Association between plasma inflammatory markers and irrational beliefs; the ATTICA epidemiological study

Association Between Family History of Diabetes, Irrational Beliefs, and Health Anxiety with 10-Year Risk of Type 2 Diabetes Mellitus: the ATTICA Epidemiological Study (2002-2012)

BACKGROUND

This study aimed to examine the relationship between family history of diabetes, irrational beliefs, and health anxiety in the development of type 2 diabetes mellitus (T2DM).

METHOD

ATTICA is a prospective, cohort study (2002-2012). The working sample included 845 participants (18-89 years), free of diabetes at baseline. Α detailed biochemical, clinical, and lifestyle evaluation was performed, while participants' irrational beliefs and health anxiety were assessed through the Irrational Beliefs Inventory and the Whiteley index scale, respectively. We evaluated the association between the participants' family history of diabetes mellitus with the 10-year risk of diabetes mellitus, both in the total study's sample and separately according to their levels of health anxiety and irrational beliefs.

RESULTS

The crude 10-year risk of T2DM was 12.9% (95%CI: 10.4, 15.4), with 191 cases of T2DM. Family history of diabetes was associated with 2.5 times higher odds (2.53, 95%CI 1.71, 3.75) of T2DM compared to those without family history. Among participants with family history of diabetes, the highest likelihood of developing T2DM, regarding their tested psychological features (i.e., low/high irrational beliefs in the entire group, low/high health anxiety in the entire group, and low/high irrational beliefs, low/high healthy anxiety), had people with high irrational beliefs, low health anxiety (OR 3.70, 95%CI 1.83, 7.48).

CONCLUSIONS

The findings underline the important moderating role of irrational beliefs and health anxiety in the prevention of T2DM, among participants at increased risk of T2DM.

Cognitive vulnerability, anxiety, and physical well-being in relation to 10-year cardiovascular disease risk: The ATTICA epidemiological study

This study aimed to evaluate the association between irrational beliefs and the 10-year cardiovascular disease (CVD) incidence among apparently healthy adults. The ATTICA study is a population-based, prospective cohort (2002-2012) consisting of 853 participants without evidence of CVD (453 men and 400 women) who underwent psychological evaluations. Participants completed the Irrational Beliefs Inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. We conducted a factor analysis to develop irrational beliefs factors to evaluate the association between subcategories of irrational beliefs and CVD incidence. Demographic characteristics, detailed medical history, other psychological factors, and dietary and other lifestyle habits were also evaluated. The incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria. The identified dominant irrational beliefs factor, "cognitive vulnerability to anxiety," consisted of demandingness, perfectionism, emotional irresponsibility, anxious overconcern, dependence on others, and overconcern for the welfare of others, was strongly associated with an increased 10-year CVD risk. Nested multi-adjusted regression analysis revealed that anxiety, as well as negative physical well-being, mediated this relationship, and subset of irrational beliefs predicted CVD risk directly and indirectly through anxiety and negative physical well-being. These findings further map the path through which irrational beliefs can contribute to CVDs and provide insights in favor of preventive healthcare.

Exploring the Role of Irrational Beliefs, Lifestyle Behaviors, and Educational Status in 10-Year Cardiovascular Disease Risk: the ATTICA Epidemiological Study

BACKGROUND

Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors.

METHODS

The ATTICA study is a population-based, prospective cohort (2002-2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria.

RESULTS

Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99).

CONCLUSIONS

The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals.

Irrational beliefs, depression and anxiety, in relation to 10-year cardiovascular disease risk: the ATTICA Epidemiological Study

BACKGROUND AND OBJECTIVES

Various bio-psychosocial mechanisms underlying the link between anxiety, depression and cardiovascular disease risk, remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety and depression in the 10-year cardiovascular disease (CVD) incidence, and the effect of biochemical and socio-behavioral factors.

DESIGN

853[453 men (45 ± 13 years) and 400 women (44 ± 18 years)] from the ATTICA study (2002-2012) and without evidence of CVD were assessed.

METHODS

The Irrational Beliefs Inventory (IBI), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI) were used for the assessments. Incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria.

RESULTS

Participants with high irrational beliefs and anxiety symptoms had a 138% greater risk of developing CVD during the 10-year follow-up (2.38; 95%CI 1.75, 3.23) as compared to those without anxiety. Among others, C-reactive protein, interleukin-6 and total antioxidant capacity were mediators in the tested association. Interaction of irrational beliefs and depression was not associated with the 10-year CVD in all models.

CONCLUSIONS

Inflammation and oxidative stress, partially explained the associations between irrational beliefs and anxiety in predicting CVD risk. These findings advance psychological research in the area of primary prevention of mental health and cardiovascular diseases.

Psychological factors in relation to the 10-year incidence of metabolic syndrome: The ATTICA epidemiological study (2002-2012)

BACKGROUND AND AIMS

Various bio-psychological mechanisms underlying the association between mental health problems and metabolic syndrome remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety, depression and hostility in the 10-year metabolic syndrome (MetS) incidence, and the effect of biochemical and socio-behavioral factors on the aforementioned associations.

METHODS AND RESULTS

ATTICA is a prospective, cohort study (2002-2012). The sample included 591 participants [51.3% men (aged 41.5 ± 10 years) and 48.7% women (aged 37.5 ± 11.5 years)], free of MetS at baseline. Detailed biochemical, clinical, and lifestyle evaluations were performed, while participants' irrational beliefs, anxiety, depression and hostility were assessed using the Irrational Beliefs Inventory, the Spielberger State-Trait Anxiety Inventory, the Zung Self-Rating Depression Scale and the Hostility and Direction of Hostility Questionnaire, respectively. Multiple logistic regression was applied to estimate the odds ratio (OR) of developing MetS and to control for confounders, as well as stratified logistic regression to detect moderator effects. High irrational beliefs were associated with 1.5-times higher odds of developing MetS than low irrational beliefs. Especially, participants with high irrational beliefs and high anxiety were 96% more likely to develop MetS, compared with those with low irrational beliefs and low or high anxiety (OR = 1.96; 95% CI = 1.01, 3.80).

CONCLUSION

The findings of the study underline the important role of irrational beliefs and anxiety in the development of MetS and the need to build new holistic approaches focused on the primary prevention of both mental health and MetS.

Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers in the 10-year diabetes mellitus risk: the ATTICA epidemiological study

Purpose

To investigate the combined role of irrational beliefs, anxiety and depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors.

Methods

Within the context of the ATTICA cohort study (2002-2012), 853 participants without evidence of CVD [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI) (range 0-88), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI). Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association (ADA).

Results

Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). Participants with high irrational beliefs who also had anxiety symptoms had a 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with high levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations.

Conclusion

Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions.

Inflammation, Self-Regulation, and Health: An Immunologic Model of Self-Regulatory Failure

Self-regulation is a fundamental human process that refers to multiple complex methods by which individuals pursue goals in the face of distractions. Whereas superior self-regulation predicts better academic achievement, relationship quality, financial and career success, and lifespan health, poor self-regulation increases a person's risk for negative outcomes in each of these domains and can ultimately presage early mortality. Given its centrality to understanding the human condition, a large body of research has examined cognitive, emotional, and behavioral aspects of self-regulation. In contrast, relatively little attention has been paid to specific biologic processes that may underlie self-regulation. We address this latter issue in the present review by examining the growing body of research showing that components of the immune system involved in inflammation can alter neural, cognitive, and motivational processes that lead to impaired self-regulation and poor health. Based on these findings, we propose an integrated, multilevel model that describes how inflammation may cause widespread biobehavioral alterations that promote self-regulatory failure. This immunologic model of self-regulatory failure has implications for understanding how biological and behavioral factors interact to influence self-regulation. The model also suggests new ways of reducing disease risk and enhancing human potential by targeting inflammatory processes that affect self-regulation.

Rational Emotive Behavior Therapy (REBT), Irrational and Rational Beliefs, and the Mental Health of Athletes

In this article Rational Emotive Behavior Therapy (REBT) is proposed as a potentially important framework for the understanding and promotion of mental health in athletes. Cognitive-behavioral approaches predominate in the provision of sport psychology, and often form the backbone of psychological skills training for performance enhancement and maintenance. But far from being solely performance-focused, the cognitive-behavioral approach to sport psychology can restore, promote, and maintain mental health. This review article presents REBT (Ellis, 1957), the original cognitive behavioral therapy, as a valuable approach to addressing mental health issues in sport. REBT holds that it is not events that directly cause emotions and behaviors. Rather, it is one's beliefs about the events that lead to emotional and behavioral reactivity. Further, REBT distinguishes between rational and irrational beliefs, and suggests that in response to failure, maltreatment, and misfortune, people can react with either healthy or unhealthy emotional and behavioral responses. The extant research indicates that irrational beliefs lead to unhealthy negative emotions, a range of pathological conditions, and a host of maladaptive behaviors that undermine mental health. Therefore, REBT proposes a process for the reduction of irrational beliefs and the promotion of rational beliefs. The use of REBT in sport is seldom reported in literature, but research is growing. This review article proposes three important areas of investigation that will aid the understanding of irrational beliefs and the application of REBT within sport. These areas are: (1) the influence of irrational beliefs and REBT on the mental health of athletes, (2) the influence of irrational beliefs and REBT on athletic performance, (3) the origins and development of irrational beliefs in athletes. Each area is discussed in turn, offering a critical and progressive review of the literature as well as highlighting research deficits, and recommendations to address each of the three areas of investigation.

Exploring the association between low socioeconomic status and cardiovascular disease risk in healthy Greeks, in the years of financial crisis (2002-2012): The ATTICA study

BACKGROUND

Despite recent declines in mortality, cardiovascular disease (CVD) remains the leading cause of death in Europe today. Given the fact that many of the biological risk factors have already been identified, researchers still search for different modifiable factors that may influence CVD risk, among which SES gathers a great part of interest.

AIMS

To explore the effect of low socioeconomic status (SES) on a 10-year cardiovascular disease (CVD) incidence, in the years of financial crisis.

METHODS

This population-based study was carried out in the province of Attica, where Athens is a major metropolis. During 2001-2002, information from 1528 men (18-87years old) and 1514 women (18-89years old) was collected. Educational level and annual income were used to define their SES. After a 10-year of follow-up period (2002-2012), CVD incidence was recorded.

RESULTS

Low compared to high SES class, at the ages above 45years, was independently associated with increased 10-year CVD incidence [adjusted odds ratio and 95% confidence interval: 2.7 (1.5, 4.9)] but not among the younger participants. SES was also negatively associated with psychological components (all p-values<0.001), diabetes mellitus (p=0.002), obesity (p=0.087) and physical activity (p=0.056).

CONCLUSION

There is evidence for a consistent reverse relation between SES and the incidence of CVD and for higher CVD risk factors among less privileged individuals. The striking differences by SES underscore the critical need to improve screening, early detection, and treatment of CVD-related conditions for people of lower SES, emphasizing in the middle-aged groups.

Chronic psychological stress induces vascular inflammation in rabbits

Psychological stress is associated with a systemic inflammatory response. It is unclear, however, whether psychological stress contributes to vascular inflammation. Here, we examined the effects of unpredictable chronic mild stress (UCMS) on vascular inflammation in rabbits. One hundred rabbits were randomly divided into control and stress groups. UCMS was induced by a set of defined adverse conditions applied in a shuffled order for 4, 8, 12, or 16 weeks, and rabbits were killed 24 h after the end of the UCMS protocol. Expression of different inflammatory molecules was analyzed by real-time polymerase chain reaction, immunohistochemistry, or enzyme-linked immunosorbent assay. UCMS resulted in depression-like behaviors, decreased body weight gain, and hypertension with no significant effects on serum lipids. Aortic mRNA and protein expression for tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), macrophage migration inhibitory factor, and expression of intercellular adhesion molecule-1 (ICAM-1) protein were increased. UCMS increased circulating concentrations of corticosterone, TNF-α, and CRP throughout. Moreover, stress downregulated the expression of endothelial nitric oxide synthase. At 16 weeks of UCMS, macrophage infiltration and lipid accumulation in the subendothelial space were detected in the aorta. In cultured murine vascular smooth muscle cells, treatment with serum from stressed rabbits significantly increased phosphorylation of p38 and c-Jun N-terminal kinase (JNK), and upregulated expression of MCP-1 and ICAM-1 mRNAs, in which the effect was blunted by a TNF-α neutralizing antibody or p38 and JNK inhibitors. Our results indicate that chronic psychological stress induces vascular inflammation via TNF-α and p38/JNK pathways, which may contribute to the development of atherosclerosis.

Do psychological factors affect inflammation and incident coronary heart disease: the Whitehall II Study

OBJECTIVE

The purpose of this study was to test whether psychological factors affect inflammation processes to an extent that increases the risk of coronary heart disease (CHD).

METHODS AND RESULTS

We used data from 6396 civil servants (4453 men, 1943 women) from the Whitehall II Study, aged 35 to 55 years and free from clinically validated CHD at the start of the follow-up period. Two psychological factors were assessed at phase 1 (1985 to 1988) and phase 2 (1989 to 1990): negative affect and psychological distress. Inflammatory biomarkers (fibrinogen, high-sensitivity C-reactive- protein, interleukin-6) and 12 baseline covariates including biological and behavioral CHD risk factors, sociodemographic variables, and work stress were measured at phase 3 (1991 to 1993). Follow-up for CHD death, first nonfatal myocardial infarction, or definite angina occurring between phase 3 and phase 7 (2003 to 2004) was based on clinical records. Higher levels of inflammatory markers were associated with higher CHD incidence, with hazard ratios (HR) ranging from 1.31 to 2.37 in age-and sex-adjusted models. Higher levels of negative affectivity and psychological distress were not associated with greater concentrations of inflammatory markers. Negative affectivity (relative index of inequality=1.68, 95% confidence interval [CI] 1.20 to 2.36) and higher psychological distress exposure (HR=1.66, 95% CI 1.28 to 2.14) were associated with higher CHD incidence and these associations remained unchanged after adjustment for inflammatory markers.

CONCLUSIONS

Our findings suggest that psychological factors do not affect inflammation although they predict incident CHD.