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Yang G, Li W, Cao H, Klupp N, Liu J, Bensoussan A, Kiat H, Chang D. Does Tai Chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review protocol. BMJ Open 2017; 7:e014507. [PMID: 28821509 PMCID: PMC5724100 DOI: 10.1136/bmjopen-2016-014507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Psychological risk factors such as stress, anxiety and depression are known to play a significant and independent role in the development and progression of CVD and its risk factors. Tai Chi has been reported to be potentially effective for health and well-being. It is of value to assess the effectiveness and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. METHODS AND ANALYSIS We will include all relevant randomised controlled trials on Tai Chi for stress, anxiety, depression, psychological well-being and quality of life in people with CVD and cardiovascular risk factors. Literature searching will be conducted until 31 December 2016 from major English and Chinese databases. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane's RevMan software. Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies are identified. ETHICS AND DISSEMINATION Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical practice and further research on Tai Chi and CVDs. DISCUSSION This review will summarise the evidence on Tai Chi for psychological well-being and quality of life in people with CVD and their risk factors. We anticipate that the results of this review would be useful for healthcare professionals and researchers on Tai Chi and CVDs. TRIAL REGISTRATION NUMBER International Prospective Register for Systematic Reviews (PROSPERO) number CRD42016042905.
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Affiliation(s)
- Guoyan Yang
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Wenyuan Li
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Huijuan Cao
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Nerida Klupp
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Alan Bensoussan
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Hosen Kiat
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- Cardiac Health Institute, Sydney, Australia
| | - Dennis Chang
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
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Abstract
Heart failure (HF) is a systemic illness with grave implications for bodily functions. The brain, among other vital organs, often suffers insults as a result of HF, and both anatomic and functional brain abnormalities were found in the HF population. This injury was demonstrated across a wide range of clinical conditions and cardiac functions and was shown to affect patients' outcomes. Although reduced cardiac output and high burden of cardiovascular risk factors are the prevailing explanations for these findings, there are data showing the involvement of neurohormonal, nutritional, and inflammatory mechanisms in this complex process. Here, the authors review the suggested pathophysiology behind brain injury in HF, describe its effect on patients' outcomes, offer a diagnostic approach, and discuss possible therapeutic options.
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153
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Lasserre AM, Strippoli MPF, Glaus J, Gholam-Rezaee M, Vandeleur CL, Castelao E, Marques-Vidal P, Waeber G, Vollenweider P, Preisig M. Prospective associations of depression subtypes with cardio-metabolic risk factors in the general population. Mol Psychiatry 2017; 22:1026-1034. [PMID: 27725658 DOI: 10.1038/mp.2016.178] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/18/2016] [Accepted: 08/24/2016] [Indexed: 11/09/2022]
Abstract
The mechanisms and temporal sequence underlying the association between major depressive disorder (MDD) and cardio-metabolic diseases are still poorly understood. Recent research suggests subtyping depression to study the mechanisms underlying its association with biological correlates. Accordingly, our aims were to (1) assess the prospective associations of the atypical, melancholic and unspecified subtypes of MDD with changes of fasting glucose, high-density lipoprotein-cholesterol, triglycerides, systolic blood pressure and the incidence of the metabolic syndrome, (2) determine the potential mediating role of inflammatory marker or adipokine concentrations, eating behaviors and changes in waist circumference during follow-up. Data stemmed from CoLaus|PsyCoLaus, a prospective cohort study including 35-66-year-old randomly selected residents of an urban area. Among the Caucasian participants who underwent the physical and psychiatric baseline evaluations, 2813 (87% participation rate) also accepted the physical follow-up exam (mean follow-up duration=5.5 years). Symptoms of mental disorders were elicited using a semi-structured interview. The atypical MDD subtype, and only this subtype, was prospectively associated with a higher incidence of the metabolic syndrome (OR=2.49; 95% CI 1.30-4.77), a steeper increase of waist circumference (β=2.41; 95% CI 1.19-3.63) and independently of this, with a steeper increase of the fasting glucose level (β=131; 95% CI 38-225) during follow-up. These associations were not attributable to or mediated by inflammatory marker or adipokine concentrations, eating behaviors, comorbid psychiatric disorders or lifestyle factors. Accordingly, our results further support the subtyping of MDD and highlight the particular need for prevention and treatment of metabolic consequences in patients with atypical MDD.
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Affiliation(s)
- A M Lasserre
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - M-P F Strippoli
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - J Glaus
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland.,Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - M Gholam-Rezaee
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - C L Vandeleur
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - E Castelao
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - P Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - G Waeber
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - P Vollenweider
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - M Preisig
- Center for Psychiatric Epidemiology and Psychopathology, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
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154
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Haaf P, Ritter M, Grize L, Pfisterer ME, Zellweger MJ. Quality of life as predictor for the development of cardiac ischemia in high-risk asymptomatic diabetic patients. J Nucl Cardiol 2017; 24:772-782. [PMID: 28091969 DOI: 10.1007/s12350-016-0759-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischemia induced by psychological stress and depression is a common phenomenon in stable coronary artery disease (CAD). We evaluated the quality of life (QoL) of diabetic patients screened for CAD and assessed the prognostic value of mental and physical QoL scores to predict the development of new cardiac ischemia. METHODS Prospective multicentre outcome study. The study comprised 400 asymptomatic diabetic patients without history or symptoms of CAD. They underwent myocardial perfusion single-photon emission computed tomography (MPS) and assessment of QoL by two questionnaires: Hospital Depression and Anxiety Scale (HADS-D and HADS-A) and Medical Outcomes Study Short Form 36 (SF-36) at baseline and after 2 years. Patients with normal MPS received usual care; those with abnormal MPS received medical or combined invasive and medical management. RESULTS Only mental QoL scores but not physical QoL scores or traditional cardiovascular risk factors were predictive of new ischemia (n = 11/306) during follow-up. The prognostic value for new ischemia as quantified by the area under the receiver operating characteristics curve (AUC) amounted to 0.784 (95% confidence interval (CI) 0.654-0.914, P = 0.002) for HADS-D and to 0.737 (95% CI 0.580-0.893, P = 0.011) for HADS-A. This finding was confirmed by SF-36 mental sum score (AUC 0.688, 95% CI 0.539-0.836, P = 0.036), but not SF-36 physical sum score. QoL scores did not change after 2 years in patients with ischemia at baseline. CONCLUSIONS QoL scores assessing mental health, particularly depression and anxiety, predicted the development of new cardiac ischemia in asymptomatic diabetic patients. The study is limited by a small number of events (new ischemia) and so the results should be considered hypothesis generating rather than conclusive.
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Affiliation(s)
- Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Myriam Ritter
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Matthias E Pfisterer
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Michael J Zellweger
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
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155
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Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 44:1744-53. [PMID: 27153046 DOI: 10.1097/ccm.0000000000001811] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To synthesize data on prevalence, natural history, risk factors, and post-ICU interventions for depressive symptoms in ICU survivors. DATA SOURCES PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and Cochrane Controlled Trials Registry (1970-2015). STUDY SELECTION Studies measuring depression after hospital discharge using a validated instrument in more than 20 adults from non-specialty ICUs. DATA EXTRACTION Duplicate independent review and data abstraction. DATA SYNTHESIS The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n = 4,113). The Hospital Anxiety and Depression Scale-Depression subscale was used most commonly (58%). The pooled Hospital Anxiety and Depression Scale-Depression subscale prevalence (95% CI) of depressive symptoms at a threshold score greater than or equal to 8 was 29% (22-36%) at 2-3 months (12 studies; n = 1,078), 34% (24-43%) at 6 months (seven studies; n = 760), and 29% (23-34%) at 12-14 months (six studies; n = 1,041). The prevalence of suprathreshold depressive symptoms (compatible with Hospital Anxiety and Depression Scale-Depression subscale, ≥ 8) across all studies, using all instruments, was between 29% and 30% at all three time points. The pooled change in prevalence (95% CI) from 2-3 to 6 months (four studies; n = 387) was 5% (-1% to +12%), and from 6 to 12 months (three studies; n = 412) was 1% (-6% to +7%). Risk factors included pre-ICU psychologic morbidity and presence of in-ICU psychologic distress symptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms. CONCLUSIONS Clinically important depressive symptoms occurred in approximately one-third of ICU survivors and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.
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156
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Kaar JL, Luberto CM, Campbell KA, Huffman JC. Sleep, health behaviors, and behavioral interventions: Reducing the risk of cardiovascular disease in adults. World J Cardiol 2017; 9:396-406. [PMID: 28603586 PMCID: PMC5442407 DOI: 10.4330/wjc.v9.i5.396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Numerous health behaviors, including physical activity, diet, smoking, and sleep, play a major role in preventing the development and progression of cardiovascular disease (CVD). Among these behaviors, sleep may play a pivotal role, yet it has been studied somewhat less than other behaviors and there have been few well-designed sleep intervention studies targeting CVD. Furthermore, despite the fact that these behaviors are often interrelated, interventions tend to focus on changing one health behavior rather than concurrently intervening on multiple behaviors. Psychological constructs from depression to positive affect may also have a major effect on these health behaviors and ultimately on CVD. In this review, we summarize the existing literature on the impact of sleep and other cardiac health behaviors on CVD onset and prognosis. We also describe interventions that may promote these behaviors, from established interventions such as motivational interviewing and cognitive behavioral therapy, to more novel approaches focused on mindfulness and other positive psychological constructs. Finally, we outline population-health-level care management approaches for patients with psychiatric conditions (e.g., depression) that may impact cardiac health, and discuss their potential utility in improving mental health, promoting health behaviors, and reducing CVD-related risk. Much work is still needed to better understand how sleep and other health behaviors may uniquely contribute to CVD risk, and additional high-quality studies of interventions designed to modify cardiac health behaviors are required to improve cardiovascular health in individuals and the population at large.
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157
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Mason Barber LA, Kimble LP, Sudia T, Taylor LF. Self-determination theory-based perceptions of community dwelling women with cardiovascular disease and prediction of perceived physical activity limitations. Appl Nurs Res 2017; 35:48-52. [PMID: 28532726 DOI: 10.1016/j.apnr.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/10/2017] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Linda A Mason Barber
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30118, USA; University of West Georgia, Tanner Health System School of Nursing, 1601 Maple Street, Carrollton, GA 30118, USA.
| | - Laura P Kimble
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30118, USA.
| | - Tanya Sudia
- Mercer University, Georgia Baptist College of Nursing, 3001 Mercer University Drive, Atlanta, GA 30118, USA; Baylor University, Louise Herrington School of Nursing, 3700 Worth Street, Dallas, TX 75246, USA.
| | - Leslie F Taylor
- Mercer University, College of Health Professions, 3001 Mercer University Drive, Atlanta, GA 30118, USA.
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158
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Pogosova N, Kotseva K, De Bacquer D, von Känel R, De Smedt D, Bruthans J, Dolzhenko M. Psychosocial risk factors in relation to other cardiovascular risk factors in coronary heart disease: Results from the EUROASPIRE IV survey. A registry from the European Society of Cardiology. Eur J Prev Cardiol 2017; 24:1371-1380. [PMID: 28534422 DOI: 10.1177/2047487317711334] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Depression and anxiety are established psychosocial risk factors for coronary heart disease. Contemporary data on their prevalence and associations with other risk factors were evaluated as part of the EUROASPIRE IV survey. Design The design of this study was cross-sectional. Methods The study group consisted of 7589 patients from 24 European countries examined at a median of 1.4 years after hospitalisation due to coronary heart disease events. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. Results Symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety score ≥8) were seen in 26.3% of participants and were more prevalent in women (39.4%) vs men (22.1%). Of the patients, 22.4% (30.6% of women and 19.8% of men) had symptoms of depression (Hospital Anxiety and Depression Scale-Depression score ≥8). Nevertheless, antidepressants and anti-anxiety medications were prescribed to only 2.4% of patients at hospital discharge, and 2.7% and 5.0% of patients, respectively, continued to take them at interview. Both anxiety and depression were associated with female gender, lower educational level and more sedentary lifestyle. Anxiety was more prevalent in younger age groups and depression rates increased with advancing age. Depression was positively associated with current smoking, central obesity and self-reported diabetes. A number of positive lifestyle changes reduced the odds of anxiety and depression. Conclusions A substantial proportion of patients have anxiety and depression symptoms after coronary heart disease events but these conditions are undertreated. These disorders, especially depression, are associated with other risk factors, including educational level, sedentary lifestyle, smoking, unhealthy diet and reduced compliance with risk factor modification.
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Affiliation(s)
- Nana Pogosova
- 1 The European Society of Cardiology, Sophia Antipolis Cedex, France.,2 Federal Health Center and Department of NCDs Secondary Prevention, National Research Center for Preventive Medicine, Russia
| | - Kornelia Kotseva
- 1 The European Society of Cardiology, Sophia Antipolis Cedex, France.,3 International Centre for Circulatory Health, Imperial College London, UK.,4 Department of Public Health, Ghent University, Belgium
| | - Dirk De Bacquer
- 1 The European Society of Cardiology, Sophia Antipolis Cedex, France.,4 Department of Public Health, Ghent University, Belgium
| | - Roland von Känel
- 5 Department of Psychosomatic Medicine, Clinic Barmelweid, Switzerland.,6 Department of Neurology, Bern University Hospital, Switzerland
| | | | - Jan Bruthans
- 1 The European Society of Cardiology, Sophia Antipolis Cedex, France.,7 Centre for Cardiovascular Prevention, Charles University, Czech Republic.,8 Thomayer Hospital, Czech Republic
| | - Maryna Dolzhenko
- 9 Department of Cardiology, Shupyk's National Medical Academy of Postgraduate Education, Ukraine
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159
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Gotink RA, Younge JO, Wery MF, Utens EMWJ, Michels M, Rizopoulos D, van Rossum LFC, Roos-Hesselink JW, Hunink MMG. Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS One 2017; 12:e0175923. [PMID: 28486559 PMCID: PMC5423609 DOI: 10.1371/journal.pone.0175923] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/31/2017] [Indexed: 11/18/2022] Open
Abstract
There is increasing evidence that mindfulness can reduce stress, and thereby affect other psychological and physiological outcomes as well. Earlier, we reported the direct 3-month results of an online modified mindfulness-based stress reduction training in patients with heart disease, and now we evaluate the effect at 12-month follow-up. 324 patients (mean age 43.2 years, 53.7% male) were randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were blood pressure, heart rate, respiratory rate, NT-proBNP, cortisol levels (scalp hair sample), mental and physical functioning (SF-36), anxiety and depression (HADS), perceived stress (PSS), and social support (PSSS12). Differences between groups on the repeated outcome measures were analyzed with linear mixed models. At 12-months follow-up, participants showed a trend significant improvement exercise capacity (6MWT: 17.9 meters, p = 0.055) compared to UC. Cohen's D showed significant but small improvement on exercise capacity (d = 0.22; 95%CI 0.05 to 0.39), systolic blood pressure (d = 0.19; 95%CI 0.03 to 0.36), mental functioning (d = 0.22; 95%CI 0.05 to 0.38) and depressive symptomatology (d = 0.18; 95%CI 0.02 to 0.35). All other outcome measures did not change statistically significantly. In the as-treated analysis, systolic blood pressure decreased significantly with 5.5 mmHg (p = 0.045; d = 0.23 (95%CI 0.05-0.41)). Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care. TRIAL REGISTRATION www.trialregister.nl NTR3453.
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Affiliation(s)
- Rinske A. Gotink
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - John O. Younge
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Machteld F. Wery
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Elisabeth M. W. J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | - Myriam M. G. Hunink
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
- Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America
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160
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Bryleva EY, Keaton SA, Grit J, Madaj Z, Sauro-Nagendra A, Smart L, Halstead S, Achtyes E, Brundin L. The acute-phase mediator serum amyloid A is associated with symptoms of depression and fatigue. Acta Psychiatr Scand 2017; 135:409-418. [PMID: 28374419 DOI: 10.1111/acps.12730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Establish whether inflammatory biomarkers-serum amyloid A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)-are related to key symptoms of depression, including anxiety and fatigue, in a cross-sectional, out-patient setting to identify biomarkers that reflect psychiatric symptomatology in a naturalistic, real-life population. METHODS We measured SAA, CRP, IL-6, and TNF-α in plasma samples from 89 adult psychiatric out-patients by multiplex, high-sensitivity electrochemiluminescent assays. Psychiatric symptoms were evaluated using the Hamilton Depression Rating Scale (HAMD-17), the Patient Health Questionnaire (PHQ-9), and the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS Plasma SAA was most robustly associated with depressive symptoms across diagnostic boundaries in this cohort of out-patients. Elevated SAA was significantly associated with higher total scores on the HAMD-17 scale and correlated with multiple scale items that rated symptoms of fatigue and depressed mood, but not with anxiety-related items. CONCLUSIONS SAA might constitute a cross-diagnostic marker indicative of depressed mood and fatigue in a naturalistic patient setting. Because SAA activates Toll-like receptors 2 and 4, present on macrophages and glial cells, its association with depression severity could also implicate this inflammatory mediator in the pathogenesis of mood disorders.
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Affiliation(s)
- E Y Bryleva
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - S A Keaton
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA.,Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA.,Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - J Grit
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Z Madaj
- Bioinformatics and Biostatistics Core, Van Andel Research Institute, Grand Rapids, MI, USA
| | - A Sauro-Nagendra
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - L Smart
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - S Halstead
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - E Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, MI, USA.,Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - L Brundin
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA.,Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
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161
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Abstract
Coronary artery disease (CAD) is the leading cause of death in the United States. The World Bank and the World Health Organization predict that depression and coronary heart disease will be the largest causes of global health burden and disability by the year 2020. Studies have demonstrated that patients with CAD experience depression at a higher rate than the general population. Because of this connection, it is critical to recognize depression and manage depression effectively for people with CAD. Studies have also provided evidence that identifying and treating depression in patients early after a myocardial infarction improve clinical outcomes. In addition, a number of studies have discussed the negative effects that can occur from untreated depression in these patients. The cited negative effects include mortality, recurrent myocardial events, and a worse quality of life. This article discusses the results of a research that was completed at a cardiology office using a retroactive medical record review that focused on outpatients with cardiac diseases. The primary aim of the study was to collect data using the Patient Health Questionnaire-9 (PHQ-9), a public domain screening tool. This research was intended to provide evidence that would support using the PHQ-9 as a standard depression screening tool for patients post-myocardial infarction. By recognizing the symptoms of depression, the patient would then be treated accordingly.
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162
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Abstract
OBJECTIVE Psychological constructs are associated with cardiovascular health, but the biological mechanisms mediating these relationships are unknown. We examined relationships between psychological constructs and markers of inflammation, endothelial function, and myocardial strain in a cohort of post-acute coronary syndrome (ACS) patients. METHODS Participants (N = 164) attended study visits 2 weeks and 6 months after ACS. During these visits, they completed self-report measures of depressive symptoms, anxiety, optimism, and gratitude; and blood samples were collected for measurement of biomarkers reflecting inflammation, endothelial function, and myocardial strain. Generalized estimating equations and linear regression analyses were performed to examine concurrent and prospective relationships between psychological constructs and biomarkers. RESULTS In concurrent analyses, depressive symptoms were associated with elevated markers of inflammation (interleukin-17: β = .047; 95% confidence interval [CI] = .010-.083]), endothelial dysfunction (endothelin-1: β = .020; 95% [CI] = .004-.037]), and myocardial strain (N-terminal pro-B-type natriuretic peptide: β = .045; 95% [CI] = .008-.083]), independent of age, sex, medical variables, and anxiety, whereas anxiety was not associated with these markers in multivariable adjusted models. Optimism and gratitude were associated with lower levels of markers of endothelial dysfunction (endothelin-1: gratitude: β = -.009; 95% [CI] = -.017 to - .001]; optimism: β = -.009; 95% [CI] = -.016 to - .001]; soluble intercellular adhesion molecule-1: gratitude: β = -.007; 95% [CI] = -.014 to - .000]), independent of depressive and anxiety symptoms. Psychological constructs at 2 weeks were not prospectively associated with biomarkers at 6 months. CONCLUSIONS Depressive symptoms were associated with more inflammation, myocardial strain, and endothelial dysfunction in the 6 months after ACS, whereas positive psychological constructs were linked to better endothelial function. Larger prospective studies may clarify the directionality of these relationships. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier NCT01709669.
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163
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Hayek SS, Ko YA, Awad M, Del Mar Soto A, Ahmed H, Patel K, Yuan M, Maddox S, Gray B, Hajjari J, Sperling L, Shah A, Vaccarino V, Quyyumi AA. Depression and chest pain in patients with coronary artery disease. Int J Cardiol 2017; 230:420-426. [PMID: 28041701 PMCID: PMC5881400 DOI: 10.1016/j.ijcard.2016.12.091] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is common in patients with coronary artery disease (CAD) and is associated with more frequent chest pain. It is however unclear whether this is due to differences in underlying CAD severity. We sought to determine [1] whether depressive symptoms are associated with chest pain independently of CAD severity, [2] whether improvement in depressive symptoms over time is associated with improvement in chest pain and [3] whether the impact of revascularization on chest pain differs between patients with and without depression. METHODS AND RESULTS 5158 patients (mean age 63±12years, 65% male, 20% African American) undergoing cardiac catheterization completed the Seattle Angina Questionnaire (SAQ) and Patient Health Questionnaire-8 (PHQ-8) to assess angina severity and screen for depression, respectively, both at baseline and between 6 and 24months of follow-up. We found significant correlations between PHQ-8 scores and angina frequency (SAQ-AF, r=-0.28), physical limitation (SAQ-PL, r=-0.32) and disease perception (SAQ-DS r=-0.37, all P<0.001), which remained significant after adjustment for clinical characteristics, CAD severity, and anti-depressant use. Improvement in depressive symptoms at follow-up was associated with improvement in angina subscales (SAQ-AF β 1.34, P<0.001), SAQ-PL β 1.85, P<0.001), and SAQ-DS (β 2.12, P<0.001), independently of CAD severity or revascularization. Patients with depression who underwent revascularization had less improvement in chest pain frequency than those without depressive symptoms. CONCLUSIONS Depression is associated with angina, independently of CAD severity. Patients with depression may not derive as adequate symptomatic benefit from revascularization as those without. Whether treatment of underlying depression improves chest pain needs to be further studied.
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Affiliation(s)
- Salim S Hayek
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Yi-An Ko
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mosaab Awad
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Andrea Del Mar Soto
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Hina Ahmed
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Keyur Patel
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael Yuan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Spencer Maddox
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Brandon Gray
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Jamal Hajjari
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Laurence Sperling
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Amit Shah
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Viola Vaccarino
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Arshed A Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States.
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Murphy MO, Cohn DM, Loria AS. Developmental origins of cardiovascular disease: Impact of early life stress in humans and rodents. Neurosci Biobehav Rev 2017; 74:453-465. [PMID: 27450581 PMCID: PMC5250589 DOI: 10.1016/j.neubiorev.2016.07.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/06/2016] [Accepted: 07/19/2016] [Indexed: 02/07/2023]
Abstract
The Developmental Origins of Health and Disease (DOHaD) hypothesizes that environmental insults during childhood programs the individual to develop chronic disease in adulthood. Emerging epidemiological data strongly supports that early life stress (ELS) given by the exposure to adverse childhood experiences is regarded as an independent risk factor capable of predicting future risk of cardiovascular disease. Experimental animal models utilizing chronic behavioral stress during postnatal life, specifically maternal separation (MatSep) provides a suitable tool to elucidate molecular mechanisms by which ELS increases the risk to develop cardiovascular disease, including hypertension. The purpose of this review is to highlight current epidemiological studies linking ELS to the development of cardiovascular disease and to discuss the potential molecular mechanisms identified from animal studies. Overall, this review reveals the need for future investigations to further clarify the molecular mechanisms of ELS in order to develop more personalized therapeutics to mitigate the long-term consequences of chronic behavioral stress including cardiovascular and heart disease in adulthood.
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Affiliation(s)
- M O Murphy
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - D M Cohn
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - A S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States.
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Brinks J, Fowler A, Franklin BA, Dulai J. Lifestyle Modification in Secondary Prevention: Beyond Pharmacotherapy. Am J Lifestyle Med 2017; 11:137-152. [PMID: 30202327 PMCID: PMC6125029 DOI: 10.1177/1559827616651402] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/19/2016] [Accepted: 05/04/2016] [Indexed: 12/17/2022] Open
Abstract
Despite significant advances in medical technology and pharmacology, cardiovascular disease (CVD) remains a major contributor to health care expenses and the leading cause of death in the United States. Patients with established CVD and their health care providers are challenged with achieving cardiovascular risk reduction to decrease the likelihood of recurrent cardiovascular events. This "secondary prevention" can be achieved, in part, through adherence to prescribed pharmacotherapies that favorably modify major coronary risk factors (ie, hypertension, hypercholesterolemia, diabetes, and obesity). However, lifestyle modification can also be helpful in this regard, providing independent and additive benefits to the associated reductions in cardiovascular morbidity and mortality. Accordingly, physicians and other health care providers should routinely counsel their coronary patients to engage in structured exercise and increased lifestyle physical activity, consume a heart-healthy diet, quit smoking and avoid secondhand smoke, and purposefully address psychosocial stressors that may elevate cardiovascular risk. These lifestyle interventions, either as an adjunct to medication therapy or independently in those patients where medications may be poorly tolerated, cost prohibitive, or ineffective, can significantly decrease cardiovascular mortality and the risk of recurrent cardiac events.
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Affiliation(s)
- Jenna Brinks
- Jenna Brinks, MS, Manager, Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI 48073, USA; e-mail:
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Finnell JE, Lombard CM, Padi AR, Moffitt CM, Wilson LB, Wood CS, Wood SK. Physical versus psychological social stress in male rats reveals distinct cardiovascular, inflammatory and behavioral consequences. PLoS One 2017; 12:e0172868. [PMID: 28241050 PMCID: PMC5328366 DOI: 10.1371/journal.pone.0172868] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 01/22/2023] Open
Abstract
Repeated exposure to social stress can precipitate the development of psychosocial disorders including depression and comorbid cardiovascular disease. While a major component of social stress often encompasses physical interactions, purely psychological stressors (i.e. witnessing a traumatic event) also fall under the scope of social stress. The current study determined whether the acute stress response and susceptibility to stress-related consequences differed based on whether the stressor consisted of physical versus purely psychological social stress. Using a modified resident-intruder paradigm, male rats were either directly exposed to repeated social defeat stress (intruder) or witnessed a male rat being defeated. Cardiovascular parameters, behavioral anhedonia, and inflammatory cytokines in plasma and the stress-sensitive locus coeruleus were compared between intruder, witness, and control rats. Surprisingly intruders and witnesses exhibited nearly identical increases in mean arterial pressure and heart rate during acute and repeated stress exposures, yet only intruders exhibited stress-induced arrhythmias. Furthermore, re-exposure to the stress environment in the absence of the resident produced robust pressor and tachycardic responses in both stress conditions indicating the robust and enduring nature of social stress. In contrast, the long-term consequences of these stressors were distinct. Intruders were characterized by enhanced inflammatory sensitivity in plasma, while witnesses were characterized by the emergence of depressive-like anhedonia, transient increases in systolic blood pressure and plasma levels of tissue inhibitor of metalloproteinase. The current study highlights that while the acute cardiovascular responses to stress were identical between intruders and witnesses, these stressors produced distinct differences in the enduring consequences to stress, suggesting that witness stress may be more likely to produce long-term cardiovascular dysfunction and comorbid behavioral anhedonia while exposure to physical stressors may bias the system towards sensitivity to inflammatory disorders.
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Affiliation(s)
- Julie E Finnell
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Calliandra M Lombard
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Akhila R Padi
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Casey M Moffitt
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - L Britt Wilson
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Christopher S Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
| | - Susan K Wood
- Department of Pharmacology, Physiology, and Neuroscience, University of South Carolina School of Medicine, Columbia, South Carolina, United States of America
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Maskeliūnas R, Blažauskas T, Damaševičius R. Depression Behavior Detection Model Based on Participation in Serious Games. ROUGH SETS 2017. [DOI: 10.1007/978-3-319-60840-2_31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Donnelly TT, Al Suwaidi JM, Al-Qahtani A, Asaad N, Qader NA, Singh R, Fung TS, Mueed I, Sharara S, El Banna N, Omar S. Depression in Cardiovascular Patients in Middle Eastern Populations: A Literature Review. J Immigr Minor Health 2016; 17:1259-76. [PMID: 24923859 DOI: 10.1007/s10903-014-0052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cardiovascular disease (CVD) is increasing in Middle Eastern countries. Depression is associated with increased morbidity and mortality rates among cardiovascular (CV) patients. Early detection of and intervention for depression among CV patients can reduce morbidity and mortality and save health care costs. Public information on mental health care needs of Arab CV patients living in Middle East regions is scattered and limited. This literature review surveyed and summarized research studies to learn what is known about the relationship between depression and CVD in Middle Eastern populations. The information will raise awareness among health care professionals and policy makers regarding the clinical significance of depression in Arab CV patients. It might contribute to development of culturally appropriate and effective mental health care services. Multiple databases were searched and 60 articles were assessed, including studies that investigated depression in Arab CV patient populations, physiological mechanisms of depression-CVD comorbidity, and intervention strategies that affect CV risk in depressed Arab patients. We discuss the extent to which this issue has been explored in Arab populations living in Middle East regions and Arab populations living abroad. We recommend that more comprehensive and in-depth research studies be conducted with Arab cardiac patients to enable implementation of culturally appropriate and effective mental health care interventions.
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Affiliation(s)
- Tam Truong Donnelly
- University of Calgary-Qatar, P.O. Box 23133, Al Rayyan Campus, Al Forousiya Road, Doha, Qatar,
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Jangpangi D, Mondal S, Bandhu R, Kataria D, Gandhi A. Alteration of Heart Rate Variability in Patients of Depression. J Clin Diagn Res 2016; 10:CM04-CM06. [PMID: 28208852 DOI: 10.7860/jcdr/2016/22882.9063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/02/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Altered cardiac autonomic functions in form of reduced Heart Rate Variability (HRV) have been found to be associated with increased cardiovascular morbidity and mortality in depressive patients. AIM To investigate the relationship between HRV measures, which is a non-invasive marker of autonomic nervous system and depression. MATERIALS AND METHODS The study included a convenient sample size of drug naive depressive patients (n=30) diagnosed on basis of ICD-10 and compared with age and gender matched healthy volunteers (n=30). Five minute ECG recording was done for HRV analysis and frequency domain measures like LF (Low Frequency), HF (High Frequency), LF/HF ratio as well as time domain measures like SDNN (Standard Deviation of all NN interval) and RMSSD (Root Mean Square of Successive differences of NN intervals) were obtained. RESULTS In the frequency domain parameters, values of LF (nu) and LF/HF Ratio were found to be significantly higher (p<0.001) whereas, that of HF (nu) was significantly lower (p<0.001) in depression group as compared to control group. However, in the time domain parameters, no significant difference was observed in SDNN and RMSSD values in between the two groups. CONCLUSION HRV recordings showed significant changes in frequency domain parameters in the patients suffering from depression. Thus, it could be said from our study that autonomic imbalance reflecting enhanced sympathetic activation relative to parasympathetic component is associated with depression.
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Affiliation(s)
- Deepti Jangpangi
- Senior Resident, Department of Physiology, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India
| | - Sunita Mondal
- Director Professor and Head, Department of Physiology, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India
| | - Rajiv Bandhu
- Professor, Department of Physiology, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India
| | - Dinesh Kataria
- Head of Department and Director Professor, Department of Psychiatry, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India
| | - Asha Gandhi
- Director Professor, Department of Physiology, Lady Hardinge Medical College and Associated Hospitals , New Delhi, India
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Korzeniowska-Kubacka I, Bilińska M, Piotrowska D, Stepnowska M, Piotrowicz R. The impact of exercise-only-based rehabilitation on depression and anxiety in patients after myocardial infarction. Eur J Cardiovasc Nurs 2016; 16:390-396. [DOI: 10.1177/1474515116682123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Iwona Korzeniowska-Kubacka
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Maria Bilińska
- Department of Arrhythmia, Institute of Cardiology, Warsaw, Poland
| | - Dorota Piotrowska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Monika Stepnowska
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, Warsaw, Poland
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171
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Grosso G, Micek A, Marventano S, Castellano S, Mistretta A, Pajak A, Galvano F. Dietary n-3 PUFA, fish consumption and depression: A systematic review and meta-analysis of observational studies. J Affect Disord 2016; 205:269-281. [PMID: 27544316 DOI: 10.1016/j.jad.2016.08.011] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/08/2016] [Accepted: 08/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fish consumption and n-3 polyunsaturated fatty acids (PUFA) have been hypothesized to exert preventive effects toward depressive disorders, but findings are contrasting. We aimed to systematically review and perform meta-analysis of results from observational studies exploring the association between fish, n-3 PUFA dietary intake, and depression. METHODS A search on the main bibliographic source of the observational studies up to August 2015 was performed. Random-effects models of the highest versus the lowest (reference) category of exposure and dose-response meta-analysis were performed. RESULTS A total of 31 studies including 255,076 individuals and over 20,000 cases of depression, were examined. Analysis of 21 datasets investigating relation between fish consumption and depression resulted in significant reduced risk (RR=0.78, 95% CI: 0.69, 0.89), with a linear dose-response despite with moderate heterogeneity. Pooled risk estimates of depression for extreme categories of both total n-3 PUFA and fish-derived n-3 PUFA [eicosapentaenoic acid (EPA)+docosahexaenoic acid (DHA)] resulted in decreased risk for the highest compared with the lowest intake (RR=0.78, 95% CI: 0.67, 0.92 and RR=0.82, 95% CI: 0.73, 0.92, respectively) and dose-response analysis revealed a J-shaped association with a peak decreased risk for 1.8g/d intake of n-3 PUFA (RR=0.30, 95% CI: 0.09, 0.98). LIMITATION Design of the studies included and confounding due to lack adjustment for certain variables may exist. CONCLUSIONS The present analysis supports the hypothesis that dietary n-3 PUFA intake are associated with lower risk of depression.
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Affiliation(s)
- Giuseppe Grosso
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Agnieszka Micek
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Stefano Marventano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy.
| | - Sabrina Castellano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Antonio Mistretta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland
| | - Fabio Galvano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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172
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Szpakowski N, Bennell MC, Qiu F, Ko DT, Tu JV, Kurdyak P, Wijeysundera HC. Clinical Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina: A Population-Based Study. Circ Cardiovasc Qual Outcomes 2016; 9:731-739. [PMID: 27703034 DOI: 10.1161/circoutcomes.116.002904] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 08/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression is prevalent among patients with myocardial infarction and is associated with a worse prognosis. However, little is known about its importance in patients with chronic stable angina. We conducted a retrospective population-based cohort study to determine the occurrence and predictors of developing depression in patients with a new diagnosis of chronic stable angina. In addition, we sought to understand its impact on subsequent clinical outcomes. METHODS AND RESULTS Our cohort included patients in Ontario, Canada, with stable angina based on obstructive coronary artery disease found on angiogram. Depression was ascertained by physician billing codes and hospital admissions diagnostic codes. We first developed multivariable Cox proportional hazards models to determine predictors of developing depression. Clinical outcomes of interest included all-cause mortality, admission for myocardial infarction, and subsequent revascularization. Using hierarchical multivariable Cox proportional hazards models with occurrence of depression as a time-varying variable to control for potential immortal time bias, we evaluated the impact of depression on clinical outcomes. Our cohort consisted of 22 917 patients. The occurrence of depression after diagnosis of stable chronic angina was 18.8% over a mean follow-up of 1084 days. Predictors of depression included remote history of depression, female sex, and more symptomatic angina based on Canadian Cardiovascular Society class. Patients who developed depression had a higher risk of death (hazard ratio 1.83, 95% confidence interval 1.62-2.07) and admission for myocardial infarction (hazard ratio 1.36, 95% confidence interval 1.10-1.67) compared with nondepressed patients. CONCLUSIONS Depression is common in patients with chronic stable angina and is associated with increased morbidity and mortality.
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Affiliation(s)
- Natalie Szpakowski
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.)
| | - Maria C Bennell
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.)
| | - Feng Qiu
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.)
| | - Dennis T Ko
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.)
| | - Jack V Tu
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.)
| | - Paul Kurdyak
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.)
| | - Harindra C Wijeysundera
- From the Schulich Heart Centre, Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Center (N.S., M.C.B., D.T.K., J.V.T., H.C.W.), Sunnybrook Research Institute (M.C.B., D.T.K., J.V.T., H.C.W.), Institute for Health Policy Management and Evaluation (D.T.K., J.V.T., P.K., H.C.W.), and Department of Psychiatry and Institute of Medical Science (P.K.), University of Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (F.Q., D.T.K., J.V.T., P.K., H.C.W.); and Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada (P.K.).
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Depression and Associated Factors in Patients with Implantable Cardioverter-Defibrillators. J Tehran Heart Cent 2016; 11:168-173. [PMID: 28496507 PMCID: PMC5424845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Psychological problems such as depression constitute a dilemma that patients with the implantable cardioverter-defibrillator (ICD) usually encounter and may impact their quality of life. The purpose of this study was to evaluate the prevalence of depression among adults with the ICD and the relationship between depression and associated factors. Methods: Totally, 115 individuals with the ICD participated in this cross-sectional study in Tehran, Iran, and depression and other related risk factors were evaluated in them. Two questionnaires, one for demographic characteristics and the Beck Depression Inventory, were applied for data acquisition. The data were analyzed, and the factors associated with depression in the patients with the ICD were assessed. Results: The mean age of the study population was 59.85 ± 11.46 years. Males comprised 88 (76.5%) and females 27 (23.5%) of the patients. The multivariate analysis on the 115 patients revealed that frequency of ICD shocks (OR = 1.08, 95%CI: 1.02 - 1.10), male sex (OR = 2.28, 95%CI: 1.027 - 5.07), more hospital admissions (OR = 1.19, 95%CI: 1.11 - 1.25), smoking cessation (OR = 9.8, 95%CI: 4.48 - 20.07), presence of ICD shocks (OR = 4.5, 95%CI: 2.45 - 7.38), dyslipidemia (OR = 2.8, 95%CI: 1.22 - 4.95), and family history of depression (OR = 6.4, 95%CI: 3.0 - 13.46) were significantly and independently associated with the Beck score classifications. Conclusion: These findings suggest that a poor psychosocial outcome in patients with the ICD may occur as a result of a variety of associated factors, most of which are predictable and preventable.
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Komasi S, Saeidi M. A Perceived Risk Factor May Lead to Increased Anxiety and Depression in Cardiovascular Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/jjcdc-34159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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van Montfort E, Denollet J, Widdershoven J, Kupper N. Interrelation and independence of positive and negative psychological constructs in predicting general treatment adherence in coronary artery patients - Results from the THORESCI study. J Psychosom Res 2016; 88:1-7. [PMID: 27521644 DOI: 10.1016/j.jpsychores.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/14/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In cardiac patients, positive psychological factors have been associated with improved medical and psychological outcomes. The current study examined the interrelation between and independence of multiple positive and negative psychological constructs. Furthermore, the potential added predictive value of positive psychological functioning regarding the prediction of patients' treatment adherence and participation in cardiac rehabilitation (CR) was investigated. METHOD 409 percutaneous coronary intervention (PCI) patients were included (mean age = 65.6 ± 9.5; 78% male). Self-report questionnaires were administered one month post-PCI. Positive psychological constructs included positive affect (GMS) and optimism (LOT-R); negative constructs were depression (PHQ-9, BDI), anxiety (GAD-7) and negative affect (GMS). Six months post-PCI self-reported general adherence (MOS) and CR participation were determined. RESULTS Factor Analysis (Oblimin rotation) revealed two components (r = − 0.56), reflecting positive and negative psychological constructs. Linear regression analyses showed that in unadjusted analyses both optimism and positive affect were associated with better general treatment adherence at six months (p < 0.05). In adjusted analyses, optimism's predictive values remained, independent of sex, age, PCI indication, depression and anxiety. Univariate logistic regression analysis showed that in patients with a cardiac history, positive affect was significantly associated with CR participation. After controlling for multiple covariates, this relation was no longer significant. CONCLUSIONS Positive and negative constructs should be considered as two distinct dimensions. Positive psychological constructs (i.e. optimism) may be of incremental value to negative psychological constructs in predicting patients' treatment adherence. A more complete view of a patients' psychological functioning will open new avenues for treatment. Additional research is needed to investigate the relationship between positive psychological factors and other cardiac outcomes, such as cardiac events and mortality.
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Affiliation(s)
- Eveline van Montfort
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, the Netherlands
| | - Johan Denollet
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, the Netherlands
| | - Jos Widdershoven
- Elisabeth Tweesteden hospital, Tilburg, the Netherlands and Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, the Netherlands
| | - Nina Kupper
- Tilburg University, Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases, the Netherlands.
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176
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Is Symptomatic Long QT Syndrome Associated with Depression in Women and Men? J Genet Couns 2016; 26:491-500. [PMID: 27553078 DOI: 10.1007/s10897-016-0004-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 08/02/2016] [Indexed: 01/01/2023]
Abstract
We examined whether long QT syndrome (LQTS) mutation carrier status or symptomatic LQTS are associated with depression, and whether there are sex differences in these potential relationships. The sample comprised 782 participants (252 men). Of the 369 genetically defined LQTS mutation carriers, 169 were symptomatic and 200 were asymptomatic. The control group consisted of 413 unaffected relatives. Depression was assessed using the Beck Depression Inventory-II (BDI-II). No association was found for LQTS mutation carrier status with depression. The multinomial logistic regression showed that LQTS mutation carrier men with arrhythmic events scored higher on depression compared with the control group, even when adjusting for age, β-blockers, antidepressants, and social support (OR = 1.09, 95 % CI [1.02, 1.15], p = .007). The binary logistic regression comparing symptomatic and asymptomatic LQTS mutation carriers showed that symptomatic LQTS was associated with depression in men (OR = 1.10, 95 % CI [1.03, 1.19], p = .009). The results were unchanged when additionally adjusted for education. These findings suggest that symptomatic LQTS is associated with depression in men but not in women. Overall, however, depression is more frequent in women than men. Thus, regular screening for depression in LQTS mutation carriers and their unaffected family members can be important.
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177
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Cai S, Coates AM, Buckley JD, Berry NM, Burres L, Beltrame J, Howe PRC, Schrader G. There is No Association Between the Omega-3 Index and Depressive Symptoms in Patients With Heart Disease Who Are Low Fish Consumers. Heart Lung Circ 2016; 26:276-284. [PMID: 27592324 DOI: 10.1016/j.hlc.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Long chain Omega-3 polyunsaturated fatty acids (LCn3PUFAs) may improve cardiovascular health and depression. This study investigated the relationships between erythrocyte membrane LCn3PUFA status, depression and angina symptoms in patients with heart disease. METHODS We recruited 91 patients (65 males and 26 females, mean age 59.2±10.3 years) with heart disease and depressive symptoms (Center for Epidemiological Studies Depression Scale, CES-D ≥ 16) and low fish/fish oil intakes. The Omega-3 Index (EPA+DHA) of erythrocyte membranes (as a percentage of total fatty acids) was assessed by gas chromatography. Depression status was measured by both self-report and clinician-report scales; CES-D and the Hamilton depression scale (HAM-D). Angina symptoms were measured using the Seattle Angina Questionnaire and the Canadian Cardiovascular Society Classification for Angina Pectoris. RESULTS The mean Omega-3 Index was 4.8±1.0% (±SD). Depression scores measured by CES-D and HAM-D were 29.2±8.8 (moderate to severe) and 11.0±5.7 (mild) (arbitrary units) respectively reflecting a different perception of depressive symptoms between patients and clinicians. Angina status was inversely associated with depression scores (r>-0.26, P<0.03). There were no significant relationships between individual LCn3PUFA or the Omega-3 Index and either the depression scores or the angina symptoms. CONCLUSION Worse angina status was associated with worse depression, but the Omega-3 Index was not associated with symptoms of depression or angina in patients with heart disease.
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Affiliation(s)
- Shaoxin Cai
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Alison M Coates
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
| | - Jonathan D Buckley
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Narelle M Berry
- Acute Care and Cardiovascular Research Group, School of Nursing and Midwifery, Flinders University, SA, Australia
| | - Lisa Burres
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
| | - John Beltrame
- Central Adelaide Local Health Network, The Queen Elizabeth Hospital and Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Peter R C Howe
- Alliance for Research in Exercise, Nutrition and Activity, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia; Clinical Nutrition Research Centre, School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Geoffrey Schrader
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
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178
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Feng HP, Chien WC, Cheng WT, Chung CH, Cheng SM, Tzeng WC. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4464. [PMID: 27559951 PMCID: PMC5400317 DOI: 10.1097/md.0000000000004464] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI.
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Affiliation(s)
- Hsin-Pei Feng
- Institute of Medical Sciences and School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital and School of Public Health, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wei-Tung Cheng
- Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung CityTaiwan (ROC)
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, School of Public Health, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Shu-Meng Cheng
- Internal Medicine, School of Medicine and Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC)
- Correspondence: Wen-Chii Tzeng, School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC) (e-mail: )
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179
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The impact of cardiac rehabilitation program on anxiety and depression levels after coronary artery bypass graft surgery. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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180
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Ski CF, Worrall-Carter L, Cameron J, Castle DJ, Rahman MA, Thompson DR. Depression screening and referral in cardiac wards: A 12-month patient trajectory. Eur J Cardiovasc Nurs 2016; 16:157-166. [DOI: 10.1177/1474515115583617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chantal F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Linda Worrall-Carter
- St Vincent’s Centre for Nursing Research, Australian Catholic University, Melbourne, Australia
| | - Jan Cameron
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
| | - David J Castle
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Muhammad A Rahman
- St Vincent’s Centre for Nursing Research, Australian Catholic University, Melbourne, Australia
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
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181
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Columbo JA, Stone DH, Goodney PP, Nolan BW, Stableford JA, Brooke BS, Powell RJ, Finn CT. The Prevalence and Regional Variation of Major Depressive Disorder Among Patients With Peripheral Arterial Disease in the Medicare Population. Vasc Endovascular Surg 2016; 50:235-40. [DOI: 10.1177/1538574416644529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Current evidence suggests an association between coronary artery disease and major depressive disorder (MDD). Data to support a similar association between peripheral arterial disease (PAD) and MDD are more limited. This study examines the prevalence and regional variation of both PAD and MDD in a large contemporary patient sample. Methods: All Medicare claims, part A and B, from January 2009 until December 2011 were queried using diagnosis codes specific for a previously validated clinical algorithm for PAD and major depression. Codes for PAD included those specific to cerebrovascular disease, abdominal aortic aneurysm, and peripheral vascular disease. Peripheral arterial disease prevalence, major depression prevalence, and coprevalence rates were determined, respectively. Regional variation of both conditions was determined using zip code data to identify potential endemic areas of disease intensity for both diagnoses. Results: Over the study interval, the percentage of Medicare beneficiaries with a diagnosis of PAD remained relatively constant (3.0%-3.7%, n = 0.85-1.06 million in part A and 17.4%-17.5%, n = 4.82-4.93 million in part B), and MDD showed a similar trend (1.6%-2.7%, n = 0.46-0.79 million in part A and 6.1%-6.7%, n = 1.69-1.90 million in part B). The observed rate of MDD in those with an established diagnosis of PAD was 5-fold higher than those without PAD in part A claims (1.8-fold in part B claims). Moreover, there was a significant linear geographic correlation among patients with PAD and MDD ( r = .54, P ≤ .01). Conclusions: This study documents a correlation between PAD and MDD and may, therefore, identify an at-risk population susceptible to inferior clinical outcomes. Significant regional variation exists in the prevalence of PAD and MDD, though there appear to be specific endemic regions notable for both disorders. Accordingly, health-care resource allocation toward endemic regions may help improve population health among this at-risk cohort.
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Affiliation(s)
- Jesse A. Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - David H. Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Philip P. Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Brian W. Nolan
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Benjamin S. Brooke
- Section of Vascular Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Richard J. Powell
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christine T. Finn
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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182
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Chang HA, Chang CC, Kuo TBJ, Huang SY. Distinguishing bipolar II depression from unipolar major depressive disorder: Differences in heart rate variability. World J Biol Psychiatry 2016; 16:351-60. [PMID: 25800950 DOI: 10.3109/15622975.2015.1017606] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Bipolar II (BPII) depression is commonly misdiagnosed as unipolar depression (UD); however, an objective and reliable tool to differentiate between these disorders is lacking. Whether cardiac autonomic function can be used as a biomarker to distinguish BPII from UD is unknown. METHODS We recruited 116 and 591 physically healthy patients with BPII depression and UD, respectively, and 421 healthy volunteers aged 20-65 years. Interviewer and self-reported measures of depression/anxiety severity were obtained. Cardiac autonomic function was evaluated by heart rate variability (HRV) and frequency-domain indices of HRV. RESULTS Patients with BPII depression exhibited significantly lower mean R-R intervals, variance (total HRV), low frequency (LF)-HRV, and high frequency (HF)-HRV but higher LF/HF ratio compared to those with UD. The significant differences remained after adjusting for age. Compared to the controls, the patients with BPII depression showed cardiac sympathetic excitation with reciprocal vagal impairment, whereas the UD patients showed only vagal impairment. Depression severity independently contributed to decreased HRV and vagal tone in both the patients with BPII depression and UD, but increased sympathetic tone only in those with BPII depression. CONCLUSIONS HRV may aid in the differential diagnosis of BPII depression and UD as an adjunct to diagnostic interviews.
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Affiliation(s)
- Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center , Taipei , Taiwan
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183
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Pederson JL, Warkentin LM, Majumdar SR, McAlister FA. Depressive symptoms are associated with higher rates of readmission or mortality after medical hospitalization: A systematic review and meta-analysis. J Hosp Med 2016; 11:373-80. [PMID: 26824220 PMCID: PMC5066695 DOI: 10.1002/jhm.2547] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 12/02/2022]
Abstract
Depressive symptoms during a medical hospitalization may be an overlooked prognostic factor for adverse events postdischarge. Our aim was to evaluate whether depressive symptoms predict 30-day readmission or death after medical hospitalization. We conducted a systematic review of studies that compared postdischarge outcomes by in-hospital depressive status. We assessed study quality and pooled published and unpublished data using random effects models. Overall, one-third of 6104 patients discharged from medical wards were depressed (interquartile range, 27%-40%). Compared to inpatients without depression, those discharged with depressive symptoms were more likely to be readmitted (20.4% vs 13.7%, risk ratio [RR]: 1.73, 95% confidence interval [CI]: 1.16-2.58) or die (2.8% vs 1.5%, RR: 2.13, 95% CI: 1.31-3.44) within 30 days. Depressive symptoms were common in medical inpatients and are associated with an increased risk of adverse events postdischarge. Journal of Hospital Medicine 2016;11:373-380. © 2016 The Authors Journal of Hospital Medicine published by Wiley Periodicals, Inc. on behalf of Society of Hospital Medicine.
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Affiliation(s)
- Jenelle L. Pederson
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Lindsey M. Warkentin
- Division of Surgery, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
| | - Sumit R. Majumdar
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
- Alberta Diabetes InstituteEdmontonCanada
| | - Finlay A. McAlister
- Division of General Internal Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
- The Patient Health Outcomes Research and Clinical Effectiveness Unit, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
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184
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What the Psychiatrist Needs to Know About Ventricular Assist Devices: A Comprehensive Review. PSYCHOSOMATICS 2016; 57:229-37. [DOI: 10.1016/j.psym.2016.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 01/04/2023]
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185
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Moryś JM, Bellwon J, Höfer S, Rynkiewicz A, Gruchała M. Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure. Arch Med Sci 2016; 12:326-33. [PMID: 27186176 PMCID: PMC4848348 DOI: 10.5114/aoms.2014.47881] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/14/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Quality of life measures are useful when interventions or treatments are indicated for several reasons such as improvement of physical functioning, pain relief, to estimate the effectiveness of therapies or to predict mortality. The aim of the current study was to describe quality of life in patients with stable coronary artery disease, myocardial infarction and heart failure and to evaluate the relationship between depression and health-related quality of life. MATERIAL AND METHODS Patients after STEMI, with stable coronary artery disease, and heart failure (n = 332) completed the MacNew Heart Disease Health-related Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale. RESULTS Patients with myocardial infarction had significantly higher scores than patients with stable coronary artery disease or heart failure on the MacNew global scale (p < 0.001) and the physical (p < 0.001), emotional (p < 0.001) and social (p < 0.001) subscales. The anxiety scores were significantly higher in the group of patients with stable coronary artery disease than in patients with myocardial infarction (p < 0.05). The depression scores were significantly higher in patients with heart failure (p < 0.01). CONCLUSIONS In patients with stable CAD, anxiety correlated mainly with symptoms, i.e. angina, than with the history of MI. Patients with symptoms of angina react to the illness with anxiety more than depression, whereas patients with heart failure with dyspnea react to the illness with depressive symptoms more than anxiety. In patients after MI and with stable CAD, cognitive-behavioral techniques could be useful to quickly reduce the level of anxiety, while patients with heart failure require long-term support therapy to reduce the risk of depressive symptoms.
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Affiliation(s)
- Joanna M. Moryś
- Department of Clinical Psychology, Medical University of Gdansk, Gdansk, Poland
- 1 Cardiology Clinic, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy Bellwon
- 1 Cardiology Clinic, Medical University of Gdansk, Gdansk, Poland
| | - Stefan Höfer
- Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrzej Rynkiewicz
- Department of Cardiology and Cardiosurgery, Division of Cardiology and Internal Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Marcin Gruchała
- 1 Cardiology Clinic, Medical University of Gdansk, Gdansk, Poland
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186
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Pederson JL, Majumdar SR, Forhan M, Johnson JA, McAlister FA. Current depressive symptoms but not history of depression predict hospital readmission or death after discharge from medical wards: a multisite prospective cohort study. Gen Hosp Psychiatry 2016; 39:80-5. [PMID: 26804774 DOI: 10.1016/j.genhosppsych.2015.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/15/2015] [Accepted: 12/09/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Although death or readmission shortly after hospital discharge is frequent, identifying inpatients at higher risk is difficult. We evaluated whether in-hospital depressive symptoms (hereafter "depression") are associated with short-term readmission or mortality after discharge from medical wards. METHODS Depression was assessed at discharge in a prospective inpatient cohort from 2 Canadian hospitals (7 medical wards) and defined as scores ≥ 11 on the 27-point Patient Health Questionnaire (PHQ-9). Primary outcome was all-cause readmission or mortality 90 days postdischarge. RESULTS Of 495 medical patients [median age 64 years, 51% women, top 3 admitting diagnoses heart failure (10%), pneumonia (10%) and chronic obstructive pulmonary disease (8%)], 127 (26%) screened positive for depression at discharge. Compared with nondepressed patients, those with depression were more frequently readmitted or died: 27/127 (21%) vs. 58/368 (16%) within 30 days and 46 (36%) vs. 91 (25%) within 90 days [adjusted odds ratio (aOR) 2.00, 95% confidence interval 1.25-3.17, P=.004, adjusted for age, sex and readmission/death prediction scores]. History of depression did not predict 90-day events (aOR 1.05, 95% CI 0.64-1.72, P=.84). Depression persisted in 40% of patients at 30 days and 17% at 90 days. CONCLUSIONS Depression was common, underrecognized and often persisted postdischarge. Current symptoms of depression, but not history, identified greater risk of short-term events independent of current risk prediction rules.
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Affiliation(s)
- Jenelle L Pederson
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Sumit R Majumdar
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3; Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Jeffrey A Johnson
- Alberta Diabetes Institute, Edmonton, AB, Canada T6G 2R3; School of Public Health, University of Alberta, Edmonton, AB, Canada T6G 2R3
| | - Finlay A McAlister
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada T6G 2R3.
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187
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Celano CM, Healy B, Suarez L, Levy DE, Mastromauro C, Januzzi JL, Huffman JC. Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:185-191. [PMID: 27021752 DOI: 10.1016/j.jval.2015.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 11/11/2015] [Accepted: 12/19/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization. METHODS The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs. RESULTS The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs. CONCLUSIONS This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge.
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Affiliation(s)
- Christopher M Celano
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Brian Healy
- Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Laura Suarez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas E Levy
- Harvard Medical School, Boston, MA, USA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Carol Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - James L Januzzi
- Harvard Medical School, Boston, MA, USA; Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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188
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Osler M, Mårtensson S, Wium-Andersen IK, Prescott E, Andersen PK, Jørgensen TSH, Carlsen K, Wium-Andersen MK, Jørgensen MB. Depression After First Hospital Admission for Acute Coronary Syndrome: A Study of Time of Onset and Impact on Survival. Am J Epidemiol 2016; 183:218-26. [PMID: 26740025 DOI: 10.1093/aje/kwv227] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/19/2015] [Indexed: 01/21/2023] Open
Abstract
We examined incidence of depression after acute coronary syndrome (ACS) and whether the timing of depression onset influenced survival. All first-time hospitalizations for ACS (n = 97,793) identified in the Danish Patient Registry during 2001-2009 and a reference population were followed for depression and mortality via linkage to patient, prescription, and cause-of-death registries until the end of 2012. Incidence of depression (as defined by hospital discharge or antidepressant medication use) and the relationship between depression and mortality were examined using time-to-event models. In total, 19,520 (20.0%) ACS patients experienced depression within 2 years after the event. The adjusted rate ratio for depression in ACS patients compared with the reference population was 1.28 (95% confidence interval (CI): 1.25, 1.30). During 12 years of follow-up, 39,523 (40.4%) ACS patients and 27,931 (28.6%) of the reference population died. ACS patients with recurrent (hazard ratio (HR) = 1.62, 95% CI: 1.57, 1.67) or new-onset (HR = 1.66, 95% CI: 1.60, 1.72) depression had higher mortality rates than patients with no depression. In the reference population, the corresponding relative estimates for recurrent (HR =1.98, 95% CI: 1.92, 2.05) and new-onset (HR = 2.42, 95% CI: 2.31, 2.54) depression were stronger. Depression is common in ACS patients and is associated with increased mortality independently of time of onset, but here the excess mortality associated with depression seemed to be lower in ACS patients than in the reference population.
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189
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Weisbord SD. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life. Semin Dial 2016; 29:158-64. [DOI: 10.1111/sdi.12464] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Steven D. Weisbord
- Renal Section; Medicine Service Line and the Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System; Pittsburgh Pennsylvania
- Renal-Electrolyte Division; Department of Medicine; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
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190
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Ernstsen L, Rangul V, Nauman J, Nes BM, Dalen H, Krokstad S, Lavie CJ, Blair SN, Wisløff U. Protective Effect of Regular Physical Activity on Depression After Myocardial Infarction: The HUNT Study. Am J Med 2016; 129:82-88.e1. [PMID: 26302141 DOI: 10.1016/j.amjmed.2015.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To study if physical activity within the recommended level over time was associated with risk of developing depression after the first myocardial infarction in older adults. METHODS Men (n = 143) and women (n = 46) who had reached the age of 60 years in 2006-2008 who participated in the Nord-Trøndelag Health Study (HUNT1, 1984-1986; HUNT2, 1995-1997; HUNT3, 2006-2008) without any mental illness or cardiovascular disease at baseline in HUNT2 and who experienced their first myocardial infarction before HUNT3 were included. Based on the patterns of physical activity from HUNT1 to HUNT2, the sample was divided into 4 groups: persistently inactive, from active to inactive, from inactive to active, and persistently active. The primary outcome, post-myocardial infarction depression symptoms, was measured with the Hospital, Anxiety and Depression Scale in HUNT3. RESULTS In HUNT3, 11% of participants had depression. After multivariable adjustment, those who were persistently active had significantly lower odds of being depressed (odds ratio 0.28; 95% confidence interval, 0.08-0.98) compared with those who were persistently inactive. Additionally, a significant test for trend (P = .033) of lowering odds of depression was observed across all 4 categories of physical activity patterns at baseline. CONCLUSIONS In this small sample of initially healthy adults, we observed a long-term protective effect of regular physical activity on the development of depression following myocardial infarction.
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Affiliation(s)
- Linda Ernstsen
- Department of Nursing Science, Faculty of Health and Social Science, Sør-Trøndelag University College, Trondheim, Norway; K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Vegar Rangul
- Faculty of Health Science, Nord-Trøndelag University College, Levanger, Norway; HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Javaid Nauman
- K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjarne M Nes
- K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- MI Lab & Department of Circulation & Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Psychiatric Department, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, La
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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191
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Ogilvie RP, Everson-Rose SA, Longstreth WT, Rodriguez CJ, Diez-Roux AV, Lutsey PL. Psychosocial Factors and Risk of Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Circ Heart Fail 2015; 9:e002243. [PMID: 26699386 DOI: 10.1161/circheartfailure.115.002243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/07/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease but not for HF. METHODS AND RESULTS We examined the relationship between psychological status and incident HF among 6782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales, and physician reviewers adjudicated incident HF events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow-up of 9.3 years, 242 participants developed incident HF. There was no association between psychosocial factors and HF hazard ratios (95% confidence interval) for the highest versus lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high versus low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident HF, but there was no association for those with good/very good/excellent self-reported health. CONCLUSIONS Overall, these psychosocial factors were not significantly associated with incident HF. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of HF. Future research with greater statistical power is necessary to replicate these findings and seek explanations.
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Affiliation(s)
- Rachel P Ogilvie
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
| | - Susan A Everson-Rose
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - W T Longstreth
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Carlos J Rodriguez
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Ana V Diez-Roux
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
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Luck-Sikorski C, Luppa M, Heser K, Bleckwenn M, Posselt T, Ernst A, Werle J, Weeg D, Mösch E, Wiese B, Steinmann S, Fuchs A, Pentzek M, König HH, Brettschneider C, Scherer M, Maier W, Weyerer S, Riedel-Heller SG. Mild Depressive Symptoms Predict Mortality from Heart Failure in Elderly Men but Not Women. J Am Geriatr Soc 2015; 63:2408-10. [PMID: 26603063 DOI: 10.1111/jgs.13802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Kathrin Heser
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Markus Bleckwenn
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelm University, Bonn, Germany
| | - Tina Posselt
- Institute of Primary Medical Care, University Medical Center Hamburg, Eppendorf, Germany
| | - Annette Ernst
- Institute of Primary Medical Care, University Medical Center Hamburg, Eppendorf, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Dagmar Weeg
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Edelgard Mösch
- Department of Psychiatry, Technical University of Munich, Munich, Germany
| | - Birgitt Wiese
- Institute of General Practice, WG IT Medical Statistics and IT Infrastructure, Hannover Medical School, Hannover, Germany
| | - Susanne Steinmann
- Institute of General Practice, WG IT Medical Statistics and IT Infrastructure, Hannover Medical School, Hannover, Germany
| | - Angela Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg, Eppendorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
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193
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Stenman M, Holzmann MJ, Sartipy U. Do socioeconomic factors modify the association between preoperative antidepressant use and survival following coronary artery bypass surgery? Int J Cardiol 2015; 198:206-12. [DOI: 10.1016/j.ijcard.2015.06.125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/19/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
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194
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Gallagher J, Parenti G, Doyle F. Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep? Curr Cardiol Rep 2015; 17:111. [DOI: 10.1007/s11886-015-0667-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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195
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Terrill AL, Gjerde JM, Garofalo JP. Background Stress Inventory: Developing a Measure of Understudied Stress. Stress Health 2015; 31:290-8. [PMID: 26468688 DOI: 10.1002/smi.2554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 09/25/2013] [Accepted: 10/23/2013] [Indexed: 01/10/2023]
Abstract
Background stress is an understudied source of stress that involves both ambient stress and daily hassles upon which new stressors are superimposed. To date, an accurate measure of the background stress construct has not been available. We developed the Background Stress Inventory, a 25-item self-report measure that asks respondents to indicate how distressed they have felt over the past month and the majority of the past year across five domains: financial, occupation, environment, health and social. Seven hundred seventy-two participants completed the paper-and-pencil measure; the sample was randomly split into two separate subsamples for analyses. Exploratory factor analysis suggested five factors corresponding to these domains, and confirmatory factor analysis showed acceptable global fit (X(2)(255) = 456.47, comparative fit index = 0.94, root mean square error of approximation = 0.045). Cronbach's alpha (0.89) indicated good internal reliability. Construct validity analyses showed significant positive relationships with measures of perceived stressfulness (r = 0.62) and daily hassles (0.41), p's < 0.01. Depressive symptoms (0.62) and basal blood pressure (0.21) were both significantly associated with background stress, p's < 0.01. The importance of the proposed measure is reflected in the limited research base on the impact of background stress. Systematic investigation of this measure will provide insight into this understudied form of chronic stress and its potential influence on both psychological and physical endpoints.
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196
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Huffman JC, Beale EE, Beach SR, Celano CM, Belcher AM, Moore SV, Suarez L, Gandhi PU, Motiwala SR, Gaggin H, Januzzi JL. Design and baseline data from the Gratitude Research in Acute Coronary Events (GRACE) study. Contemp Clin Trials 2015; 44:11-19. [PMID: 26166171 DOI: 10.1016/j.cct.2015.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/02/2015] [Accepted: 07/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Positive psychological constructs, especially optimism, have been linked with superior cardiovascular health. However, there has been minimal study of positive constructs in patients with acute coronary syndrome (ACS), despite the prevalence and importance of this condition. Furthermore, few studies have examined multiple positive psychological constructs and multiple cardiac-related outcomes within the same cohort to determine specifically which positive construct may affect a particular cardiac outcome. MATERIALS AND METHODS The Gratitude Research in Acute Coronary Events (GRACE) study examines the association between optimism/gratitude 2weeks post-ACS and subsequent clinical outcomes. The primary outcome measure is physical activity at 6months, measured via accelerometer, and key secondary outcome measures include levels of prognostic biomarkers and rates of nonelective cardiac rehospitalization at 6months. These relationships will be analyzed using multivariable linear regression, controlling for sociodemographic, medical, and negative psychological factors; associations between baseline positive constructs and subsequent rehospitalizations will be assessed via Cox regression. RESULTS Overall, 164 participants enrolled and completed the baseline 2-week assessment; the cohort had a mean age of 61.5+/?10.5years and was 84% men; this was the first ACS for 58% of participants. CONCLUSION The GRACE study will determine whether optimism and gratitude are prospectively and independently associated with physical activity and other critical outcomes in the 6months following an ACS. If these constructs are associated with superior outcomes, this may highlight the importance of these constructs as independent prognostic factors post-ACS.
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Affiliation(s)
- Jeff C Huffman
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
| | - Eleanor E Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Scott R Beach
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christopher M Celano
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Arianna M Belcher
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Shannon V Moore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Laura Suarez
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Parul U Gandhi
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - Shweta R Motiwala
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hanna Gaggin
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
| | - James L Januzzi
- Harvard Medical School, Boston, MA, United States; Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
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197
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DuBois CM, Lopez OV, Beale EE, Healy BC, Boehm JK, Huffman JC. Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review. Int J Cardiol 2015; 195:265-80. [PMID: 26048390 DOI: 10.1016/j.ijcard.2015.05.121] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/11/2015] [Accepted: 05/19/2015] [Indexed: 02/06/2023]
Abstract
Depression and anxiety are well-known to be associated with adverse health outcomes in cardiac patients. However, there has been less work synthesizing the effects of positive psychological constructs (e.g., optimism) on health-related outcomes in cardiac patients. We completed a systematic review of prospective observational studies using established guidelines. A search of PubMed and PsycINFO databases from inception to January 2014 was used to identify articles. To be eligible, studies were required to assess effects of a positive psychological construct on subsequent health-related outcomes (including mortality, rehospitalizations, self-reported health status) in patients with established heart disease. Exploratory random effects' meta-analyses were performed on the subset of studies examining mortality or rehospitalizations. Seventy-seven analyses from 30 eligible studies (N=14,624) were identified. Among studies with 100 or more participants, 65.0% of all analyses and 64.7% of analyses adjusting for one or more covariates reported a significant (p<.05) association between positive psychological constructs and subsequent health outcomes. An exploratory meta-analysis of 11 studies showed that positive constructs were associated with reduced rates of rehospitalization or mortality in unadjusted (odds ratio=.87; 95% confidence interval [.83, .92]; p<.001) and adjusted analyses (odds ratio=.89; 95% confidence interval [.84, .91]; p<.001); there was little suggestion of publication bias. Among cardiac patients, positive psychological constructs appear to be prospectively associated with health outcomes in most but not all studies. Additional work is needed to identify which constructs are most important to cardiac health, and whether interventions can cultivate positive attributes and improve clinical outcomes.
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Affiliation(s)
- Christina M DuBois
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Oriana Vesga Lopez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Eleanor E Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Brian C Healy
- Harvard Medical School, Boston, MA, United States; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Julia K Boehm
- Department of Psychology, Chapman University, Orange, CA, United States
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States; Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
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198
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Mills PJ, Redwine L, Wilson K, Pung MA, Chinh K, Greenberg BH, Lunde O, Maisel A, Raisinghani A, Wood A, Chopra D. The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients. ACTA ACUST UNITED AC 2015. [PMID: 26203459 DOI: 10.1037/scp0000050] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value.
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Affiliation(s)
- Paul J Mills
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA ; Department of Psychiatry, University of California, San Diego, La Jolla, CA ; UC San Diego Center of Excellence for Research and Training in Global Integrative Health, University of California, San Diego, La Jolla, CA ; Chopra Center for Wellbeing, University of California, San Diego, La Jolla, CA
| | - Laura Redwine
- Department of Psychiatry, University of California, San Diego, La Jolla, CA ; UC San Diego Center of Excellence for Research and Training in Global Integrative Health, University of California, San Diego, La Jolla, CA
| | - Kathleen Wilson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Meredith A Pung
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Kelly Chinh
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Barry H Greenberg
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Ottar Lunde
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Alan Maisel
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Ajit Raisinghani
- Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Alex Wood
- Department of Behavioral Science, University of Stirling, Stirling Scotland
| | - Deepak Chopra
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA ; Chopra Center for Wellbeing, University of California, San Diego, La Jolla, CA
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199
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Return to work after depression-related absence by employees with and without other health conditions: a cohort study. Psychosom Med 2015; 77:126-35. [PMID: 25675157 DOI: 10.1097/psy.0000000000000138] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Among employees with depression, diagnoses of other psychiatric and somatic conditions are common. However, few studies have examined whether the combined presence of depression and other psychiatric or somatic disorders adversely affects return to work after depression-related absence from work. METHODS We examined the association of present and recent psychiatric and somatic conditions and return to work after depression-related absence in a cohort of 9908 Finnish public sector employees with at least one such episode. The data included a total of 14,101 episodes during the period January 2005 to December 2011. RESULTS A total of 89% (n = 12,486) of depression-related absence episodes ended in return to work during the follow-up. For those episodes, the median length of absence was 34 days (interquartile range, 20-69 days). After adjustment for sex, age, socioeconomic status, and type of employment contract, present or recent psychiatric disorders other than depression (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.74-0.83), cancer (HR = 0.66, 95% CI = 0.47-0.92), diabetes (HR = 0.73, 95% CI = 0.62-0.86), cardiovascular disease (HR = 0.78, 95% CI = 0.62-0.99), hypertension (HR = 0.76, 95% CI = 0.67-0.85), musculoskeletal disorders (HR = 0.82, 95% CI = 0.77-0.87), and asthma (HR = 0.84, 95% CI = 0.75-0.94) were all associated with a lower likelihood of returning to work compared with depression episodes without other conditions. CONCLUSIONS Among employees with depression-related absence, return to work is delayed in the presence of other psychiatric and somatic conditions. These findings suggest that other diseases should be taken into account when evaluating the outcome of depression-related absence. Randomized controlled trials are needed to examine whether integrated treatment of mental and physical disorders improves successful return to work after depression.
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Abstract
OBJECTIVE To characterize the relationship between stress and future risk of sepsis. We also evaluated the role of depression in this relationship. METHODS We used population-based data on 30,183 participants in the Reasons for Geographic and Racial Differences in Stroke cohort, characterizing stress using the Perceived Stress Scale (PSS) and depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). We identified incident sepsis events as hospitalizations for a serious infection with the presence of at least two systemic inflammatory response syndrome criteria. We assessed associations between PSS and incidence of sepsis for 1 and 10 years of follow-up, adjusting for demographics and chronic medical conditions and assessing the role of health behaviors and CES-D in these relationships. RESULTS In 2003 to 2012, 1500 participants experienced an episode of sepsis. Mean PSS and CES-D scores were 3.2 (2.9) and 1.2 (2.1). PSS was associated with increased 1-year adjusted incidence of sepsis (hazard ratio [HR] = 1.21 per PSS standard deviation, 95% confidence interval = 1.06-1.38); multivariable adjustment for health behaviors and CES-D did not change this association (1.20, 1.03-1.39). PSS was also associated with increased 10-year adjusted incidence of sepsis (HR = 1.07 per PSS standard deviation; 95% confidence interval = 1.02-1.13). Multivariable adjustment showed that health behaviors did not affect this long-term association, whereas the addition of CES-D reduced the association between PSS and sepsis during 10-year follow-up (HR = 1.04, 0.98-1.11). CONCLUSIONS Increased stress was associated with higher 1-year adjusted incidence of sepsis, even after accounting for depressive symptoms. The association between stress and 10-year adjusted incidence of sepsis was also significant, but this association was reduced when adjusting for depressive symptoms. Reduction of stress may limit short-term sepsis risk.
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