on a developing fetus and child is underrepresented in the literature. Empirical papers have typically focused on the effects of postpartum depression (after birth) instead of prepartum depression (before birth). Disparate empirical findings have produced ongoing debate regarding the effects of prenatal depression on a developing fetus and later in infancy and early childhood. Even more controversial is determining the role of antidepressant medication on offspring outcomes and whether research that does not include the proper control population (e.g., unmedicated depressed participants) can adequately address questions about risks and benefits of treatment during pregnancy. The current review systematically summarizes the literature focusing on unmedicated prenatal depression and offspring outcome and concludes that prepartum depression is highly prevalent, is associated with negative outcomes in offspring, and remains understudied.

Cardiovascular risk factor screening satisfaction in the Heart of New Ulm Project

OBJECTIVE

Community-based cardiovascular disease (CVD) risk factor screening programs have been used successfully in rural health improvement initiatives. However, little is known about what consumers like or dislike about them, which is a barrier to the design of future process improvements. The objective of this study was to examine the degree to which health risks and participant characteristics predicted screening satisfaction.

DESIGN

This study utilized a cross-sectional survey design.

SETTING

Data was collected as part of the broader Heart of New Ulm Project, which is a community-based CVD prevention demonstration project based in rural Minnesota.

PARTICIPANTS

There were 126 randomly invited individuals from the CVD risk factor screenings, with 118 individuals who agreed to participate and had complete data available for analyses.

METHODS

A multivariate logistic regression analysis was used to examine the association between demographics, lifestyle, and biometric risk factors and screening satisfaction.

RESULTS

Twenty percent of respondents indicated some level of dissatisfaction with the screening process. Satisfied participants were more likely to be female (OR=4.15), not have an optimal lifestyle (OR=3.47), and have an intention to improve their lifestyle habits (OR=3.26). Age, education, and CVD risk level were not significant predictors in the final model.

CONCLUSION

Satisfaction was high in this screening program, with healthy males being least satisfied with their experience. This has implications for the design of future intervention efforts, as they may require specific programmatic features and more specialized, targeted marketing strategies to attract a broad spectrum of participants likely to benefit.

Selective serotonin reuptake inhibitors and intraoperative blood pressure

BACKGROUND

The influence of selective serotonin reuptake inhibitors (SSRIs) on blood pressure is poorly understood. We hypothesized that if SSRIs have an influence on blood pressure, this might become manifest in changes in intraoperative blood pressure. We aimed to study the association between perioperative use of SSRIs and changes in intraoperative blood pressure by measuring the occurrence of intraoperative hyper- and hypotension.

METHODS

We conducted a retrospective observational follow-up study among patients who underwent elective primary total hip arthroplasty. The index group included users of SSRIs. The reference group included a random sample (ratio 1:3) of nonusers of an antidepressant agent. The outcome was the occurrence of intraoperative hypo- and hypertensive episodes (number, mean and total duration, and area under the curve (AUC)). The outcome was adjusted for confounding factors using regression techniques.

RESULTS

The index group included 20 users of an SSRI. The reference group included 60 nonusers. Users of SSRIs showed fewer intraoperative hypotensive episodes, a shorter mean and total duration, and a smaller AUC when compared to the reference group. After adjustment for confounders, SSRI use was associated with a significantly shorter total duration of hypotension: mean difference of -29.4 min (95% confidence interval (CI) -50.4 to -8.3). Two users of an SSRI and two patients in the reference group had a hypertensive episode.

CONCLUSIONS

Continuation of treatment with SSRIs before surgery was associated with a briefer duration of intraoperative hypotension.

Adaptation of a Psycho-Oncology Intervention for Black Breast Cancer Survivors: Project CARE

Black women are traditionally underserved in all aspects of cancer care. This disparity is particularly evident in the area of psychosocial interventions where there are few programs designed to specifically meet the needs of Black breast cancer survivors. Cognitive-behavioral stress management intervention (CBSM) has been shown to facilitate adjustment to cancer. Recently, this intervention model has been adapted for Black women who have recently completed treatment for breast cancer. We outline the components of the CBSM intervention, the steps we took to adapt the intervention to meet the needs of Black women (Project CARE) and discuss the preliminary findings regarding acceptability and retention of participants in this novel study.

Anorexia nervosa: a case report of a teenager presenting with bradycardia, general fatigue, and weakness

BACKGROUND

Anorexia nervosa is a disease with high prevalence in adolescents and carries the highest mortality of any psychiatric disorder.

CASE

We present a case of a 17-year-old female presenting to the emergency department with bradycardia that was subsequently diagnosed with anorexia nervosa. We also review the clinical features, diagnosis, complications, and emergency department management of this disease.

CONCLUSIONS

Patients with anorexia may present with multiple medical complaints, and it is imperative that the emergency physician be familiar with the syndrome so as to correctly identify and treat patients with this disease.

Pollen-specific immunoglobulin E positivity is associated with worsening of depression scores in bipolar disorder patients during high pollen season

OBJECTIVE

An association between allergic disease and depression has been consistently reported, but whether the key mediating ingredients are predominantly biological, psychological, or mere artifacts remains unknown. In the current study, we examined a hypothesized relationship between allergen-specific immunoglobulin E (IgE) status and changes in allergy symptoms with worsening in depression scores.

METHODS

In patients with recurrent mood disorders, we individually coupled sensitization to specific seasonal aeroallergens (as assessed by allergen-specific IgE) with temporal windows of exposure to aeroallergens (low versus high tree or ragweed pollen counts, measured according to the National Allergy Bureau guidelines). We compared Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD) depression score changes in 41 patients with mood disorders [25 with major depression and 16 with bipolar I disorder, diagnosed by Structured Clinical Interview for DSM (SCID)] seropositive for tree or ragweed pollen-specific IgE antibody versus 53 patients with mood disorders (30 with major depression and 23 with bipolar I disorder) seronegative for aeroallergen-specific IgE.

RESULTS

Worsening in total depressive scores from low to high pollen exposure was greater in allergen-specific IgE-positive patients as compared to allergen-specific IgE antibody-negative patients (p = 0.01). When stratified by polarity, the association was significant only in patients with bipolar I disorder (p = 0.004). This relationship was resilient to adjustment for changes in allergy symptom scores.

CONCLUSION

To our knowledge, this is the first report of coupling a molecular marker of vulnerability (allergen-specific IgE) with a specific environmental trigger (airborne allergens) leading to exacerbation of depression in patients with bipolar I disorder.

Maintenance of a positive outlook during acute stress protects against pro-inflammatory reactivity and future depressive symptoms

Cognitive and affective responses to acute stress influence pro-inflammatory cytokine reactivity, and peripheral cytokines (particularly interleukin-1 beta (IL-1β)), can act on the brain to promote depressive symptoms. It is unknown whether acute stress-induced changes in positive affect and cognitions (POS) and pro-inflammatory reactivity predict future depressive symptoms. We examined acute stress responses among women, to determine prospective predictors of depressive symptoms.

HYPOTHESES

(1) Stress-induced decreases in POS will be associated with stress-related increases in circulating IL-1β. (2) Acute stress-induced decreases in POS and increases in IL-1β reactivity will predict increases in depressive symptoms 1 year later. Thirty-five post-menopausal women were exposed to acute stress with the Trier Social Stress Task (TSST) and provided blood samples under resting conditions and 30 min after the conclusion of the TSST, which were assayed for IL-1β. IL-1β reactivity was quantified as post minus pre-TSST. Failure to maintain POS was quantified as the decrease in POS during the TSST. Change in depressive symptoms from the study baseline to the following year was determined. Greater acute stress-induced declines in POS were significantly associated with increased IL-1β reactivity (p≤.02), which significantly predicted increases in depressive symptoms over the following year (p<.01), controlling for age, body mass index, chronic stress, antidepressant use and baseline depressive symptoms. IL-1β reactivity was a significant mediator of the relationship between POS decline and future increases in depressive symptoms (p=.04). Difficulty maintaining positivity under stress and heightened pro-inflammatory reactivity may be markers and/or mechanisms of risk for future increases in depressive symptoms.

Physical Activity and Fitness Effects on Cognition and Brain Health in Children and Older Adults

Our increasingly inactive lifestyle is detrimental to physical and cognitive health. This review focuses on the beneficial relation of physical activity and aerobic fitness to the brain and cognitive health in a youth and elderly population to highlight the need to change this pattern. In children, increased physical activity and higher levels of aerobic fitness have been associated with superior academic achievement and cognitive processes. Differences in brain volumes and brain function of higher-fit and lower-fit peers are potential mechanisms underlying the performance differences in cognitive challenges. We hope that this research will encourage modifications in educational policies that will increase physical activity during the school day. In addition, older adults who participate in physical activity show higher performance on a variety of cognitive tasks, coupled with less risk of cognitive impairment. The cognitive enhancements are in part driven by less age-related brain tissue loss and increases in the efficiency of brain function. Given the increasing aging population and threat of dementia, research about the plasticity of the elderly active brain has important public health implications. Collectively, the data support that participation in physical activity could enhance daily functioning, learning, achievement, and brain health in children and the elderly.

Impact of perinatal somatic and common mental disorder symptoms on functioning in Ethiopian women: the P-MaMiE population-based cohort study

BACKGROUND

Little is known of the relationship between perinatal somatic and common mental disorder (CMD) symptoms and impaired functioning in women from settings where the burden of undernutrition and infectious disease morbidity is high.

METHODS

A population-based sample of 1065 women from Butajira, Ethiopia, was recruited in pregnancy (86.4% of those eligible) and reassessed two months postnatal (954 with singleton, live infants). At both time-points, women were administered a modified version of the Patient Health Questionnaire-15 and the Self-Reporting Questionnaire (locally-validated) to assess somatic and CMD symptoms, respectively. Negative binomial regression was used to investigate associations of CMD and somatic symptoms with functional impairment (World Health Organisation Disability Assessment Scale, version-II), after adjusting for maternal anthropometric measures, physical ill-health and sociodemographic factors.

RESULTS

In pregnancy, somatic and CMD symptoms were independently associated with worse maternal functional impairment after adjustment for confounders (WHODAS-II score multiplied by 1.09 (95%CI 1.06, 1.13) and 1.11 (95%CI 1.08, 1.14) respectively for each additional symptom). In the postnatal period, the size of association between somatic symptoms and functional impairment was diminished, but the association with CMD symptoms was virtually unchanged (multiplier value 1.04 (95%CI 1.00, 1.09) and 1.11 (95%CI 1.07, 1.16) respectively).

LIMITATIONS

Use of largely self-report measures.

CONCLUSIONS

Somatic and CMD symptoms were independently associated with functional impairment in both pregnancy and the postnatal period, with CMD symptoms showing a stronger and more consistent association. This emphasises the public health relevance of both CMD and somatic symptoms in the perinatal period.

Sleep and academic performance in Indigenous Australian children from a remote community: an exploratory study

AIM

Disruptions to sleep in childhood are associated with poor behaviour and deficits in academic performance and executive function. Although academic performance of indigenous children from remote communities in Australia is documented as well below that of non-indigenous children, the extent of sleep disruption and its contribution to academic performance among this population has not been assessed. This pilot study aimed to objectively assess the sleep of remote indigenous children and the association between sleep disruption and both academic performance and executive function.

METHOD

Twenty-one children from a remote Australian indigenous community aged 6-13 years wore actigraphy for two consecutive nights, reported subjective sleepiness, and were objectively assessed for academic performance (Wechsler Individual Achievement Test, 2nd Edition) and executive function (NEuroloPSYcological Assessment-II).

RESULTS

Results show marked reduction in sleep time, sleep fragmentation, academic performance and auditory attention compared with non-indigenous norms. Sleep duration was not associated with performance, possibly because of reduced sleep and performance observed across the entire group. Sleep fragmentation was associated with reduced reading and numerical skills (P < 0.05).

CONCLUSIONS

The sleep of indigenous children in remote communities is an important area of future inquiry, and our initial findings of poor sleep and an association between sleep disruption and academic performance may have important implications for intervention strategies aimed at 'closing the gap'. Further studies should assess a broader range of demographic, social and economic factors to better understand the associations reported here and guide future intervention.

Clinical features and risk factors for post-partum depression in a large cohort of Chinese women with recurrent major depressive disorder

BACKGROUND

Post partum depression (PPD) is relatively common in China but its clinical characteristics and risk factors have not been studied. We set out to investigate whether known risk factors for PPD could be found in Chinese women.

METHODS

A case control design was used to determine the impact of known risk factors for PPD in a cohort of 1970 Chinese women with recurrent DSM-IV major depressive disorder (MDD). In a within-case design we examined the risk factors for PPD in patients with recurrent MDD. We compared the clinical features of MDD in cases with PPD to those without MDD. Odds ratios were calculated using logistic and ordinal regression.

RESULTS

Lower occupational and educational statuses increased the risk of PPD, as did a history of pre-menstrual symptoms, stressful life events and elevated levels of the personality trait of neuroticism. Patients with PPD and MDD were more likely to experience a comorbid anxiety disorder, had a younger age of onset of MDD, have higher levels of neuroticism and dysthymia.

LIMITATIONS

Results obtained in this clinical sample may not be applicable to PPD within the community. Data were obtained retrospectively and we do not know whether the correlations we observe have the same causes as those operating in other populations.

CONCLUSIONS

Our results are consistent with the hypothesis that the despite cultural differences between Chinese and Western women, the phenomenology and risk factors for PPD are very similar.

Epidemiological characteristics of male sexual assault in a criminological database

Sexual assault among males, compared with females, is understudied, and may also be significantly underreported. Past studies have relied primarily on population-based survey data to estimate the prevalence of sexual assault and associated health outcomes. However, survey-based studies rely primarily on self-reports of victimization and may not accurately estimate the true prevalence of male sexual assault victimization. In order to obtain a detailed assessment of sexual assault among males, criminological databases like the National Incident Based Reporting System (NIBRS) may provide an important and unique source of information. The objective of the current study was to use data from the 2001-2005 NIBRS to construct an epidemiological profile of sexual assault among males. Our results suggest that the incidence of sexual assault was higher among young males (less than 19 years of age), with approximately 90% of all cases being reported among members of this age group. Among males of all ages, forcible fondling and sodomy were the most prevalent forms of sexual assault. Results from additional analyses include age- and race-specific rates of male sexual assault, the prevalence and severity of injury, and time trends detailing incidence by time of the day and location of the incident. Our analyses show that sexual assault is experienced by males of all age groups. However, the rate of sexual assault is higher among younger males. Despite some limitations, results from this study suggest that NIBRS data may provide a important complement to survey data for understanding breadth and consequences of male sexual assault.

Alexithymia in healthy young men: a voxel-based morphometric study

BACKGROUND

Alexithymia is a personality construct predominately associated with an impaired ability to identify and communicate emotions. Functional imaging studies showed that an altered function of the anterior cingulate cortex (ACC) may be relevant in alexithymia. In this study we investigated if the altered functional anatomy is related to structural changes (A) in the whole brain and (B) specifically in the ACC by applying a region-of-interest analysis.

METHODS

33 high- and 31 low-alexithymic right-handed young male subjects (selected by the 20-item Toronto Alexithymia Scale, TAS-20) were investigated using voxel-based morphometry (VBM) on high-resolution 3D magnetic resonance images. The group differences were analyzed by applying voxel-wise comparisons using two-sample t-tests. Moreover regression analyses with regard to the individual TAS-20 sum scores were calculated.

RESULTS

Neither the subtraction analyses nor the correlation analyses revealed significant differences between high- and low-alexithymic subjects. Thus, according to our results, the null hypothesis of no structural difference between the groups could not be rejected.

LIMITATIONS

The findings cannot be generalized to female subjects.

CONCLUSIONS

Our results did not reveal morphological differences between high- and low-alexithymic subjects. The functional differences known from imaging studies could not be attributed to underlying anatomical changes. Thus, the personality trait of alexithymia might be associated with fewer morphological abnormalities than previously assumed.

[Reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale]

AIM

To investigate the reliability and validity of the Japanese version of the abbreviated Lubben Social Network Scale (LSNS-6), which is used worldwide as a screening tool for social isolation in elderly individuals.

METHODS

An interview-format questionnaire survey was given to 232 elderly community residents undergoing general health checkups. In addition to the Japanese version of the LSNS-6, other questionnaire items regarding social support, the Japanese version of the Zung Self-Rating Depression Scale (SDS), base attributes, and self-ratings of health, physical function and suicidal ideation were obtained. The internal consistency, test-retest, and interrater reliability of the Japanese version of the LSNS-6 were determined using the Cronbach α correlation, Spearman correlation, and intraclass correlation coefficients, respectively. Construct validity was investigated by comparison with the results of a previous study, while concurrent validity was determined in relation to SDS scores as well as questionnaire items on social support.

RESULTS

The Cronbach α coefficient was 0.82, the correlation coefficient for the test-retest was 0.92 (P<0.001), and the intraclass correlation coefficient for interrater reliability was 0.96 (95% confidence interval [CI] 0.90-0.99). Mean scores on the Japanese version of the LSNS-6 increased as the number of household members increased (P=0.033), but decreased among elderly individuals at risk of suicide (P=0.026), and tended to decrease among those with a poor self-rated health score (P=0.081). Scores on the Japanese version of the LSNS-6 had a significant negative correlation with SDS scores (P<0.001) On 4 of the 5 questionnaire items on social support, and those without social support had significantly lower mean scores on the Japanese version of the LSNS-6 (P<0.05) than those with social support.

CONCLUSIONS

We confirmed the reliability and validity of the Japanese version of the abbreviated LSNS-6.

Randomised clinical trial: pregabalin attenuates the development of acid-induced oesophageal hypersensitivity in healthy volunteers - a placebo-controlled study

BACKGROUND

Acid infusion in humans induces primary and secondary oesophageal hypersensitivity. The effects of pregabalin, a centrally-acting modulator of voltage-sensitive calcium channels, on development of acid-induced oesophageal hypersensitivity remain unknown.

AIM

To study the effects of pregabalin on development of secondary oesophageal hypersensitivity in healthy humans.

METHODS

Placebo-controlled, double-blind, randomised, cross-over study of 15 healthy volunteers (six women, age 21-56 years). After oesophageal manometry, baseline pain thresholds (PTs) to proximal oesophageal electrical stimulation were determined using bipolar ring electrodes. A 30-min infusion of HCl was performed in the distal oesophagus followed by PT measurements at 30 and 90 min. This protocol was repeated after administration of pregabalin (dosing schedule: 75 mg twice daily for 3 days then 150 mg twice daily for 1 day and then 150 mg on the morning of study) or placebo.

RESULTS

T0 PTs were similar in patients after receiving placebo or pregabalin [mean (s.d.) 32.9 mA (20.5) vs. 34.1 (15.7), P = 0.42]. Pregabalin reduced development of acid-induced hypersensitivity in the proximal oesophagus at 30 min [mean change in PT (C.I.) placebo -6.2 mA (-11.3 to +1.3) vs. pregabalin +0.20 mA (-2.7 to +3.3)] and 90 min [placebo -3.7 mA (-10.0 to +2.0) vs. pregabalin +0.7 mA (-4.7 to 7.3)] overall P = 0.001. Pregabalin reduced median visual analogue scale score for acid-induced pain (1/10 vs. placebo 3/10, P = 0.027).

CONCLUSIONS

Pregabalin attenuates development of secondary hypersensitivity in the proximal oesophagus after distal oesophageal acidification; it may thus have a role in treatment of patients with proven oesophageal pain hypersensitivity.

Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load

OBJECTIVE

Low socioeconomic status (SES) early in life is one of the most well-established social predictors of poor health. However, little is understood about why some adults who grew up in low-SES environments do not have poor health outcomes. This study examined whether the psychological characteristic of "shift-and-persist" protects adults from the physiological risks of growing up in low-SES households. Shift-and-persist consists of reframing appraisals of current stressors more positively (shifting), while simultaneously persisting with a focus on the future. We hypothesized that this characteristic would be associated with reduced physiological risk in low-childhood SES individuals.

METHODS

A national sample of 1207 adults (aged 25-74 years) from the Survey of Midlife Development in the United States completed psychological questionnaires and were queried about parent education. Biologic assessments consisted of 24 different measures across seven physiological systems, from which a composite measure representing cumulative physiological risk (allostatic load) was derived.

RESULTS

Among adults who grew up in low-SES households, those who engaged in high-shift-and-high-persist strategies had the lowest allostatic load (b = -0.15, p = .04). No benefit of shift-and-persist was found for those from higher-childhood SES backgrounds (p = .36).

CONCLUSIONS

Identifying the health-related protective qualities that naturally occur in some low-SES individuals represents one important approach for developing future health improvement interventions for those who start out life low in SES. Moreover, the psychological qualities that are protective from future disease risk for those from low-SES backgrounds are different from those beneficial to high-SES individuals.

Suicidal intention and negative spiritual coping one year after the earthquake of L'Aquila (Italy)

BACKGROUND

This study investigated the rate of suicidal intention and its relationship with the features of religious involvement in a non-clinical sample of the adult population exposed to the L'Aquila earthquake.

METHODS

The study population was composed of 426 people who had experienced the earthquake (188 males and 238 females). For comparison, 522 people were recruited from nearby unaffected areas. The sample was investigated for suicidal intention screening, distinguishing Suicidal Screen-Negative (SSN) subjects from Positive (SSP) subjects. Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and Impact of Event Scale (IES) assessments were administered.

RESULTS

More SSP subjects were observed in the population exposed to the earthquake (Odds Ratio 3.54). A higher proportion of females showed suicidal ideation. Multivariate analysis showed overall significance for the between-subject factor. Univariate F tests for each BMMRS variable that contributed to significant overall effect showed that negative spiritual coping was significantly different. No differences were observed for IES scores between the two groups, but correlations with negative spiritual coping were found.

LIMITATIONS

The samples are relatively small and data are based on self-reports.

CONCLUSIONS

Negative religious coping such as expression of conflict and doubt regarding matters of faith, as well as a feeling of being punished or abandoned by God, can prevail in response to prolonged stress without relief, as was experienced by the population exposed to the earthquake. These features are more associated with suicide ideation. Degree of religious affiliation and commitment examination by mental health practitioners can be useful when suicidal ideation is investigated.

Plasma fibrinogen: a possible link between job stress and cardiovascular disease among Chinese workers

BACKGROUND

Little is known about the effect of effort-reward imbalance (ERI) on fibrinogen. We aimed to examine the association between ERI and fibrinogen among Chinese workers.

METHODS

A total of 732 subjects without vascular diseases were analyzed. Associations between job stress evaluated by ERI model and plasma fibrinogen were explored by multiple regression.

RESULTS

Effort, overcommitment, and ERI were significantly positively associated with fibrinogen, while reward was negatively related with fibrinogen both for men and for women. Compared with low level group, high level of effort, overcommitment, and ERI significantly increased risk of elevated fibrinogen (more than mean concentration) with adjusted OR of 3.3, 12.5, and 7.7 for men; 2.9, 7.2, and 7.2 for women, respectively; however, high reward reduced 80% risk for elevated fibrinogen.

CONCLUSIONS

Effort, overcommitment, and ERI are significantly associated with fibrinogen among Chinese workers. High fibrinogen may be a possible link between job stress and cardiovascular disease.

Prevalence of musculoskeletal disorders among farmers: A systematic review

OBJECTIVE

To determine the prevalence of musculoskeletal disorders (MSDs) among farmers and to establish the most common regional MSDs reported.

METHODS

Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using keywords for MSDs and farmers. Pooled estimates of prevalence with 95% confidence intervals were calculated for overall MSD prevalence and the most common regional MSDs reported.

RESULTS

Twenty-four studies fulfilled the inclusion criteria and were incorporated into this review. From these studies, life-time prevalence of any form of MSD among farmers was 90.6% while 1-year MSD prevalence was 76.9% (95% CI 69.8-82.7). The majority of studies focused on spinal MSDs with low back pain (LBP) the most frequently investigated. Life-time LBP prevalence was 75% (95% CI 67-81.5) while 1-year LBP prevalence was 47.8% (95% CI 40.2-55.5). The next most common regional MSDs reported were upper (range 3.6-71.4%) and lower extremities (range 10.4-41%).

CONCLUSIONS

The systematic review identified the prevalence of MSDs by body region in farmers and established that LBP was the most common MSD, followed by upper and then lower extremity MSDs. Reported trends suggest that the prevalence of MSDs in farmers is greater than in non-farmer populations. Case-definition uniformity among MSD researchers is warranted. More studies are needed regarding upper and lower extremity MSDs, gender, workplace, and task context of MSDs.

Self-rated health compared with objectively measured health status as a tool for mortality risk screening in older adults: 10-year follow-up of the Bambuí Cohort Study of Aging

Interest in self-rated health (SRH) as a tool for use in disease and mortality risk screening is increasing. The authors assessed the discriminatory ability of baseline SRH to predict 10-year mortality rates compared with objectively measured health status. Principal component analysis was used to create a health score that included systolic blood pressure, presence of diabetes mellitus, body mass index, electrocardiographic parameters, B-type natriuretic peptide, and other biochemical and hematologic measures. From 1997 to 2007, a total of 474 of the 1,388 baseline participants died and 81 were lost to follow-up, yielding 11,833 person-years of observation. The adjusted hazard ratio for death was 1.74 (95% confidence interval (CI): 1.32, 2.29) for persons reporting poor health versus those reporting good health. When combined with age and sex, SRH had a C statistic to predict death equal to 0.69 (95% CI: 0.67, 0.71), which was comparable to that of the inclusive health score (C = 0.69, 95% CI: 0.67, 0.72). The addition of other parameters, such as lifestyle, physical functioning, mental symptoms, and physical symptoms, had little effect on these 2 predictive models (C = 0.71 (95% CI: 0.69, 0.73) and C = 0.71 (95% CI: 0.69, 0.74), respectively). The abilities of the SRH and the health score models to predict death decreased in parallel fashion over time. These results suggest that older adults who report poor health warrant particular attention as persons who have accumulated biologic markers of disease.

The Impact of Exercise on the Mental Health and Quality of Life of People with Severe Mental Illness: A Critical Review

Introduction:

Physical exercise has been proven to benefit the general population in terms of mental health and wellbeing. However, there is little research investigating the impact of exercise on mental health and quality of life for people who experience a severe and enduring mental illness.

Method:

This review aims to describe the effect of physical exercise intervention on the mental health and quality of life of people with severe mental illness. Quantitative and qualitative articles published between 1998–2009 were sourced using electronic databases. Articles were included if the study intervention involved exercise and the outcome measure included mental health or quality of life. Sixteen articles were analysed for common themes and appraised critically.

Findings:

The findings show that exercise can contribute to improvements in symptoms, including mood, alertness, concentration, sleep patterns and psychotic symptoms. Exercise can also contribute to improved quality of life through social interaction, meaningful use of time, purposeful activity and empowerment.

Implications:

Future research is warranted to describe the way exercise can meet the unique needs of this population. Studies with a focus on psychological outcome measures would provide greater evidence for its use in therapy.

Online cognitive-behavioural treatment of bulimic symptoms: a randomized controlled trial

BACKGROUND

Manualized cognitive-behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet-delivered treatment may reduce current barriers.

OBJECTIVE

This study aimed to assess the efficacy of a new online CBT of bulimic symptoms.

METHOD

Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre-treatment, post-treatment and 1-year follow-up.

OUTCOME MEASURES

The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE-Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test.

RESULTS

Dropout from Internet treatment was 26%. Intention-to-treat ANCOVAs of post-test data revealed that the EDE-Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between-group effect size: d = 0.9). At 1-year follow-up, improvements in the online CBT group had sustained.

CONCLUSION

This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms.

Intact sensory function in anorexia nervosa

BACKGROUND

In anorexia nervosa (AN), taste and smell are believed to be anhedonic, hunger and pain are muted, and body-image distortion obscures wasting, which together facilitate self-starvation. However, the emphasis on these deficits may be biased because other sensory systems have been sparsely investigated.

OBJECTIVES

Objectives of the study were to clarify whether these dysfunctions are specific or part of a pattern of sensory-perceptual deficits in AN patients and to test the gustatory senses dissociated from ingestion to clarify whether any deficit is sensory or affective.

DESIGN

In 15 adolescent, first-episode, hospitalized, restrictive AN patients and 15 matched healthy controls who responded to gustatory stimuli (intensity and hedonics of 5 basic tastes and tastes and odors of foods and nonfoods), size estimation (manual and oral judgment of size and shape, kinesthesia, and body size and esthetics), cold pain, and auditory and visual processing were compared.

RESULTS

AN patients did not differ on most tests, were better at odor recognition, were less successful in central auditory processing and oral assessment of size and shape, and may have been more sensitive to cold. Body-image dissatisfaction in AN patients was not related to dysfunctional size estimation.

CONCLUSIONS

There is no systematic sensory-perceptual deficit in AN patients, and specifically, not in gustatory function. The few differences shown might be due to fear of food-related stimuli or comorbidity.

Serum and colonic mucosal immune markers in irritable bowel syndrome

OBJECTIVES

Low-grade colonic mucosal inflammation has been postulated to have an important role in the pathophysiology of irritable bowel syndrome (IBS). The objectives of this study were (i) to identify serum and tissue-based immunological and neuroendocrine markers associated with mucosal inflammation in male (M) and female (F) patients with non-post-infectious IBS (non-PI-IBS) compared with healthy controls and (ii) to assess possible correlations of such markers with IBS symptoms.

METHODS

Sigmoid mucosal biopsies were obtained from 45 Rome II positive IBS patients without a history of PI-IBS (26 F, 35.5% IBS-C, 33.3% IBS-D, 31.1% IBS-A/M) and 41 healthy controls (22 F) in order to measure immunological markers (serum cytokine levels, colonic mucosal mRNA levels of cytokines, mucosal immune cell counts) and neuroendocrine markers associated with mucosal inflammation (corticotropin releasing factor- and neurokinin (NK)-related ligands and receptors, enterochromaffin cells). Symptoms were measured using validated questionnaires.

RESULTS

Of all the serum and mucosal cytokines measured, only interleukin-10 (IL-10) mRNA expression showed a group difference, with female, but not male, patients showing lower levels compared with female controls (18.0±2.9 vs. 29.5±4.0, P=0.006). Mucosal mRNA expression of NK-1 receptor was significantly lower (1.15±0.19 vs. 2.66±0.56, P=0.008) in female, but not male, patients compared with healthy controls. No other significant differences were observed.

CONCLUSIONS

Immune cell counts and levels of cytokines and neuropeptides that are associated with inflammation were not significantly elevated in the colonic mucosa of non-PI-IBS patients, and did not correlate with symptoms. Thus, these findings do not support that colonic mucosal inflammation consistently has a primary role in these patients. However, the finding of decreased IL-10 mRNA expression may be a possible biomarker of IBS and warrants further investigation.

Psychological distress and salivary cortisol covary within persons during pregnancy

The mechanisms whereby maternal stress during pregnancy exerts organizational effects on fetal development require elaboration. The aim of this study was to assess the plausibility of cortisol as a biological link between maternal psychological distress during pregnancy and fetal development. Previous research has resulted in equivocal findings for between-persons differences in stress and cortisol. Ecological momentary assessment was used to simultaneously assess mood and cortisol 5 times daily for 3 days in 83 women (gestational ages 6-37 weeks). Results from multilevel analysis indicated a robust within-person association between negative mood and cortisol. For each 1.0% increase in negative mood there was a corresponding 1.9% increase in cortisol. This association was unaffected by advancing gestational age. The results suggest that cortisol is a plausible biological mechanism for transducing the effects of maternal psychological distress during pregnancy to fetal development.

Impact of breast cancer recurrence and cancer-specific stress on spouse health and immune function

Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence - a cancer-specific stressful event - and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.

Prevalence and correlates of complicated grief in adults who have undergone a coronary artery bypass graft

BACKGROUND

Complicated grief (CG) is a recently described mental health condition that follows bereavement. CG is often comorbid with depression and may also be associated with poor health outcomes. However, CG has not been studied in depressed medically ill populations. This study examined the prevalence, correlates, and impact of CG in depressed post-coronary artery bypass graft surgery (CABG) patients.

METHODS

A 5-item CG screen was administered to 302 depressed post-CABG patients participating in a comparative effectiveness intervention trial at 7 Pittsburgh-area hospitals from March 2004 to September 2007. Eligible patients were randomly assigned to either a telephone-delivered collaborative care intervention for depression or their primary care physicians' usual care. Measures examined depression, physical and mental health-related quality of life, and physical functioning over 8 months.

RESULTS

Compared to CG screen-negative patients, CG screen-positive patients were younger, more likely to: be female, non-White, have lost a partner or child, and to have used tobacco or antidepressants. At baseline, they had significantly higher depression and lower mental health scores. At 8 months, screen-positives had poorer physical functioning and marginally higher depression scores.

LIMITATIONS

The study lacked a definitive measure of CG. Moreover, the CG-positive group was relatively small, reducing the power to detect differences between groups or control for the possible influence of other variables on identified results.

CONCLUSIONS

CG in depressed post-CABG patients is associated with negative health and mental health outcomes. These results underscore the importance of identifying and treating CG in depressed medically ill populations.

The capacity of acute stress disorder to predict posttraumatic psychiatric disorders

BACKGROUND

One rationale for establishing the acute stress disorder diagnosis was to identify recently trauma-exposed people who may develop later posttraumatic stress disorder (PTSD). This study conducted a multi-site assessment of the extent to which ASD predicts subsequent PTSD, and also major depressive disorder, panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, and substance use disorder, 12 months after trauma.

METHOD

Consecutive admissions to 5 major trauma hospitals across Australia (N = 1084) were assessed during hospital admission and within one month of trauma exposure and subsequently re-assessed for psychiatric disorder 12 months after the initial assessment (N = 859).

RESULTS

Whereas 120 (10%) patients met criteria for ASD in the initial month after trauma, 83 (10%) met criteria for PTSD, and 268 (31%) had any psychiatric disorder at 12 months. In terms of those diagnosed with ASD, 28 (36%) subsequently met criteria for PTSD and 50 (65%) subsequently developed any psychiatric disorder.

CONCLUSIONS

Whereas the majority of people with ASD subsequently develop a psychiatric disorder, most people with a disorder at 12 months do not initially display ASD.

Pollen counts and suicide rates. Association not replicated

OBJECTIVE

  To replicate a previously reported association between pollen counts and county suicide rates in the continental United States, across space and time.

METHOD

  The authors evaluated the relationship between airborne pollen counts and suicide rates in 42 counties of the continental United States, containing a pollen-counting station participating in the Aeroallergen Monitoring Network in the United States (N = 120,076 suicides), considering years' quarter, age group, sex, race, rural/urban location, number of local psychiatrists, and median household income, from 1999 to 2002. The county-level effects were broken into between-county and within-county.

RESULTS

  No within-county effects were found. Between-county effects for grass and ragweed pollen on suicide rates lost statistical significance after adjustment for median income, number of psychiatrists, and urban vs. rural location.

CONCLUSION

  Future research is necessary to reappraise the previously reported relationship between pollen levels and suicide rates that may have been driven by socioeconomic confounders.

Experiential avoidance and the relationship between child maltreatment and PTSD symptoms: preliminary evidence

OBJECTIVE

Not every adolescent exposed to child maltreatment develops symptoms of post-traumatic stress disorder (PTSD), emphasizing the need to identify variables that explain how some maltreated children come to develop these symptoms. This study tested whether a set of variables, respiratory sinus arrhythmia (RSA) and cortisol reactivity as well as experiential avoidance, explained the relationship between child maltreatment and PTSD symptoms.

METHODS

Adolescent females (N=110; n=51 maltreated) 14-19 years of age completed interviews, questionnaires, and a stressor paradigm. A multiple mediator model was used to assess the effect for the set of variables while identifying specific indirect effects for each variable.

RESULTS

Results indicated that the set of variables mediated the relationship between child maltreatment and PTSD symptoms. However, only experiential avoidance contributed significantly to this effect when simultaneously estimating all other variables. The indirect effect for experiential avoidance was also significantly stronger than the effects of RSA and cortisol reactivity.

CONCLUSIONS

Data support the examination of experiential avoidance in understanding how adolescents who have been maltreated develop PTSD symptoms with implications for prevention and intervention.

Executive functions in elderly men

The executive function deficit is greater in depressed patients with cardiovascular disease than in depressed patients without cardiovascular disease. Late-life depression is said to have a vascular etiology and would worsen the executive function. A cross-sectional design was used for this study. The study was done in outpatient clinics of Kaohsiung Veterans General Hospital and National Cheng Kung University Hospital, Taiwan. Three hundred thirty-five older elderly men (>75 years old) were chosen as study participants, some military veterans and some not. The mini-mental state examination was used to exclude those suspected of dementia, the Mini-International Neuropsychiatric Interview to screen those undergoing a current major depressive episode, and the revised Geriatric Depression Scale Short Form to measure the severity of depression. Specialist physicians obtained past histories of medical illnesses through chart reviews, history taking, and health examinations. Elderly men with major depression comorbid with cardiovascular disease had worse executive functions. Executive function impairment is greater in elderly men diagnosed with major depression comorbid with cardiovascular disease than in those without cardiovascular disease.