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Brostow DP, Hirsch AT, Kurzer MS. Recruiting older patients with peripheral arterial disease: evaluating challenges and strategies. Patient Prefer Adherence 2015; 9:1121-8. [PMID: 26273200 PMCID: PMC4532167 DOI: 10.2147/ppa.s83306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral arterial disease (PAD) is a group of syndromes characterized by chronic and progressive atherosclerosis with a high burden of physical disability and cardiovascular morbidity and mortality. Recruiting patients for clinical research is therefore challenging. In this article, we describe and evaluate our methods for recruiting participants for a cross-sectional feasibility study of PAD, nutritional status, and body composition. We used convenience and purposive sampling approaches to identify potential participants. Between May 2012 and April 2013, 1,446 patients were identified, and 165 patients (11.4%) responded to recruitment requests. The final enrollment was 64 participants (64/1,446; 4.4%), and four subjects (6.3%) subsequently withdrew from the study. Recruiting PAD patients presents a variety of challenges, due largely to the burdens of living with coexistent illnesses, and patients' reluctance or inability to travel for research. In this article, we delineate suggestions for improving the efficacy of recruitment methods in future PAD studies.
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Affiliation(s)
- Diana P Brostow
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
- Correspondence: Diana P Brostow, Veterans Affairs Eastern Colorado Health Care System, 1055 Claremont Street, Research A151, Denver, CO 80220, USA, Email
| | - Alan T Hirsch
- Department of Medicine, Vascular Medicine Program, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Mindy S Kurzer
- Department of Food Science and Nutrition, University of Minnesota, Twin Cities, MN, USA
- Healthy Lives Institute, St Paul, MN, USA
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202
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Lanata A, Valenza G, Nardelli M, Gentili C, Scilingo EP. Complexity Index From a Personalized Wearable Monitoring System for Assessing Remission in Mental Health. IEEE J Biomed Health Inform 2015; 19:132-9. [DOI: 10.1109/jbhi.2014.2360711] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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203
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Leslie G, Robinson EM, Zwirner M, Purcell JJ, Cremens C. Making Treatment Choices From "Dark Places": A Role for Ethics Consultation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:72-74. [PMID: 26147279 DOI: 10.1080/15265161.2015.1042742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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204
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Suarez L, Beach SR, Moore SV, Mastromauro CA, Januzzi JL, Celano CM, Chang TE, Huffman JC. Use of the Patient Health Questionnaire-9 and a detailed suicide evaluation in determining imminent suicidality in distressed patients with cardiac disease. PSYCHOSOMATICS 2014; 56:181-9. [PMID: 25660436 DOI: 10.1016/j.psym.2014.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The risk of suicide is elevated in patients with cardiac disease in comparison with the general population. OBJECTIVE In distressed cardiac inpatients, we explored the use of Item 9 of the Patient Health Questionnaire-9, which inquires about thoughts of death or suicide, and a detailed suicide evaluation (DSE) triggered by positive responses to Item 9 as means of assessing suicide. METHODS Among cardiac inpatients endorsing current emotional distress, we recorded the prevalence of positive responses to Item 9, gathered information about outcomes and time spent completing the DSE, and examined the frequency of imminent suicidality identified by the DSE among Item 9-positive patients. RESULTS Among 366 patients, 77 (21%) answered affirmatively to Item 9. All DSEs were successfully completed but consumed 17 clinician hours. Among the 71 patients receiving the DSE, 2 (0.5% of total sample; 2.8% of Item 9-positive patients) were imminently suicidal (i.e., had intent or plan). CONCLUSION Nearly 1 in 4 patients had a positive response to Item 9, but very few had imminent suicidality; the DSE was easy to use and acceptable to patients but time consuming. A more narrowly focused alternative to Item 9 may more accurately predict imminent suicidality and reduce the burden of further detailed suicide screening.
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Affiliation(s)
- Laura Suarez
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH)
| | - Scott R Beach
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH).
| | - Shannon V Moore
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH)
| | - Carol A Mastromauro
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH)
| | - James L Januzzi
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Division of Cardiology, Massachusetts General Hospital, Boston, MA (JLJ)
| | - Christopher M Celano
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH)
| | - Trina E Chang
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH)
| | - Jeff C Huffman
- Harvard Medical School, Boston, MA (LS, SRB, SVM, CAM, JLJ, CMC, TEC, JCH); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (LS, SRB, SVM, CAM, CMC, TEC, JCH)
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205
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Breunig IM, Shaya FT, Tevie J, Roffman D. Incident depression increases medical utilization in Medicaid patients with hypertension. Expert Rev Cardiovasc Ther 2014; 13:111-8. [PMID: 25487173 DOI: 10.1586/14779072.2014.969712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
UNLABELLED Hypertension is an important risk factor for cardiovascular disease and occurs disproportionately among patients with depression. Few studies have rigorously examined outcomes specifically among hypertensive patients with newly diagnosed comorbid depression. AIM We hypothesized that incident depression would exacerbate hypertensive disease and that this would be evident through greater utilization of medical services than would otherwise occur in the absence of depression. METHODS Claims data for hypertensive patients enrolled in Maryland Medicaid (2005-2010) were used to estimate the change in annualized utilization following incident depression, compared to a matched cohort of hypertensive patients never diagnosed with depression. Multivariate regression was used to adjust for changes in antihypertensive medications, adherence and comorbidity that followed depression onset. RESULTS While medical utilization increased after incident depression, additional encounters tended to be for nonacute medical care and there was no significant increase in encounters specifically for cardiovascular or hypertension-related conditions. DISCUSSION The results contribute to the discussion on the relationship between depression and cardiovascular disease and will inform future studies that aim to look at longer term outcomes in patients with hypertension.
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Affiliation(s)
- Ian Michael Breunig
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch St, 12th Floor, Baltimore, MD 21201, USA
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206
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Serodio KJ, Ardern CI, Rotondi MA, Kuk JL. Tricyclic and SSRI usage influences the association between BMI and health risk factors. Clin Obes 2014; 4:296-302. [PMID: 25826158 DOI: 10.1111/cob.12067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
Abstract
To determine if selective-serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) influence the association between obesity and cardiovascular disease risk, participants from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1992) and continuous NHANES (1999-2009, n = 18 274) were used. For a given body mass index (BMI), individuals taking SSRIs (n = 219) tended to have significantly better health risk profiles with lower systolic blood pressure (P = 0.002) and higher high-density lipoprotein (P = 0.003) compared with non-users. Conversely, those who used TCAs (n = 116) had significantly worse health risk profiles with higher diastolic blood pressure (P ≤ 0.0001) and triglycerides (P = 0.023) as compared with non-users for a given BMI. Insulin resistance (HOMA-IR) was higher in TCA users and those with larger BMIs, whereby the differences in insulin resistance between TCA users and non-users was greater with higher BMIs (interaction effect: P = 0.013). Furthermore, individuals taking SSRIs were less likely to have cardiovascular disease than non-users (odds ratio, 95% confidence interval = 0.50, 0.33-0.75) for a given BMI, with no differences by TCA use (odds ratio = 0.74, 0.44-1.24). SSRI and TCA use may alter how body weight relates with cardiovascular risk. When prescribing antidepressant medications, it may be necessary to monitor and consider body weight and cardiovascular risk profile of individual patients.
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Affiliation(s)
- K J Serodio
- Faculty of Health, School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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207
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Weibel L, Massarotto P, Hediger H, Mahrer-Imhof R. Early education and counselling of patients with acute coronary syndrome. A pilot study for a randomized controlled trial. Eur J Cardiovasc Nurs 2014; 15:213-22. [PMID: 25341680 DOI: 10.1177/1474515114556713] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 10/03/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND At time of discharge, patients with acute coronary syndrome often have a knowledge deficit regarding their disease, further treatment and necessary behavioural changes. It is well known that self-efficacy as a prerequisite for behavioural changes can be influenced by patient education. This study investigated whether an individualized education programme starting early in the cardiac care unit enhanced self-efficacy and rehabilitation programme attendance, and was feasible and satisfying for patients. METHODS AND DESIGN In a pilot randomized controlled trial, 40 patients with acute coronary syndrome were enrolled. The intervention group received in addition to standard care an early individual needs-oriented educational session in the cardiac care unit and subsequently one on the ward addressing risk factors, medication and self-management as well as referral to a rehabilitation programme by a nurse. Self-efficacy was assessed twice, at attendance in a rehabilitation programme six weeks after discharge. The participants' satisfaction with the intervention was assessed qualitatively. RESULTS When controlling for anxiety and depression, the intervention group showed significant better self-efficacy scores on the ability to control the symptoms (p=0.034). When controlling additionally for age, no significant differences could be detected. The attendance of a rehabilitation programme was higher in the intervention group. The participants in the intervention group reported high satisfaction with the early education. CONCLUSION Early education seems to benefit patients with acute coronary syndrome. In light of increased confidence to control one's symptoms and the higher attendance in rehabilitation programmes, as well as a high satisfaction with the intervention, a full powered study will be pursued.
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Affiliation(s)
- Lukas Weibel
- Medical Intensive Care Unit, University Hospital Basel, Switzerland Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Paola Massarotto
- Medical Intensive Care Unit, University Hospital Basel, Switzerland
| | - Hannele Hediger
- Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Romy Mahrer-Imhof
- Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
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208
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Mejia-Lancheros C, Estruch R, Martínez-González MA, Salas-Salvadó J, Corella D, Gómez-Gracia E, Fiol M, Santos JM, Fitó M, Arós F, Serra-Majem L, Pintó X, Basora J, Sorlí JV, Muñoz MA. Blood pressure values and depression in hypertensive individuals at high cardiovascular risk. BMC Cardiovasc Disord 2014; 14:109. [PMID: 25160563 PMCID: PMC4243424 DOI: 10.1186/1471-2261-14-109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/20/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypertension and depression are both important risk factors for cardiovascular diseases. Nevertheless, the association of blood pressure on and depression has not been completely established. This study aims to analyze whether depression may influence the control of blood pressure in hypertensive individuals at high cardiovascular risk. METHODS Cross-sectional study, embedded within the PREDIMED clinical trial, of 5954 hypertensive patients with high cardiovascular risk factor profiles. The relationship between blood pressure control and depression was analyzed. A multivariate analysis (logistic and log-linear regression), adjusting for potential confounders (socio-demographic factors, body mass index, lifestyle, diabetes, dyslipidemia, and antihypertensive treatment), was performed. RESULTS Depressive patients, with and without antidepressant treatment, had better blood pressure control (OR: 1.28, CI 95%: 1.06-1.55, and OR: 1.30, CI 95%: 1.03-1.65, respectively) than non-depressive ones. Regarding blood pressure levels, systolic blood pressure values (mmHg) were found to be lower in both treated and untreated depressive patients (Log coefficient Beta: -1.59, 95% CI: -0.50 to -2.69 and Log coefficient Beta: -3.49, 95% CI: -2.10 to -4.87, respectively). CONCLUSIONS Among hypertensive patients at high cardiovascular risk, the control of blood pressure was better in those diagnosed with depression. TRIAL REGISTRATION Unique identifier: ISRCTN35739639.
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Affiliation(s)
- Cilia Mejia-Lancheros
- />Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramón Estruch
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Internal Medicine of Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Miguel Angel Martínez-González
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Jordi Salas-Salvadó
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />Human Nutrition Department, Hospital Universitari Sant Joan, Institut d’Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Dolores Corella
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Enrique Gómez-Gracia
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Preventive Medicine, University of Malaga, Malaga, Spain
| | - Miquel Fiol
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />Institute of Health Sciences (IUNICS), University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain
| | - José Manuel Santos
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville, Spain
| | - Montse Fitó
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />Cardiovascular Risk and Nutrition Research Group of Institut Mar d’Investigacions Mèdiques (IMIM)–Research Institute Hospital del Mar, Barcelona, Spain
| | - Fernando Arós
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Cardiology, University Hospital of Alava, Vitoria, Spain
| | - Lluis Serra-Majem
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Xavier Pintó
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Basora
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />Primary Care Division, Catalan Institute of Health, Institut d’Investigació en Atenció Primària Jordi Gol, Tarragona-Reus, Spain
| | - José Vicente Sorlí
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Preventive Medicine, University of Valencia, Valencia, Spain
- />Primary Care Division, Valencia Institute of Health, Valencia, Spain
| | - Miguel-Angel Muñoz
- />Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- />Catalan Institute of Health, Institut d’Investigació en Atenció Primària Jordi Gol, Sardenya 375, Entlo, 08025 Barcelona, Spain
| | - the PREDIMED Study Investigators
- />Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición(CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- />The PREDIMED Study (Prevención con Dieta Mediterránea) Network (RD 06/0045), Instituto de Salud Carlos III, Madrid, Spain
- />The Department of Internal Medicine of Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
- />Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
- />Human Nutrition Department, Hospital Universitari Sant Joan, Institut d’Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
- />The Department of Preventive Medicine, University of Valencia, Valencia, Spain
- />The Department of Preventive Medicine, University of Malaga, Malaga, Spain
- />Institute of Health Sciences (IUNICS), University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain
- />The Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville, Spain
- />Cardiovascular Risk and Nutrition Research Group of Institut Mar d’Investigacions Mèdiques (IMIM)–Research Institute Hospital del Mar, Barcelona, Spain
- />The Department of Cardiology, University Hospital of Alava, Vitoria, Spain
- />The Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain
- />Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
- />Primary Care Division, Catalan Institute of Health, Institut d’Investigació en Atenció Primària Jordi Gol, Tarragona-Reus, Spain
- />Primary Care Division, Valencia Institute of Health, Valencia, Spain
- />Catalan Institute of Health, Institut d’Investigació en Atenció Primària Jordi Gol, Sardenya 375, Entlo, 08025 Barcelona, Spain
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Kéri S, Szabó C, Kelemen O. Expression of Toll-Like Receptors in peripheral blood mononuclear cells and response to cognitive-behavioral therapy in major depressive disorder. Brain Behav Immun 2014; 40:235-43. [PMID: 24726793 DOI: 10.1016/j.bbi.2014.03.020] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 12/27/2022] Open
Abstract
In recent years, increased attention has been paid to the inflammatory mechanisms of major depressive disorder (MDD). The aim of the present study was to investigate pro-inflammatory pathways related to the "leaky gut" hypothesis of MDD, which is based on the putative intestinal translocation of Gram-negative bacteria and a subsequent abnormal immune response mediated by the Toll-Like Receptor-4 (TLR-4) pathway. 50 patients with first-episode MDD and 30 healthy control subjects participated in the study. Real-time quantitative PCR was used to measure TLR-4 and TLR-2 RNA from peripheral mononuclear blood cells, as well as the expression of NF-κβ, a key transcription factor of the pro-inflammatory response. TLR-4 protein expression was determined by using flow cytometry. TLR-2 served as a control molecule. Low-grade inflammation was characterized by the measurement of interleukin-6 (IL-6) and C-reactive protein (CRP). Bacterial translocation was investigated by the measurement of the 16S rRNA subunit (16S rDNA) of intestinal microbiota in the blood plasma of the participants. We performed these analyses before (t1) and after (t2) cognitive-behavioral therapy (CBT) in MDD. The healthy control subjects were also assessed two times. We found significantly elevated expressions of all three markers (TLR-4 RNA and protein, NF-κβ RNA) and 16S rDNA in MDD at t1 relative to healthy control subjects. These markers showed a significant decrease during CBT (t1>t2 in MDD). We observed no between-group differences and changes in the case of TLR-2. Greater reduction of pro-inflammatory markers during CBT was associated with more pronounced clinical improvement. IL-6 and CRP displayed a moderately elevated level in MDD and did not change during CBT. In conclusion, TLR-4 signaling is up-regulated in newly diagnosed patients with MDD, which may be related to bacterial translocation or to the presence of various damage-associated molecular patterns. Clinical improvement during psychotherapy is associated with decreased expression of pro-inflammatory markers.
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Affiliation(s)
- Szabolcs Kéri
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary; Nyírő Gyula Hospital - National Institute of Psychiatry and Addictions, Budapest, Hungary; Department of Physiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Csilla Szabó
- Nyírő Gyula Hospital - National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Oguz Kelemen
- Bács-Kiskun County Hospital, Psychiatry Center, Kecskemét, Hungary
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Weisbord SD, Mor MK, Sevick MA, Shields AM, Rollman BL, Palevsky PM, Arnold RM, Green JA, Fine MJ. Associations of depressive symptoms and pain with dialysis adherence, health resource utilization, and mortality in patients receiving chronic hemodialysis. Clin J Am Soc Nephrol 2014; 9:1594-602. [PMID: 25081360 DOI: 10.2215/cjn.00220114] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Depressive symptoms and pain are common in patients receiving chronic hemodialysis, yet their effect on dialysis adherence, health resource utilization, and mortality is not fully understood. This study sought to characterize the longitudinal associations of these symptoms with dialysis adherence, emergency department (ED) visits, hospitalizations, and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS As part of a trial comparing symptom management strategies in patients receiving chronic hemodialysis, this study prospectively assessed depressive symptoms using the Patient Health Questionnaire 9, and pain using the Short-Form McGill Pain Questionnaire, monthly between 2009 and 2011. This study used negative binomial, Poisson, and proportional hazards regression to analyze the longitudinal associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with missed and abbreviated hemodialysis treatments, ED visits, hospitalizations, and mortality, respectively. RESULTS Among 286 patients, moderate-to-severe depressive symptoms were identified on 788 of 4452 (18%) assessments and pain was reported on 3537 of 4459 (79%) assessments. Depressive symptoms were independently associated with missed (incident rate ratio [IRR], 1.21; 95% confidence interval [95% CI], 1.10 to 1.33) and abbreviated (IRR, 1.08; 95% CI, 1.03 to 1.14) hemodialysis treatments, ED visits (IRR, 1.24; 95% CI, 1.12 to 1.37), hospitalizations (IRR, 1.19; 95% CI, 1.10 to 1.30), and mortality (IRR, 1.40; 95% CI, 1.11 to 1.77). Pain was independently associated with abbreviated hemodialysis treatments (IRR, 1.03; 95% CI, 1.01 to 1.06) and hospitalizations (IRR, 1.05; 95% CI, 1.00 to 1.10). Severe pain was independently associated with abbreviated hemodialysis treatments (IRR, 1.16; 95% CI, 1.06 to 1.28), ED visits (IRR, 1.58; 95% CI, 1.28 to 1.94), and hospitalizations (IRR, 1.22; 95% CI, 1.03 to 1.45), but not mortality (hazard ratio, 1.71; 95% CI, 0.81 to 2.96). CONCLUSIONS Depressive symptoms and pain are independently associated with dialysis nonadherence and health services utilization. Depressive symptoms are also associated with mortality. Interventions to alleviate these symptoms have the potential to reduce costs and improve patient-centered outcomes.
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Affiliation(s)
- Steven D Weisbord
- Renal Section, Medicine Service Line, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Renal-Electrolyte Division, Department of Medicine, and
| | - Maria K Mor
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Ann Sevick
- Department of Population Health, New York University School of Medicine, New York, New York; and
| | - Anne Marie Shields
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Bruce L Rollman
- Department of Population Health, New York University School of Medicine, New York, New York; and
| | - Paul M Palevsky
- Renal Section, Medicine Service Line, and Renal-Electrolyte Division, Department of Medicine, and
| | - Robert M Arnold
- Divisions of General Internal Medicine and Palliative Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jamie A Green
- Nephrology Department, Geisinger Medical Center, Danville, Pennsylvania
| | - Michael J Fine
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Divisions of General Internal Medicine and
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211
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Goodhart A. The relationship between heart and 'inner self' from Aristotle to current clinical practice. MEDICAL HUMANITIES 2014; 40:61-66. [PMID: 24100141 DOI: 10.1136/medhum-2013-010392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Modern songs, films, novels and daily speech often use heart imagery to illustrate 'inner self' experiences, such as deeply felt emotions. Where do these ideas come from and what relevance (if any) do they have for medicine today? This article explores some of the key origins and periods of development of heart/'inner self' ideas before considering the significance of heart/'inner self' interactions in modern clinical practice: from Aristotelian anatomy and the translated Hebrew Scriptures; through Shakespeare, William Harvey and the Protestant Reformation; to theories of emotion and modern-day cardiology. I conclude that heart/'inner self' interactions exist in clinically significant ways, but are poorly understood and under-recognised in healthcare settings. Greater integration of cardiovascular and psychosocial medicine would improve patient care.
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212
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Chang P, Nead KT, Olin JW, Cooke JP, Leeper NJ. Clinical and socioeconomic factors associated with unrecognized peripheral artery disease. Vasc Med 2014; 19:289-296. [PMID: 24872403 DOI: 10.1177/1358863x14535475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Peripheral artery disease (PAD) is a highly prevalent condition that frequently goes undetected and untreated. Socioeconomic factors associated with unrecognized PAD are not known. The ankle-brachial index (ABI) was calculated in 1656 study participants undergoing non-emergent coronary angiography with PAD defined as an ABI <0.9. Subjects were followed for mortality and cardiovascular outcomes. Compared to those without PAD, those with unrecognized PAD at enrollment were older, had higher rates of cardiovascular comorbidities, and had higher major adverse cardiovascular events (MACE) (p<0.03 for all). Among those enrolling without a reported history of PAD, there was a higher prevalence of PAD with decreasing income (p=0.004), education level (p<0.001), social isolation (p=0.027) and depression (p=0.034); 50% of these individuals reported symptoms suggestive of claudication. In conclusion, the prevalence of unrecognized PAD is high amongst a cohort of high-risk individuals referred for coronary angiography. A profile of lower socioeconomic status is associated with unrecognized PAD. These subjects will report symptoms suggestive of claudication and impaired walking ability when directly queried.
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Affiliation(s)
- Peter Chang
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin T Nead
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeffrey W Olin
- Zena and Michael A Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - John P Cooke
- Methodist Hospital Research Institute, Houston, TX, USA
| | - Nicholas J Leeper
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA Stanford Cardiovascular Institute, Stanford, CA, USA
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213
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Johansson P, Svensson E, Alehagen U, Dahlström U, Jaarsma T, Broström A. Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease. Sleep Breath 2014; 19:263-71. [PMID: 24859483 DOI: 10.1007/s11325-014-1006-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/05/2014] [Accepted: 05/09/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD. METHODS Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation. RESULTS Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15). CONCLUSIONS Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.
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Affiliation(s)
- Peter Johansson
- Department of Cardiology, Linköping University, Linköping, Sweden,
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214
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Wright L, Simpson W, Van Lieshout RJ, Steiner M. Depression and cardiovascular disease in women: is there a common immunological basis? A theoretical synthesis. Ther Adv Cardiovasc Dis 2014; 8:56-69. [DOI: 10.1177/1753944714521671] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Clinical studies have established an inherent comorbidity between depression and the development of cardiovascular disease (CVD). Furthermore, this comorbidity seems to be more amplified in women than in men. To further investigate this comorbidity, a thorough literature review was conducted on studies from 1992 to date. The PubMed database was accessed using the keywords: cardiovascular disease, inflammation, depression, and sex differences. Both human and animal studies were considered. This review takes the standpoint that depression and CVD are both inflammatory disorders, and that their co-occurrence may be related to how the hypothalamic–pituitary–adrenal axis, serotonergic transmission and circulation, and the renin–angiotensin–aldosterone system via angiotensin II are affected by the excess secretion of proinflammatory cytokines. More recently, preliminary research attributes this systemic inflammation to a global deficiency in CD4+CD25+FOXP3 regulatory T cells. 17-β estradiol and progesterone mediated modulation of cytokine secretion may partially explain the sex differences observed. These hormones and reproductive events associated with hormonal fluctuations are discussed in depth, including the analysis of perinatal models of depression and CVD, including preeclampsia. However, as evidenced by this review, there is a need for mechanistic research in humans to truly understand the nature and directionality of the relationship between depression and CVD.
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Affiliation(s)
- Lauren Wright
- MiNDS Neuroscience Program, McMaster University, Canada and Women’s Health Concerns Clinic, St Joseph’s Healthcare, Hamilton, ON, Canada
| | - William Simpson
- MiNDS Neuroscience Program, McMaster University, Canada and Women’s Health Concerns Clinic, St Joseph’s Healthcare, Hamilton, ON, Canada
| | - Ryan J. Van Lieshout
- MiNDS Neuroscience Program, McMaster University, Canada and Women’s Health Concerns Clinic, St Joseph’s Healthcare, and Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Meir Steiner
- MiNDS Neuroscience Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada and Women’s Health Concerns Clinic, St Joseph’s Healthcare, 301 James Street South, Hamilton, ON, Canada L8P 3B6
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215
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Abstract
OBJECTIVE Depression has been associated with increased risk of heart failure (HF). Because anxiety is highly comorbid with depression, we sought to establish if anxiety, depression, or their co-occurrence is associated with incident HF. METHODS A retrospective cohort (N = 236,079) including Veteran's Administration patients (age, 50-80 years) free of cardiovascular disease (CVD) at baseline was followed up between 2001 and 2007. Cox proportional hazards models were computed to estimate the association between anxiety disorders alone, major depressive disorder (MDD) alone, and the combination of anxiety and MDD, with incident HF before and after adjusting for sociodemographics, CVD risk factors (Type 2 diabetes, hypertension, hyperlipidemia, obesity), nicotine dependence/personal history of tobacco use, substance use disorders (alcohol and illicit drug abuse/dependence), and psychotropic medication. RESULTS Compared with unaffected patients, those with anxiety only, MDD only, and both disorders were at increased risk for incident HF in age-adjusted models (hazard ratio [HR] = 1.19 [ 95% confidence interval {CI} = 1.10-1.28], HR = 1.21 [95% CI = 1.13-1.28], and HR = 1.24 [95% CI = 1.17-1.32], respectively). After controlling for psychotropics in a full model, the association between anxiety only, MDD only, and both disorders and incident HF increased (HRs = 1.46, 1.56, and 1.74, respectively). CONCLUSIONS Anxiety disorders, MDD, and co-occurring anxiety and MDD are associated with incident HF in this large cohort of Veteran's Administration patients free of CVD at baseline. This risk of HF is greater after accounting for protective effects of psychotropic medications. Prospective studies are needed to clarify the role of depression and anxiety and their pharmacological treatment in the etiology of HF.
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216
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Karmakar CK, Jelinek HF, Warner P, Khandoker AH, Palaniswami M. Effect of gender and diabetes on major depressive disorder using heart rate asymmetry. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:6679-6682. [PMID: 25571528 DOI: 10.1109/embc.2014.6945160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this study, we have investigated how heart rate asymmetry (HRA) changes in major depressive disorder (MDD) subjects with comorbid diabetes as well as in male and female. Depression score was determined based on PHQ-9 questionnaire and from 135 subjects 70 subjects were selected with 1000 or more RR intervals. Heart rate asymmetry is a Poincaré plot based nonlinear technique to analyze the asymmetry using RR interval time-series signal. Three commonly used HRA indices Guzik's index (GI), Porta's index (PI) and Ehlers' index (EI) were used to understand the changes in HRA in MDD. Results indicate significantly (p<;0.05) different GI and EI values between 'Dep' and 'NonDep' subgroups in 'Combined' group. All three HRA indices are found significantly different in presence of depression in female subjects. These results provide better understanding about changes in HRA in MDD and HRA indices could be a plausible nonlinear HRV feature for differentiating Depression 'Dep' from NonDepression `NonDep' group - i) without comorbid diabetes; ii) in Female subjects.
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217
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Esteghamat SS, Moghaddami S, Esteghamat SS, Kazemi H, Kolivand PH, Gorji A. The course of anxiety and depression in surgical and non-surgical patients. Int J Psychiatry Clin Pract 2014; 18:16-20. [PMID: 24370120 DOI: 10.3109/13651501.2013.878365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to compare the level of anxiety and depression in patients admitted to surgery or internal departments. METHODS The study was carried out on 359 hospitalized patients over the age of 18 years and designed as a cross sectional survey. Participants were recruited from internal medicine and surgery departments of Khatam Ol Anbia hospital, Tehran, Iran. Information was collected using the Hospital Anxiety and Depression Scale. RESULTS Ninety-four (26.18%) patients had no anxiety and depression, 96 (26.7%) were borderline cases of anxiety, 140 (39%) were very anxious, 89 (24.8%) were borderline cases of depression, and 106 (29.5%) had depressed mood. There was a significant correlation between anxious mood and sex and duration of background disease as well as between the level of depressive mood and age. Patients with anxiety are significantly more prone to depression. However there were no significant differences between the level of anxiety or depression between surgical or non-surgical patients. CONCLUSIONS The prevalence of anxious and depressive moods was high in both surgical and non-surgical patients. However, non-surgical treatments were as stressful as surgical procedures for patients admitted to hospital in the first 24 h.
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Abstract
Depressive disorders are among the most common ailments affecting humankind and some of the world's leading causes of medical disability. Despite being common, disabling and a major public health problem, the etiology of depression is unknown. Indeed, investigators have suggested that the causes of depression are multiple and multi-factorial. With these considerations in mind, in this article we examine the hypothesis that our inability to identify the causes of depressive disorders is because depression is a nonspecific epiphenomenon of brain injury or insult arising through multiple pathways.
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Affiliation(s)
- Stephen M Strakowski
- Division of Bipolar Disorders Research, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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219
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Moore RC, Chattillion EA, Ceglowski J, Ho J, von Känel R, Mills PJ, Ziegler MG, Patterson TL, Grant I, Mausbach BT. A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP). Behav Res Ther 2013; 51:623-32. [PMID: 23916631 DOI: 10.1016/j.brat.2013.07.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/01/2013] [Accepted: 07/09/2013] [Indexed: 12/26/2022]
Abstract
Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.
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Affiliation(s)
- Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, USA; Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, USA
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