Men deny and women cry, but who dies? Do the wages of "denial" include early ischemic coronary heart disease?

Naturalistic randomized controlled trial demonstrating effectiveness of Text4Hope in supporting male population mental health during the COVID-19 pandemic

Background

Mental illness is not uncommon among males. It is estimated that males are more likely to die by suicide, become dependent on alcohol, report frequent drug use, and be dissatisfied with their life, compared to women. In this study, we assessed the potential to offer support to this population using Text4Hope, a texting mental health service.

Methods

The study was a naturalistic randomized controlled trial comparing two populations of Text4Hope male subscribers; an intervention group (IG, Text4Hope subscribers who received once-daily supportive text messages for 6 weeks) and a control group (CG, Text4Hope subscribers who joined the program in the same time frame but were yet to receive text messages). Inferential statistics were used to compare the severity and the prevalence of the likely stress, anxiety, and depression, between the two groups, using the Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder 7-item (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9), and defined the Composite Mental Health (CMH) score as the sum of these three. T-test, Chi-squared association, and binary logistic regression analyses were applied.

Results

There were 286 male subscribers to Text4Hope. The majority were above 40 years, white, employed, had postsecondary education, were in a relationship, and owned a home. Mean scores of PSS-10, GAD-7, and PHQ-9 scales and the CMH were significantly higher for the CG compared to the IG, 11.4, 28.8, 25.8, and 18.7%, respectively. Similarly, a statistically significantly lower prevalence in IG, compared to the CG, on likely MDD (58.15 vs. 37.4%) and likely GAD (50 vs. 30.8%), with a small effect size. The IG was a significant predictor for lower odds of both likely MDD and likely GAD while controlling for sociodemographic characteristics.

Conclusions

The Text4Hope service is an effective tool for mental health support for male subscribers during the COVID-19 pandemic. Compared to the males who didn't receive the service, those who received it were in better mental health conditions. Further effort is still needed to encourage males to participate in such online services that can help them receive adequate support, particularly during crisis times.

Depression and anxiety following acute myocardial infarction in women

Cardiovascular disease is the leading global cause of mortality, with ischemic heart disease causing the majority of cardiovascular deaths. Despite this, diagnostic delay commonly occurs in women experiencing acute myocardial infarction (AMI) who have a higher associated in-hospital mortality. Several studies have demonstrated that women are significantly more likely than men to experience depression and anxiety following AMI which is linked with increased morbidity, rehospitalization, and mortality, as well as decreased quality of life. Thus, it is imperative that future work aims to understand the factors that put women at higher risk for depression and anxiety following AMI, informing prevention and intervention. This narrative review will summarize the current literature on the association between AMI and mental health in women, including the impact on morbidity, mortality, and quality of life.

Longitudinal change and prognostic value of anxiety and depression in coronary heart disease patients

BACKGROUND

This study aimed to investigate the longitudinal changes and risk factors of anxiety and depression, as well as their values in predicting major adverse cardiovascular events (MACE) occurrence in coronary heart disease (CHD) patients.

METHODS

Every 3 months until 36 months (M36), 190 newly diagnosed CHD patients were consecutively recruited and followed up. Anxiety and depression were assessed using hospital anxiety and depression scale (HADS) at each follow-up timepoint. Meanwhile, MACE occurrence was recorded.

RESULTS

Anxiety occurrence sustainably increased from 42.6% at baseline to 51.1% at M36; meanwhile, depression occurrence also sustainably elevated from 33.3% at baseline to 43.7% at M36. Then, independent risk factors for anxiety and depression at baseline/1 year/2 years/3 years were assessed, which revealed that female, diabetes, and higher Gensini score independently predicted anxiety occurrence at each time point, while single/divorced/widowed status independently predicted anxiety occurrence at some specific time points; regarding depression, female, single/divorced/widowed status, diabetes and higher Gensini score independently predicted depression occurrence at each time point, whereas higher education duration, family history of CHD and age > 60 years only predicted depression at some individual time points. Interestingly, baseline/1-year depression were correlated with increased accumulating MACE occurrence, while no correlation of baseline/1-year /2-year/3-year anxiety or 2-year/3-year depression with accumulating MACE occurrence was found.

CONCLUSION

Anxiety and depression are common and progress sustainably with female, diabetes, and higher Gensini score as their independent risk factors; meanwhile, depression but not anxiety may predict increased accumulating MACE occurrence in CHD patients.

Voice Stress Analysis: A New Framework for Voice and Effort in Human Performance

People rely on speech for communication, both in a personal and professional context, and often under different conditions of physical, cognitive and/or emotional load. Since vocalization is entirely integrated within both our central (CNS) and autonomic nervous system (ANS), a mounting number of studies have examined the relationship between voice output and the impact of stress. In the current paper, we will outline the different stages of voice output, i.e., breathing, phonation and resonance in relation to a neurovisceral integrated perspective on stress and human performance. In reviewing the function of these three stages of voice output, we will give an overview of the voice parameters encountered in studies on voice stress analysis (VSA) and review the impact of the different types of physiological, cognitive and/or emotional load. In the section "Discussion," with regard to physical load, a competition for ventilation processes required to speak and those to meet metabolic demand of exercised muscles is described. With regard to cognitive and emotional load, we will present the "Model for Voice and Effort" (MoVE) that comprises the integration of ongoing top-down and bottom-up activity under different types of load and combined patterns of voice output. In the MoVE, it is proposed that the fundamental frequency (F0) values as well as jitter give insight in bottom-up/arousal activity and the effort a subject is capable to generate but that its range and variance are related to ongoing top-down processes and the amount of control a subject can maintain. Within the MoVE, a key-role is given to the anterior cingulate cortex (ACC) which is known to be involved in both the equilibration between bottom-up arousal and top-down regulation and vocal activity. Moreover, the connectivity between the ACC and the nervus vagus (NV) is underlined as an indication of the importance of respiration. Since respiration is the driving force of both stress and voice production, it is hypothesized to be the missing-link in our understanding of the underlying mechanisms of the dynamic between speech and stress.

"The Less I Think About It, the Better I Feel": A Thematic Analysis of the Subjective Experience of Malignant Mesothelioma Patients and Their Caregivers

Aim: A cancer diagnosis-and in particular a Malignant Mesothelioma (MM) one-breaks the somatopsychic balance of the individual, compromising the quality of residual life and giving rise to many negative emotions difficult to integrate and to elaborate (such as depression, fears, anxieties, hopelessness, guilt, shame, and rage). Several national and international guidelines acknowledged the importance of evaluating psychological and socio-relational features in MM patients and their caregiver. However, only few studies have investigated the subjective experience of MM patients and even less research has focused on the caregivers' experience. Thus, the aim of the present study is to investigate the lived experience of both MM patients and their caregivers, providing an in-depth comprehension of the psychological sequelae of the disease. Materials and Methods: Within a psychoanalytically-informed conceptual framework, open-ended interviews were conducted with 10 MM patients and 9 caregivers. Thematic analysis was employed: interviews were audio-recorded, transcribed verbatim, and coded in order to identify the main recurring themes across the narratives. Results: We detected four different themes: (1) bodily symptoms and embodied emotions; (2) living in or near a National Priority Contaminated Site (NCPS); (3) "nothing is like it was" (that is, the impact of the diagnosis on everyday life, the changes it causes in the family relationships, the things that are still possible to do, the mourning process); (4) "what will become of us?" (that is, worries about the impact of the diagnosis on the beloved ones, death and legacy). Discussion: MM patients and caregivers seem to be stuck in a concrete mental functioning focused on symptoms and they find it difficult to openly think and talk about the affective and emotional consequences of the diagnosis. Alongside this, they express the need to find new and less conflictual ways to stay together and talk to each other during the period of active treatments for the illness (i.e., chemotherapy, radiotherapy, etc) and the end-of-life. The results of this study have important implications for the clinical management of MM and can help develop multi-professional specialist interventions addressed to both patients and caregivers.

Illness trajectories in patients with amyotrophic lateral sclerosis: How illness progression is related to life narratives and interpersonal relationships

AIMS AND OBJECTIVES

To identify illness trajectories in amyotrophic lateral sclerosis by analysing personal, social and functional dimensions related to amyotrophic lateral sclerosis progression.

BACKGROUND

Previous studies have considered some psychological distinct variables that may moderate illness progression, but no research has combined an extensive qualitative understanding of amyotrophic lateral sclerosis patients' psychological characteristics and illness progression.

DESIGN

A mixed-methods approach was used to combine quantitative and qualitative measures. Illness progression was assessed through a longitudinal design.

METHODS

Eighteen patients with amyotrophic lateral sclerosis attending a Neurology Department in northern Italy participated in the study. Semi-structured interviews to explore personal experience, and dependency grids to assess the distribution of dependency; ALSFRS-R and neuropsychological screening were, respectively, used to measure physical and cognitive impairment. To assess the progression of the disease, ALSFRS-R was re-administered after 8 months and mortality rate was considered. Data were analysed using the grounded theory approach.

RESULTS

Illness progression changed according to the perception of the disease, the trust placed in medical care, self-construction and the distribution of dependency. Based on these categories, cases that had similar experiences were grouped, and four illness trajectories were identified: aggressiveness, threat, constriction and guilt.

CONCLUSION

The findings suggest that it is possible to identify different illness trajectories in amyotrophic lateral sclerosis.

RELEVANCE TO CLINICAL PRACTICE

Personalised intervention strategies may be construed based on the different trajectories identified.

Existential Threat or Dissociative Response? Examining Defensive Avoidance of Point-of-Care Testing Devices Through a Terror Management Theory Framework

Using a terror management theory framework, this study investigated if providing mortality reminders or self-esteem threats would lead participants to exhibit avoidant responses toward a point-of-care testing device for cardiovascular disease risk and if the nature of the device served to diminish the existential threat of cardiovascular disease. One hundred and twelve participants aged 40-55 years completed an experimental questionnaire. Findings indicated that participants were not existentially threatened by established terror management methodologies, potentially because of cross-cultural variability toward such methodologies. Highly positive appraisals of the device also suggest that similar technologies may beneficially affect the uptake of screening behaviors.

Monitoring emotion through body sensation: a review of awareness in Goenka's Vipassana

Awareness is one of the two most important abilities cultivated in Goenka's Vipassana meditation, which refers to sensitivity to subtle bodily sensations and the associated psychological processes. This sensitivity and its derived function of monitoring emotion are not of notable concern in modern mindfulness-based psychotherapies. Evidence supports that Vipassana meditation truly enhances sensitivity to bodily sensations, but further study is required to assess the awareness of psychological processes. The value of monitoring mental processing has been widely accepted in psychology, as has enhanced sensitivity along with the potential dangers to mental health. Implications for practice and future studies are discussed.

One size does not fit all: psychometric properties of the Shona Symptom Questionnaire (SSQ) among adolescents and young adults in Zimbabwe

BACKGROUND

Depression is a major contributor to the global burden of disease. Onset commonly occurs during the adolescent period. Understanding how depression tools are functioning among adolescents has been relatively overlooked.

METHODS

Using cross-sectional survey data among a sample of 2768 adolescents (aged 15-19) and 2027 young adults (aged 20-24) living in Zimbabwe this paper calibrated the Shona Symptom Questionnaire (SSQ) against the Self Report Questionnaire (SRQ-20) and examined the performance indices of the SSQ based on various cut points for classification. Using a multivariate logistic regression model we isolated particular characteristics to test their association with the odds of being misclassified as non-depressed by the SSQ.

RESULTS

A modified cut point of five or more substantially increases the depression estimates for both age groups. The prevalence of depression increased from 3.5% to 13.2% among adolescents and from 5.1% to 16.2% among young adults based on these revisions. Adolescents who were orphaned or ever had sex had significantly a greater odd of being misclassified. When retested using the modified cut point of five or greater, associations with misclassification disappeared.

LIMITATIONS

Scales were not administered separately or in their entirety but rather overlapping items were only asked once, utilizing exclusively SRQ-20 phrasing rather than the culturally-emic language in the SSQ.

CONCLUSIONS

Not all depression scales are appropriate for use among adolescents given their unique developmental stage. An alternative cut point for depression classification could improve detection of depression among Zimbabwean adolescents.

Measurement of depressive symptoms among cardiac patients: Should sex differences be considered?

Confounding of depressive and cardiac symptoms may hold implications for assessment. This study investigated psychometric properties and sex differences in two depression scales among cardiac patients. Cardiac inpatients from 11 hospitals were recruited and completed a mailed survey including the Beck Depression Inventory-II and Gotland Scale of Male Depression 1 year later. The scales were significantly correlated and both were associated with social desirability. Females scored higher than males on the fatigue factor only ( p < .001). Psychometric properties of the Beck Depression Inventory-II were more favorable in this population. Practitioners must not overlook reports of fatigue in female cardiac patients.

Knowledge of reproductive system cancers, their treatments and side effects

We explored, via an online questionnaire, knowledge of breast and reproductive system cancers in patients and non-patients who access the internet for information on these diseases. We compared that knowledge to the attention the diseases have received in medical research and on the Internet. Data were collected from 690 respondents (37 % male, 63 % female) about their knowledge of prevalence, lethality, treatments and side effects of testicular, prostate, breast, uterine, cervical and ovarian cancers. Most males, but only half of the female participants, were patients themselves. Although participants showed better knowledge of cancers specific to their own sex, both sexes felt familiar with breast cancer and less aware of other cancers. Women were as aware as men of side effects of treatments for male reproductive cancers. Sex differences in awareness appear to reflect different attitudes towards illness, bias toward females as caregivers, and the disproportionate media attention given to breast cancer.

Are somatic symptoms of depression better predictors of cardiac events than cognitive symptoms in coronary heart disease?

Several recent studies have found that somatic symptoms of depression predict cardiac events in patients with established coronary heart disease but cognitive symptoms of depression do not. However, other studies have not supported this finding, and the research in this area is complicated by methodological differences and inconsistencies in the classification of "cognitive" and "somatic" symptoms. In addition, somatic symptoms are more common than cognitive symptoms in cardiac patients and are often associated with more severe depression. These factors may confound the relationship between somatic symptoms and cardiac outcomes. Some reasons why somatic symptoms may be more common than cognitive symptoms in cardiac patients are considered, as well as whether somatic symptoms are likely to be symptoms of depression or of medical illness. Finally, some directions for future research are proposed.

Higher comorbidity of depression and cardiovascular disease in women: a biopsychosocial perspective

OBJECTIVES

The present paper aims at offering a synthesis of possible reasons of the higher comorbidity of cardiovascular disease (CVD) and depression in women from a biopsychosocial perspective.

METHOD

The available literature is reviewed under sex/gender aspects related to the link between depression and CVD and common pathways to depression and CVD associated with chronic stress experiences including pathophysiological mechanisms and behavioural, cognitive, psychosocial and sociological risk factors/predictors.

RESULTS

There is considerable evidence that greater exposure to chronic stressors in women, interpersonal stress responsiveness, and internalizing coping styles are associated with an elevated risk of CVD and/or depression through behavioural and pathophysiological mechanisms including alterations in HPA axis functioning and autonomic nervous system which appear to be specific for women.

CONCLUSION

Women seem to be more strongly affected by psychosocial stressors related to CVD and depression as well as by direct and indirect effects of chronic stress compared to men. More evidence in understanding these differences within the biological, psychosocial and sociostructural determinants and pathways is essential for promoting women's health.

Gender-specific characteristics of individuals with depressive symptoms and coronary heart disease

OBJECTIVE

In individuals with depressive symptoms and coronary heart disease (CHD), little is known about gender-specific characteristics that may inform treatments and outcomes. This study sought to identify characteristics that distinguish men from women with both conditions.

METHODS

By cross-sectional design, 1951 adults with CHD and elevated depressive symptoms completed questionnaires to measure anxiety, hostility, perceived control, and knowledge, attitudes, and beliefs about CHD. Gender differences were evaluated by multivariable logistic regression.

RESULTS

Women were more likely to be single (odds ratio [OR] 3.61, P < .001), to be unemployed (OR 2.52, P < .001), to be poorly educated (OR 2.52, P < .001), to be anxious (OR 1.14, P < .01), and to perceive lower control over health (OR 1.34, P < .01) than men.

CONCLUSION

Women with CHD and depressive symptoms have fewer resources, greater anxiety, and lower perceived control than men. In women, targeting modifiable factors, such as anxiety and perceived control, is warranted.

Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients

The combination of negative affectivity (NA) and social inhibition (SI) - the Type D Personality - is associated with poor outcomes in coronary artery disease (CAD) patients. A Norwegian translation of the standard instrument measuring Type D (DS14) was tested on 432 CAD patients receiving coronary revascularization treatment. Factor analysis produced two factors with high inter-item reliability, indicating that the Norwegian DS14 has acceptable psychometric properties. Eighteen percent were classified as Type D, lower than has been reported elsewhere. Type D was associated with anxiety, depression, and passive coping. NA correlated positively with depression, anxiety, and passive coping. SI correlated positively with depression and anxiety, and negatively with active coping. The prevalence of Type D was higher among women, and negatively correlated with time since treatment. The variation in Type D prevalence among studies needs further elucidation as does the predictive power of continuous scoring of the Type D trait.

Application of the Type D Scale (DS14) in Chinese coronary heart disease patients and healthy controls

OBJECTIVE

To examine the psychometric properties of the Type D Scale (DS14) in mainland China.

METHODS

One hundred and seventy-eight coronary heart disease (CHD) patients and 376 healthy controls were recruited. They completed the Chinese version of the DS14, the Zung Self-Rating Depression Scale, the Positive Affect and Negative Affect Scale, the Perceived Social Support Scale, and the Social Avoidance and Distress Scale. Thirty-five of the patients were also rated by their family members on the DS14.

RESULTS

The two-factor structure of the DS14 was replicated. The Cronbach's alpha coefficients for the negative affectivity (NA) and social inhibition (SI) subscales were 0.90 and 0.85, respectively, for the CHD patients and 0.87 and 0.69, respectively, for the healthy subjects. The correlations between the self-reports and the observer ratings (r(NA)=0.56, r(SI)=0.69) supported satisfactory consensual validity. Good convergent validity was shown by the expected correlations and the scale-level factor analyses of NA with depression and negative affect, and SI with perceived social support and social avoidance and distress. With the standardized cut-off of NA >or=10 and SI >or=10, 31.4% of the CHD patients and 31.9% of the healthy controls in China were defined as having a Type D personality.

CONCLUSIONS

The results indicate that the Type D construct is valid and reliable in Chinese populations. The Chinese version of the DS14 shows good psychometric properties. The prevalence of Type D personality in China falls within the range of what has been found in Western countries, at least for CHD patients. This study indicates that it is possible to use the DS14 among Chinese populations in future cross-cultural studies.

Physical activity as a potential mechanism through which social support may reduce cardiovascular disease risk

Social support has been associated with a reduced risk of cardiovascular disease (CVD). It has been suggested that the protective effect of social support is mediated through the autonomic nervous system and/or unhealthy lifestyle behaviors, but data are sparse, especially in diverse populations. The purpose of this study was to evaluate possible pathways through which social support may reduce cardiovascular disease risk. Baseline data from The National Heart, Lung, and Blood Institute Family Intervention Trial for Heart Health were included in this analysis (N = 501, mean age 48 +/- 13 years, 66% female, 36% nonwhite). Social support was calculated using the Enhancing Recovery in Coronary Heart Disease Patients Social Support Instrument, a validated tool measuring emotional and instrumental support. Emotional support is defined as the belief that one is cared about (high = score > or = 18); instrumental social support is defined as help with services (high = score > or = 3). Demographics, physical activity, and diet were assessed by standardized questionnaires, and cardiovascular disease risk factors were measured systematically. Linear regression models were adjusted for age, race/ethnicity, sex, marital status, and education. Higher instrumental social support was positively associated with minutes of physical activity per week (P = .007). Higher emotional social support was positively associated with number of days of physical activity per week (P = .023), number of servings of wine per week (P = .007), and increased high-density lipoprotein cholesterol (P = .014). A mediational analysis was performed, and the relationship between emotional social support and high-density lipoprotein cholesterol was significantly attenuated by physical activity days per week and number of servings of wine per week. No significant associations were found for other potential mediators tested including body mass index, waist circumference, and intake of omega-3 fatty acids, beer, or liquor. In this ethnically diverse population, emotional social support was linked to higher high-density lipoprotein cholesterol levels through increased physical activity and wine intake, suggesting possible mechanisms through which social support may reduce cardiovascular disease risk.

Is disturbed sleep a mediator in the association between social support and myocardial infarction?

The objective of this study was to investigate a mediating relationship between social support and disturbed sleep in cases surviving myocardial infarction. The case-referent studies, Stockholm Heart Epidemiological Program (SHEEP) and Västernorrland Heart Epidemiological Program (VHEEP) were used comprising 6231 participants (2046 women). Referents were randomly selected. Disturbed sleep was operationalized by the Karolinska Sleep Questionnaire, network support by the Availability of Social Integration Index and emotional support by the Availability of Attachment Index. Mediating associations were tested with logistic regression. The results show that disturbed sleep may act as a mediator between low network support and myocardial infarction in women.

Neural substrates of implicit and explicit emotional processes: a unifying framework for psychosomatic medicine

There are two broad themes in psychosomatic medicine research that relate emotions to physical disease outcomes. Theme 1 holds that self-reported negative affect has deleterious effects and self-reported positive affect has salubrious effects on health. Theme 2 holds that interference with the experience or expression of negative affect has adverse health consequences. From the perspective of self-report these two traditions appear contradictory. A key thesis of this paper is that the foundational distinction in cognitive neuroscience between explicit (conscious) and implicit (unconscious) processes, corresponding to Themes 1 and 2, respectively, provides a unifying framework that makes empirical research on unconscious emotional processes more tractable. A psychological model called "levels of emotional awareness" is presented first that places implicit and explicit emotional processes on a cognitive-developmental continuum. This model holds that the ability to become consciously aware of one's own feelings is a cognitive skill that goes through a developmental process similar to that which Piaget described for other cognitive functions. Empirical findings using the Levels of Emotional Awareness Scale are presented. A parallel hierarchical model of the neural substrates of emotional awareness is presented next supported by recent neuroimaging and lesion work. The evidence presented in this review suggests that the neural substrates of implicit and explicit emotional processes are distinct, that the latter have a modulatory effect on the former, and that at the neural level Theme 1 and Theme 2 phenomena share critical similarities. The implications of this psychobiological model for research in psychosomatic medicine are discussed.

Does dissociation of emotional and physiological reactivity predict blood pressure change at 3- and 10-year follow-up?

One of the major theories of psychosomatic medicine is that pervasive dissociations between physiological reactivity and simultaneous emotion awareness may be an important marker for the long-term development of cardiac problems. Subjective autonomic discrepancy (SAD) scores are proposed as a method of capturing the dissociation between physiological and emotional reactivity and increasing the explanatory power of predictive models of cardiac health outcomes. It was found that SAD scores for blood pressure indices show trait-like stability over a period of 3 years. Although linear 3-year prediction of systolic blood pressure came close to traditional definitions of significance, neither a linear nor a quadratic model was found to show significant prospective validity in predicting ambulatory blood pressure change over a 10-year period. Dissociation between physiological arousal and emotional awareness does not appear to be an important variable in the identification of individuals at risk for later cardiovascular health problems.

Screening, diagnosis & monitoring of depression/distress in CHF patients

Objective and validated measures of depression/distress (anxiety and anger) are available and readily usable at the bedside or in clinic. Foremost among these is the Patient's Health Questionnaire--an adaptation of DSM IV criteria for Major Depressive Disorder that permits administration and scoring by nursing or physician personnel, and quantification of the intensity of depression. A score of 10 or greater indicates a need for evaluation/treatment. Because of patient denial/minimization/alexithymia, PHQ negatives should undergo further screening by having a spouse or friend complete a depression/distress rating scale. The only standardized, normed, and validated spouse/friend scale presently available is the Ketterer Stress Symptom Frequency Checklist, which is available by internet.

Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review

OBJECTIVE

The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES).

METHODS

We conducted a retrospective review of patients diagnosed with PNES in a 5-year period.

RESULTS

Fifty patients with PNES were identified, giving an estimated incidence of 0.91/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments.

CONCLUSIONS

PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.

Empirically Derived Psychometric Screening for Emotional Distress in Coronary Artery Disease Patients

BACKGROUND AND RESEARCH OBJECTIVES

Multiple types of evidence implicate emotional distress as a cause of adverse outcomes in individuals with coronary artery disease. The present study was intended to determine the most accurate and user-friendly means of screening patients with coronary artery disease for emotional distress using age at initial diagnosis as the criterion.

SUBJECTS AND METHODS

Two clinical databases consisting of patients with documented coronary artery disease, each contained multiple measures of emotional distress, were used. These databases were investigated by tests of covariation of the emotional distress measures with age at initial diagnosis. If these were statistically significant, sequential testing of cutpoints yielded the minimum score for positivity. Sensitivity, specificity, and positive predictive value calculations were made for the significant measures. Single-sex tests of covariation were also examined.

RESULTS AND CONCLUSIONS

The Patient Health Questionnaire was the only significant bedside measure of emotional distress (Pearson r = -0.149, P = .058), with a cutpoint of 10 or greater. The Beck Depression Inventory, Hospital Anxiety and Depression Scale, and Crown-Crisp Phobic Anxiety Scale failed to reach significance as covariates of age at initial diagnosis. Substantially greater sensitivity occurs with larger and more cumbersome measures of emotional distress. For example, the Ketterer Stress Symptom Frequency Checklist yielded consistent results with greater variance explained, particularly in men (Pearson r for self-ratings of anger = -0.339, P = .001; depression = -0.363, P = .005; anxiety = -0.273, P = .028). Brief bedside/clinic screening of emotional in populations with coronary artery disease is possible and necessary to improve quality of life, compliance (eg, smoking cessation), and possibly morbidity/mortality. Initial screening can and should occur at the bedside/clinic by cardiology or primary care personnel using the Patient Health Questionnaire.

Gender differences in cardiovascular disease and comorbid depression

Although gender is increasingly perceived as a key determinant in health and illness, systematic gender studies in medicine are still lacking. For a long time, cardiovascular disease (CVD) has been seen as a “male” disease, due to men's higher absolute risk compared with women, but the relative risk in women of CVD morbidity and mortality is actually higher: Current knowledge points to important gender differences in age of onset, symptom presentation, management, and outcome, as well as traditional and psychosocial risk factors. Compared with men, CVD risk in women is increased to a greater extent by some traditional factors (eg, diabetes, hypertension, hypercholesterolemia, obesity,) and socioeconomic and psychosocial factors also seem to have a higher impact on CVD in women. With respect la differences in CVD management, a gender bias in favor of men has to be taken into account, in spite of greater age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression has been shown to be an independent risk factor and consequence of CVD; however, concerning gender differences, The results have been inconsistent. Current evidence suggests that depression causes a greater increase in CVD incidence in women, and that female CVD patients experience higher levels of depression than men. Gensier aspects should be more intensively considered, both in further research on gender differences in comorbid depresion, and in cardiac treatment and rehabilitation, with the goal of making secondary prevention more effective.

Hostile personality traits and coronary artery calcification in middle-aged and older married couples: different effects for self-reports versus spouse ratings

OBJECTIVE

To examine the association between hostile personality traits and coronary artery disease (CAD) and the role of aspects of hostility, method of assessment, and age as influences on its magnitude, as prior studies of hostility and coronary artery calcification (CAC) have produced conflicting findings.

METHODS

Participants included 300 married couples (mean age = 54.4 years) free from diagnosed CAD. Participants completed four measures of hostility-self-reports and spouse ratings of angry hostility (i.e., tendency to experience anger) and antagonism (i.e., argumentative, mistrusting, and cold interpersonal behavior).

RESULTS

In hierarchical random regression models accounting for dependency between husbands' and wives' observations, analyses of log-transformed Agatston scores indicated that self-reports of angry hostility and antagonism were not related to CAC. However, spouse ratings of both anger and antagonism were significantly associated with CAC severity. Interactions with age indicated that these associations occurred only among older participants. Control of behavioral and biomedical risk factors did not eliminate these effects. Antagonism but not anger was an independent predictor of CAC when considered simultaneously.

CONCLUSIONS

Hostility is associated with concurrent asymptomatic CAD as assessed through CAC, but this effect is likely to be underestimated when hostility is assessed through self-reports rather than ratings by others and in samples with lower prevalence and severity of CAC.

Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress

PURPOSE OF REVIEW

Pilowsky introduced the term 'abnormal illness behaviour' to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. This review summarizes recent work from sociology, health psychology and psychiatry that contributes to an understanding of the processes that may underlie abnormal illness behaviour.

RECENT FINDINGS

Disturbances in the regulation of physiological systems may account for many 'unexplained' symptoms and sickness behaviour. Increased attention to bodily sensations, sensitivity to pain and catastrophizing play important roles in illness behaviour in medical illness. Developmental adversities and parental modelling of illness behaviour in childhood may increase bodily preoccupation and health care utilization. Apparent cross-national differences in illness behaviour may reflect differences in health care systems, but cultural models of illness and social stigma remain important determinants of illness denial and avoidance of mental health services.

SUMMARY

Research into illness behaviour is relevant to efforts to rethink the psychiatric nosology of somatoform disorders. The discrete somatoform disorders might well be replaced by a dimensional framework that identifies specific pathological processes in cognition, perception and social behaviour that contribute to bodily distress, impaired coping, inappropriate use of health services, chronicity and disability.

Do others really know us better? Predicting migraine activity from self- and other-ratings of negative emotion

OBJECTIVE

The validity of self-reported negative emotion to predict health status is limited by response biases, introspection limitations, and methodological confounds. The reports of significant others about the patients' negative emotion may circumvent these limitations. This study sought to compare the validity of self- versus other-reported negative emotion as a correlate of migraine headache activity.

METHODS

On 89 patients with migraine headache (74 women and 15 men), we correlated self-ratings and significant-other-ratings of patients' negative emotion with patients' report of migraine frequency and severity, which were assessed both cross-sectionally and prospectively, 3 months later.

RESULTS

Other-reported negative emotion correlated with migraine activity better than did self-reported negative emotion, both cross-sectionally and prospectively. Patterns were different for women and men, however. Among women, other-reported negative emotion was positively associated with migraine activity. Among men, other-reported negative emotion was inversely associated with migraine frequency and severity.

CONCLUSION

The results suggest that it may be valuable to obtain significant-other-ratings when assessing negative emotion in patients and that the genders may differ in how others' ratings are related to the patients' health.

Anxiety and depression following myocardial infarction: gender differences in a 5-year prospective study

OBJECTIVE

The aim of this study was to examine the impact of the first myocardial infarction (MI) and the relative influence of preexisting confounding factors on anxiety and depression in the following 5 years.

METHODS

A total of 23,693 participants, 35-79 years of age at baseline, attended two population-based prospective studies in 1984-1986 and in 1995-1997. They underwent physical examination and self-reported demographic, lifestyle, psychosocial, and medical health characteristics in both surveys. Outcome measure was the Hospital Anxiety and Depression rating Scale (HADS).

RESULTS

Five hundred twelve participants suffered their first MI in the last 5 years before follow-up. Women showed an increased risk for both anxiety and depression in the first 2 years post-MI, followed by a significant symptom reduction. In contrast, the risk for depression in men increased after 2 years post-MI. Anxiety and depression, low educational level, obesity, daily smoking, and physical inactivity pre-MI significantly predicted a poor psychiatric outcome at follow-up.

CONCLUSION

Five-year follow-up after MI revealed gender-specific outcomes of anxiety and depression not previously described.

DS14: standard assessment of negative affectivity, social inhibition, and Type D personality

OBJECTIVE

Type D personality-a joint tendency toward negative affectivity (NA) and social inhibition (SI)-is related to poor cardiac prognosis, but there is no standard for assessing Type D. This study reports on the Type D Scale-14 (DS14) as a standard measure of NA, SI, and Type D.

METHODS

The study included 3813 participants (2508 from the general population, 573 cardiac patients, 732 hypertension patients). They all filled out the DS14, containing 7-item NA and SI subscales; 275 subjects also completed the NEO-FFI, and 121 patients filled out the DS14 twice.

RESULTS

Factor analysis of the DS14 yielded 2 dominant traits; all of the NA and SI items loaded between 0.62 to 0.82 on their corresponding factor (N = 3678). The NA scale covered dysphoria, worry, and irritability; the SI scale covered discomfort in social interactions, reticence, and lack of social poise. The NA and SI scales were internally consistent (alpha = 0.88/0.86; N = 3678), stable over a 3-month period (test-retest r = 0.72/0.82) and not dependent on mood and health status (N = 121). NA correlated positively with neuroticism (r = 0.68); SI correlated negatively with extraversion (r = -0.59/-0.65). Scale-level factor analysis confirmed the construct validity of the DS14 against the NEO-FFI. Using a cutoff of 10 (NA > or =10 and SI > or =10), 1027 subjects (28%) were classified as Type D, 21% in the general population versus 28% in coronary heart disease and 53% in hypertension (p < or = .001). Age, sex, and Type D (odds ratio, 3.98; 95% confidence interval, 3.2-4.6; p <.0001) were independently associated with cardiovascular morbidity.

CONCLUSION

The DS14 is a brief, psychometrically sound measure of negative affectivity and social inhibition that could readily be incorporated in epidemiologic and clinical research.