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Jørgensen TSH, Wium-Andersen MK, Jørgensen MB, Osler M. The impact of mental vulnerability on the relationship between cardiovascular disease and depression. Eur Psychiatry 2020; 63:e16. [PMID: 32093792 PMCID: PMC7315880 DOI: 10.1192/j.eurpsy.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background. The mechanisms linking cardiovascular disease (CVD) and depression are still not established. We investigated the impact of mental vulnerability on the relationship between CVD and depression. Methods. A total of 19,856 individuals from five cohorts of random samples of the background population in Copenhagen were followed from baseline (1983–2011) until 2017 in Danish registries. Additive hazard and Cox proportional hazard models were used to analyze the effects of confounding by mental vulnerability as well as interactions between mental vulnerability and CVD on the risk of depression. Results. During follow-up, 15.3% developed CVD, while 18.1% experienced depression. A strong positive association between CVD and depression (hazard ratio: 3.60 [95% confidence intervals (CI): 3.30; 3.92]) corresponding to 35.4 (95% CI: 31.7; 39.1) additional cases per 1,000 person-years was only slightly attenuated after adjustment for mental vulnerability in addition to other confounders. Synergistic interaction between CVD and mental vulnerability was identified in the additive hazard model. Due to interaction between CVD and mental vulnerability, CVD was associated with 50.9 more cases of depression per 1,000 person-years among individuals with high mental vulnerability compared with individuals with low mental vulnerability. Conclusions. Mental vulnerability did not explain the strong relationship between CVD and depression. CVD was associated with additional cases of depression among individuals with higher mental vulnerability indicating that this group holds the greatest potential for intervention, for example, in rehabilitation settings.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Department O, Psychiatric Center Copenhagen, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Sequeira CADC, Barbosa ENM, Nogueira MJC, Sampaio FMC. Evaluation of the Psychometric Properties of the Mental Vulnerability Questionnaire in Undergraduate Students. Perspect Psychiatr Care 2017; 53:243-250. [PMID: 27198975 DOI: 10.1111/ppc.12164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/16/2016] [Accepted: 03/04/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Translate, adapt the language, and assess the psychometric properties of the Mental Vulnerability Questionnaire (MVQ) in a Portuguese population sample of young adults. DESIGN AND METHODS A psychometric validation study was performed. The sample comprised 166 undergraduate students. Factor analysis was applied to extract three indicators. FINDINGS The MVQ showed divergent validity with the Positive Mental Health Questionnaire (p < .001) and convergent validity with the Mental Health Inventory including five items (p < .001). Reliability was verified through the assessment of internal consistency, evidencing positive outcomes (Cronbach's α = 0.81). PRACTICE IMPLICATIONS The MVQ shows psychometric properties enabling its adaptation to clinical practice and research, essential to an effective screening of mental vulnerability.
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Affiliation(s)
- Carlos Alberto da Cruz Sequeira
- Coordinator Professor at Porto Nursing School, Scientific Pedagogical Unit "Management of Signs and Symptoms,", Porto, and Coordinator of the Research Group "NurID: Innovation and Development in Nursing-CINTESIS-FMUP,", Porto, Portugal
| | | | | | - Francisco Miguel Correia Sampaio
- Registered Nurse at the Psychiatry Department, Hospital de Braga, Braga, and an Invited Assistant at Porto Nursing School, Porto, Portugal
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Levenstein S, Jacobsen RK, Rosenstock S, Jørgensen T. Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort. Scand J Gastroenterol 2017; 52:954-961. [PMID: 28503971 DOI: 10.1080/00365521.2017.1324897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. MATERIALS AND METHODS A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry. RESULTS Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. CONCLUSIONS A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.
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Affiliation(s)
- Susan Levenstein
- a Aventino Medical Group , Rome , Italy.,b Research Centre for Prevention and Health, The Capital Region of Denmark , Glostrup , Denmark
| | - Rikke Kart Jacobsen
- b Research Centre for Prevention and Health, The Capital Region of Denmark , Glostrup , Denmark
| | - Steffen Rosenstock
- c Gastroenterology Department , Surgical Section, Hvidovre University Hospital , Copenhagen , Denmark
| | - Torben Jørgensen
- b Research Centre for Prevention and Health, The Capital Region of Denmark , Glostrup , Denmark.,d Department of Public Health, Faculty of Health Science , University of Copenhagen , Copenhagen , Denmark.,e Faculty of Medicine , Aalborg University , Aalborg , Denmark
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Poulsen CH, Eplov LF, Hjorthøj C, Eliasen M, Skovbjerg S, Dantoft TM, Schröder A, Jørgensen T. Irritable bowel symptoms and the development of common mental disorders and functional somatic syndromes identified in secondary care - a long-term, population-based study. Clin Epidemiol 2017; 9:393-402. [PMID: 28814899 PMCID: PMC5546191 DOI: 10.2147/clep.s141344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Irritable bowel syndrome (IBS) is associated with mental vulnerability, and half of patients report comorbid somatic and mental symptoms. We aimed to investigate the relationship between an IBS symptom continuum and the subsequent development of common mental disorders (CMDs) and functional somatic syndromes (FSSs). Methods and study design A longitudinal population-based study comprising two 5-year follow-up studies, Dan-MONICA 1 (1982–1987) and Inter99 (1999–2004), recruited from the western part of Copenhagen County. The total study population (n = 7,278) was divided into symptom groups according to the degree of IBS definition fulfillment at baseline and/or follow-up and was followed until December 2013 in Danish central registries. Cox regression was used for the analyses, adjusting for age, sex, length of education and cohort membership. In a subsequent analysis, we adjusted for mental vulnerability as a risk factor for both CMDs and FSSs, including IBS. Results Over a 5-year period, 51% patients had no IBS symptoms, 17% patients had IBS symptoms without abdominal pain, 22% patients had IBS symptoms including abdominal pain and 10% patients fulfilled the IBS definition. IBS and IBS symptoms including abdominal pain were significantly associated with the development of CMDs and other FSSs identified in secondary care. When adjusting for mental vulnerability, IBS and IBS symptoms including abdominal pain were no longer associated with CMDs, but the significant relationship to other FSSs remained. Conclusion In a clinical setting, the perspective should be broadened to individuals not fulfilling the symptom cluster of IBS but who report frequent abdominal pain. Additionally, it is important to combine symptom-based criteria of IBS with psychosocial markers such as mental vulnerability, because it could guide clinicians in decisions regarding prognosis and treatment.
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Affiliation(s)
- Chalotte Heinsvig Poulsen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup.,Copenhagen University Hospital, Mental Health Centre Copenhagen, Hellerup
| | | | - Carsten Hjorthøj
- Copenhagen University Hospital, Mental Health Centre Copenhagen, Hellerup
| | - Marie Eliasen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup
| | | | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen.,The Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol 2015; 13:498-506.e1. [PMID: 25111233 DOI: 10.1016/j.cgh.2014.07.052] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/22/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is controversy over whether psychological stress contributes to development of peptic ulcers. We collected data on features of life stress and ulcer risk factors from a defined population in Denmark and compared these with findings of confirmed ulcers during the next 11-12 years. METHODS We collected blood samples and psychological, social, behavioral, and medical data in 1982-1983 from a population-based sample of 3379 Danish adults without a history of ulcer participating in the World Health Organization's MONICA study. A 0- to 10-point stress index scale was used to measure stress on the basis of concrete life stressors and perceived distress. Surviving eligible participants were reinterviewed in 1987-1988 (n = 2809) and 1993-1994 (n = 2410). Ulcer was diagnosed only for patients with a distinct breach in the mucosa. All diagnoses were confirmed by review of radiologic and endoscopic reports. Additional cases of ulcer were detected in a search of all 3379 subjects in the Danish National Patient Register. RESULTS Seventy-six subjects were diagnosed with ulcer. On the basis of the stress index scale, ulcer incidence was significantly higher among subjects in the highest tertile of stress scores (3.5%) than the lowest tertile (1.6%) (adjusted odds ratio, 2.2; 95% confidence interval [CI], 1.2-3.9; P < .01). The per-point odds ratio for the stress index (1.19; 95% CI, 1.09-1.31; P < .001) was unaffected after adjusting for the presence of immunoglobulin G antibodies against Helicobacter pylori in stored sera, alcohol consumption, or sleep duration but lower after adjusting for socioeconomic status (1.17; 95% CI, 1.07-1.29; P < .001) and still lower after further adjustments for smoking, use of nonsteroidal anti-inflammatory drugs, and lack of exercise (1.11; 95% CI, 1.01-1.23; P = .04). The risk for ulcer related to stress was similar among subjects who were H pylori seropositive, those who were H pylori seronegative, and those exposed to neither H pylori nor nonsteroidal anti-inflammatory drugs. On multivariable analysis, stress, socioeconomic status, smoking, H pylori infection, and use of nonsteroidal anti-inflammatory drugs were independent predictors of ulcer. CONCLUSIONS In a prospective study of a population-based Danish cohort, psychological stress increased the incidence of peptic ulcer, in part by influencing health risk behaviors. Stress had similar effects on ulcers associated with H pylori infection and those unrelated to either H pylori or use of nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
| | - Steffen Rosenstock
- Gastroenterology Department, Surgical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - Rikke Kart Jacobsen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
| | - Torben Jorgensen
- Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
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Østergaard D, Dalton SO, Bidstrup PE, Poulsen AH, Frederiksen K, Eplov LF, Johansen C, Mortensen EL. Mental vulnerability as a risk factor for depression: a prospective cohort study in Denmark. Int J Soc Psychiatry 2012; 58:306-14. [PMID: 21441278 DOI: 10.1177/0020764010396409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Mental vulnerability (i.e. a tendency to experience psychosomatic symptoms, mental symptoms or interpersonal problems) is associated with various diseases. This study investigated whether mental vulnerability is associated with hospitalization for depression. METHODS A prospective study was conducted of six cohorts from the population of Copenhagen County, Denmark, with baseline information on mental vulnerability, lifestyle, social factors and comorbidity collected in 1976, 1982-84, 1991 and 1997-98 (N = 11,862). By register-linkage information on hospital contacts for affective disorders were obtained from the Danish Psychiatric Central Register. The association between mental vulnerability and depression was examined using Kaplan-Meier plots allowing for death as competing risk and Cox proportional-hazard models adjusting for possible confounders. RESULTS The cohort of 11,862 persons yielded a mean follow-up time of 12.3 years with 170 persons hospitalized with depression. The adjusted hazard ratio for hospitalization for depression associated with mental vulnerability was 1.23 (95% CI, 1.16-1.31) per step on the most used 12-item scale. CONCLUSIONS Mental vulnerability may be a risk factor for depression. Early identification and treatment of depression are essential for preventing chronic depression, reduced social functioning and disability. Psychiatric interviews should be used to evaluate whether the criteria for depression are fulfilled, but it may furthermore be relevant to identify persons who may be at risk of developing depression in the long term. The possibility of using, for example, the mental vulnerability scale for such purpose should be further investigated.
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Affiliation(s)
- Ditte Østergaard
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
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EPLOV LENEFALGAARD, PETERSEN JANNE, JøRGENSEN TORBEN, JOHANSEN CHRISTOFFER, BIRKET-SMITH MORTEN, LYNGBERG ANNCHRISTINE, MORTENSEN ERIKLYKKE. The Mental Vulnerability Questionnaire: A psychometric evaluation. Scand J Psychol 2010; 51:548-54. [DOI: 10.1111/j.1467-9450.2010.00834.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mental disorders and general well-being in cardiology outpatients--6-year survival. J Psychosom Res 2009; 67:5-10. [PMID: 19539812 DOI: 10.1016/j.jpsychores.2009.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 12/22/2008] [Accepted: 01/13/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Long-term survival in a sample of cardiology outpatients with and without mental disorders and other psychosocial risk factors. METHODS In a cardiology outpatient setting, 103 consecutive patients were asked to participate in the study. Of these, 86 were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders; Structured Clinical Interview for DSM-III-R, Non-Patient Edition, psychosis screening; the Clock Drawing Test; and the WHO-5 Well-Being Index. The cardiologists were asked in each patient to rate the severity of somatic disease and mental problems on visual analogue scales (VAS-somatic and VAS-mental). Cardiac diagnosis, noncardiac comorbidity, history of mental disorder, and the number of daily social contacts were noted. Survival was followed for 6 years. RESULTS At baseline, 33 (38.4%) patients had mental disorder, 6 dementia, 11 major depression, 6 minor depression, 6 anxiety disorder, 2 unspecified somatoform disorder, 1 alcohol abuse, and 1 psychosis. At 6 years of follow-up, 40 (47%) patients were deceased, 17 (48%) of those with and 23 (46%) of those without mental disorder. In a survival analysis, mortality was significantly predicted by age [hazard ratio (HR), 1.058], WHO-5 (HR, 0.977), the number of social contacts (HR, 0.699), VAS-somatic (HR, 1.016), and cardiac diagnosis (HR, 0.333). CONCLUSION In chronic heart disease, well-being and social support seem related to long-term survival.
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Screening for risk of cardiovascular disease is not associated with mental distress: the Inter99 study. Prev Med 2009; 48:242-6. [PMID: 19150366 DOI: 10.1016/j.ypmed.2008.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 12/12/2008] [Accepted: 12/12/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze mental distress in relation to participation in lifestyle intervention. METHODS In 2000-2001 a total of 1948 consecutive participants, living in the suburbs of Copenhagen, were asked to complete a short version of SCL-90-R (anxiety, depression, and somatization) before screening, immediately after screening, and one and 10 months after screening. The screening classified participants into high or low risk individuals. High risk individuals received personal lifestyle counselling and were randomized to either group-based counselling (A) or referred care (B). Multilevel regression models taking into account repeated measurements and missing data at follow-up were performed. RESULTS Before screening, high risk individuals had higher scores on anxiety, depression, and somatization than low risk individuals. All categories of participants decreased in scores after screening. The scores increased after 1 month, but were still significantly lower than before screening. After 10 months, low risk individuals and high risk individuals in group A still had significantly lower scores (except for depression) compared with pre-screening levels, whereas high risk individuals in group B reached the pre-screening level (except for anxiety). CONCLUSION Screening for risk of cardiovascular disease followed by health counselling does not give rise to mental distress, but has a temporary beneficial effect.
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Toft UN, Kristoffersen LH, Aadahl M, von Huth Smith L, Pisinger C, Jørgensen T. Diet and exercise intervention in a general population mediators of participation and adherence: the Inter99 study. Eur J Public Health 2006; 17:455-63. [PMID: 17170019 DOI: 10.1093/eurpub/ckl262] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Drop-out rates are high in many lifestyle programmes. To promote adherence, the aim of this study was to identify mediators of participation in a diet and exercise (DE) intervention in a general population. METHODS Data were baseline data from a randomized non-pharmacological clinical trial in Copenhagen during 1999-2001. The participation rate was 53.3%. Participants at high risk of ischaemic heart disease (IHD) and who were offered participation in a DE counselling group intervention were included (N = 2022). Clinical characteristics, and demographic, psychosocial and lifestyle factors were measured. RESULTS Mediators of acceptance of participation were awareness of an unhealthy lifestyle or a bad health, low self-rated care of own health, perceived susceptibility of cardiovascular disease (CVD; overall and associated with lifestyle), high degree of motivation towards dietary changes and low self-efficacy about increasing physical activity. Overweight and impaired glucose tolerance (IGT)/screen-detected diabetes predicted acceptance whereas an absolute risk score for IHD was inverse associated with acceptance. Mediators of high adherence were low self-efficacy about changing dietary habits and perceived susceptibility of CVD and furthermore screen-detected diabetes and overweight predicted high adherence. CONCLUSION Awareness of unhealthy lifestyle, perceived susceptibility of disease and motivation towards lifestyle changes were important mediators of participation. Screen-detected diabetes/IGT predicted participation and adherence whereas overweight individuals were more likely to accept but also to drop out of the course. The use of an absolute risk score in health promotion should be further evaluated.
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Affiliation(s)
- Ulla N Toft
- Research Centre for Prevention and Health, Copenhagen, Denmark.
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