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Qi X, Wang S, Qiu L, Chen X, Huang Q, Ouyang K, Chen Y. Causal association between self-reported fatigue and coronary artery disease: a bidirectional two-sample Mendelian randomization analysis. Front Psychiatry 2023; 14:1166689. [PMID: 37799396 PMCID: PMC10547863 DOI: 10.3389/fpsyt.2023.1166689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Background Observational studies have reported the association between fatigue and coronary artery disease (CAD), but the causal association between fatigue and CAD is unclear. Method We conducted a bidirectional Mendelian randomization (MR) study using publicly available genome-wide association studies (GWAS) data. The inverse-variance weighted (IVW) method was used as the primary analysis. We performed three complementary methods, including weighted median, MR-Egger regression, and MR pleiotropy residual sum and outlier (MR-PRESSO) to evaluate the sensitivity and horizontal pleiotropy of the results. Result Self-reported fatigue had a causal effect on coronary artery atherosclerosis (CAA) (OR 1.047, 95%CI 1.033-1.062), myocardial infarction (MI) (OR 1.027 95%CI 1.014-1.039) and coronary heart disease (CHD) (OR 1.037, 95%CI 1.021-1.053). We did not find a significant reverse causality between self-reported fatigue and CAD. Given the heterogeneity revealed by MR-Egger regression, we employed the IVW random effect model. For the examination of fatigue on CHD and the reverse analysis of CAA, and MI on fatigue, the MR-PRESSO test found horizontal pleiotropy. No significant outliers were found. Conclusion The MR analysis reveals a causal relationship between self-reported fatigue and CAD. The results should be interpreted with caution due to horizontal pleiotropy.
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Affiliation(s)
- Xiaoyi Qi
- Departments of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
- Medical College, Shantou University, Shantou, China
| | - Shijia Wang
- Departments of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Liangxian Qiu
- Departments of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiongbiao Chen
- Departments of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qianwen Huang
- Departments of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Kunfu Ouyang
- Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanjun Chen
- Departments of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
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Altamura M, D’Andrea G, Angelini E, Tortorelli FMP, Balzotti A, Porcelli P, Margaglione M, Brunetti ND, Cassano T, Bellomo A. Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients. PLoS One 2022; 17:e0265282. [PMID: 35271674 PMCID: PMC8912235 DOI: 10.1371/journal.pone.0265282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Psychosomatic syndromes have emerged as an important source of comorbidity in cardiac patients and have been associated with increased risk for adverse outcomes in patients with heart failure (HF). Understanding of the mechanisms underlying this connection is limited, however immune activity represents a possible pathway. While there have been numerous studies connecting immune activity to psychosomatic psychopathology, there is a lack of research on patients with HF. We examined forty-one consecutive outpatients affected by HF. We assessed psychosomatic psychopathology using the Diagnostic Criteria for Psychosomatic Research (DCPR) and the Patient Health Questionnaire-15 (PHQ-15). The Psychosocial Index (PSI) was used for assessing stress and psychosocial dimensions. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Circulating levels of proinflammatory cytokines IL-6 and TNF-alpha were ascertained. Univariate and multivariable regression models were used to test for associations between inflammatory cytokines and psychosomatic psychopathology (i.e., DCPR syndromes, PHQ-15) and psychological dimensions (i.e., BDI-II, PSI). A significant positive correlation was found between IL-6 levels and psychosomatic psychopathology even when controlling for any confounding variables (i.e., Body-mass index (BMI), New York Heart Association (NYHA) class, smoking habits, alcohol consumption, statin use, aspirin use, beta blockers use, age, and gender). In contrast, the associations between TNF-alpha levels were non-significant. These findings can contribute to research in support of a psychoneuroimmune connection between psychosomatic psychopathology and HF. Findings also suggest the possibility that elevated IL-6 levels are more relevant for the pathogenesis of psychosomatic syndromes than for depression in patients with HF.
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Affiliation(s)
- Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- * E-mail:
| | - Giovanna D’Andrea
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Eleonora Angelini
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Angela Balzotti
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, D’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Natale D. Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tommaso Cassano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Roni RG, Tsipi H, Ofir BA, Nir S, Robert K. Disease evolution and risk-based disease trajectories in congestive heart failure patients. J Biomed Inform 2021; 125:103949. [PMID: 34875386 DOI: 10.1016/j.jbi.2021.103949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/10/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
Congestive Heart Failure (CHF) is among the most prevalent chronic diseases worldwide, and is commonly associated with comorbidities and complex health conditions. Consequently, CHF patients are typically hospitalized frequently, and are at a high risk of premature death. Early detection of an envisaged patient disease trajectory is crucial for precision medicine. However, despite the abundance of patient-level data, cardiologists currently struggle to identify disease trajectories and track the evolution patterns of the disease over time, especially in small groups of patients with specific disease subtypes. The present study proposed a five-step method that allows clustering CHF patients, detecting cluster similarity, and identifying disease trajectories, and promises to overcome the existing difficulties. This work is based on a rich dataset of patients' records spanning ten years of hospital visits. The dataset contains all the health information documented in the hospital during each visit, including diagnoses, lab results, clinical data, and demographics. It utilizes an innovative Cluster Evolution Analysis (CEA) method to analyze the complex CHF population where each subject is potentially associated with numerous variables. We have defined sub-groups for mortality risk levels, which we used to characterize patients' disease evolution by refined data clustering in three points in time over ten years, and generating patients' migration patterns across periods. The results elicited 18, 23, and 25 clusters respective to the first, second, and third visits, uncovering clinically interesting small sub-groups of patients. In the following post-processing stage, we identified meaningful patterns. The analysis yielded fine-grained patient clusters divided into several finite risk levels, including several small-sized groups of high-risk patients. Significantly, the analysis also yielded longitudinal patterns where patients' risk levels changed over time. Four types of disease trajectories were identified: decline, preserved state, improvement, and mixed-progress. This stage is a unique contribution of the work. The resulting fine partitioning and longitudinal insights promise to significantly assist cardiologists in tailoring personalized interventions to improve care quality. Cardiologists could utilize these results to glean previously undetected relationships between symptoms and disease evolution that would allow a more informed clinical decision-making and effective interventions.
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Affiliation(s)
| | | | | | - Shlomo Nir
- The Leviev Heart Center, Sheba Medical Center, Israel.
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Balog P, Konkolÿ Thege B. The role of vital exhaustion in predicting the recurrence of vascular events: A longitudinal study. Int J Clin Health Psychol 2019; 19:75-79. [PMID: 30619500 PMCID: PMC6300713 DOI: 10.1016/j.ijchp.2018.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022] Open
Abstract
Background/objective The aim of this study was to examine the role of vital exhaustion in predicting the recurrence of vascular events. Method The sample comprised of 816 individuals (65.3% female, Mage = 43.2 years, SD = 14.7 years), 395 (48.4%) of whom reported treatment for the reoccurrence of a vascular event during the four-year follow-up period. Concurrent effects of baseline vital exhaustion (measured by a shortened version of the Maastricht Questionnaire), depression (assessed by a shortened version of the BDI), anxiety (assessed by the HADS), and hostility (assessed by a shortened version of the Cook-Medley Hostility Scale) in predicting the recurrence of T2 vascular events were examined. The analyses were also controlled for traditional risk factors, such as age, education, body mass index, smoking, alcohol use, and lack of physical activity. Results The regression analyses showed that vital exhaustion scores significantly predicted the reoccurrence of vascular events even after controlling for all covariates. None of the other psychological predictors (depression, anxiety, and hostility) was significant in the final model. Conclusions These results suggest that despite the partial conceptual overlap with several similar constructs, vital exhaustion is a distinct phenomenon that deserves consideration when planning and implementing interventions to reduce the risk of vascular diseases.
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Affiliation(s)
- Piroska Balog
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Barna Konkolÿ Thege
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Deter HC, Weber C, Herrmann-Lingen C, Albus C, Juenger J, Ladwig KH, Soellner W, de Zwaan M, Hellmich M, Grün AS, Ronel J, Orth-Gomér K. Gender differences in psychosocial outcomes of psychotherapy trial in patients with depression and coronary artery disease. J Psychosom Res 2018; 113:89-99. [PMID: 30190055 DOI: 10.1016/j.jpsychores.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The biological and psychosocial risk profile differs between women and men with coronary artery disease (CAD). Depressive symptoms and Vital Exhaustion (VE) predict an unfavourable course of CAD. The secondary analysis of the SPIRR-CAD trial offered the possibility to examine gender as exposure variable of the clinical and psychological situation at baseline and in a variety of psychosocial measures as outcomes. METHODS In this trial, 450 men (78.9%) and 120 women (21.1%) with CAD (age ≤ 75 y), with mild to moderate depression (scoring ≥8 on the HADS), were randomized to usual care with or without a stepwise psychotherapy intervention. Beside clinical measures exhaustion and other indicators of depressive symptoms were collected at baseline and 18-month follow up. RESULTS Men had more signs and symptoms of heart disease at baseline, whereas women had higher psychosocial burden (e.g. negative affect). Women were more likely to live alone, had lower educational levels and employment rates and higher levels of depression and exhaustion. The psychotherapy intervention differed as a function of gender: In women, VE decreased from 29.4 ± 8.1 to 22.1 ± 11.7 in the intervention group (IG) and from 29.2 ± 8.2 to 25.1 ± 11.3 in the control group (CG). In men VE decreased from 23.3 + -10.8 to 21.2 ± 9.7 in the IG and from 23.6 ± 10.7 to 19.3 ± 11.3 in the CG (time x intervention x gender; F = 4.97; p = .026). DISCUSSION Women had a higher psychosocial burden than men. VE compared to other rating instruments of depressive symptoms suggested a stronger response to the intervention in women. VE may help to understand gender differences in psychotherapeutic treatment studies of CAD. ISRCTN 76240576; clinicaltrials.gov.
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Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany.
| | - Cora Weber
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Christoph Herrmann-Lingen
- Dept. of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Goettingen, Germany
| | - Christian Albus
- Dept. of Psychosomatics and Psychotherapy, University of Cologne, Germany
| | - Jana Juenger
- Dept. of General Internal and Psychosomatic Medicine, University of Heidelberg, Germany
| | - Karl-Heinz Ladwig
- GSF- National Research Center for Environment and Health, Institute of Epidemiology, Munich-Neuherberg and Institute and Dept. of Psychosomatic Medicine, Psychotherapy and Medical Psychology, Technical Univ. of Munich, Klinikum rechts der Isar, Germany
| | - Wolfgang Soellner
- Dep. of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Germany
| | - Martina de Zwaan
- Dept. of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany
| | - Martin Hellmich
- Institut of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Anna-Sophia Grün
- Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany
| | - Joram Ronel
- Institute and Dept. of Psychosomatic Medicine, Psychotherapy and Medical Psychology, Technical Univ. of Munich, Klinikum rechts der Isar, Germany
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Zhang M, Liu L, Shi Y, Yang Y, Yu X, Angerer P, Kristensen TS, Li J. Longitudinal associations of burnout with heart rate variability in patients following acute coronary syndrome: A one-year follow-up study. Gen Hosp Psychiatry 2018; 53:59-64. [PMID: 29859340 DOI: 10.1016/j.genhosppsych.2018.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate longitudinal associations of burnout with heart rate variability (HRV) in patients after their first events of acute coronary syndrome (ACS). METHODS In total, two hundred eight patients participated in this one-year follow-up study. On the day before discharge, their personal burnout level was assessed by the Copenhagen Burnout Inventory. HRV signals were collected at four time points: the day before discharge, one month, six month and one year after discharge. HRV was measured by 24-hour ambulatory electrocardiography and analyzed in time and frequency domains. Generalized estimating equations were applied to analyze the associations of burnout at baseline with longitudinal tracking of HRV during follow-up in format of natural logarithmic transformation. RESULTS After adjusting for relevant confounding factors, high burnout at baseline was significantly associated with low standard deviation of NN intervals (SDNN), a time domain measure of HRV (p < 0.05). Also, baseline burnout was inversely associated with five frequency domain measures, i.e., high frequency power (HF), low frequency power (LF), very low frequency power (VLF), and ultra low frequency power (ULF), and total power (TP) (all p < 0.05). CONCLUSION Personal burnout is longitudinally associated with decreased HRV during one-year period among patients after first ACS.
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Affiliation(s)
- Min Zhang
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Ling Liu
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yunke Shi
- Cardiology Department, 1st Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yanfei Yang
- Cardiology Department, Kunming Children's Hospital, Kunming, Yunnan 650228, China
| | - Xiaoju Yu
- Cardiology Department, 1st hospital of Yibin City, Yibin, Sichuan 644000, China
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
| | | | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
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Pinaire J, Azé J, Bringay S, Landais P. Patient healthcare trajectory. An essential monitoring tool: a systematic review. Health Inf Sci Syst 2017; 5:1. [PMID: 28413630 PMCID: PMC5390363 DOI: 10.1007/s13755-017-0020-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/29/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient healthcare trajectory is a recent emergent topic in the literature, encompassing broad concepts. However, the rationale for studying patients' trajectories, and how this trajectory concept is defined remains a public health challenge. Our research was focused on patients' trajectories based on disease management and care, while also considering medico-economic aspects of the associated management. We illustrated this concept with an example: a myocardial infarction (MI) occurring in a patient's hospital trajectory of care. The patient follow-up was traced via the prospective payment system. We applied a semi-automatic text mining process to conduct a comprehensive review of patient healthcare trajectory studies. This review investigated how the concept of trajectory is defined, studied and what it achieves. METHODS We performed a PubMed search to identify reports that had been published in peer-reviewed journals between January 1, 2000 and October 31, 2015. Fourteen search questions were formulated to guide our review. A semi-automatic text mining process based on a semantic approach was performed to conduct a comprehensive review of patient healthcare trajectory studies. Text mining techniques were used to explore the corpus in a semantic perspective in order to answer non-a priori questions. Complementary review methods on a selected subset were used to answer a priori questions. RESULTS Among the 33,514 publications initially selected for analysis, only 70 relevant articles were semi-automatically extracted and thoroughly analysed. Oncology is particularly prevalent due to its already well-established processes of care. For the trajectory thema, 80% of articles were distributed in 11 clusters. These clusters contain distinct semantic information, for example health outcomes (29%), care process (26%) and administrative and financial aspects (16%). CONCLUSION This literature review highlights the recent interest in the trajectory concept. The approach is also gradually being used to monitor trajectories of care for chronic diseases such as diabetes, organ failure or coronary artery and MI trajectory of care, to improve care and reduce costs. Patient trajectory is undoubtedly an essential approach to be further explored in order to improve healthcare monitoring.
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Affiliation(s)
- Jessica Pinaire
- Biostatistics, Epidemiology and Public Health Department, Nîmes University Hospital, Place R Debré, 30 029 Nîmes, France
- UPRES EA 2415, Clinical Research University Institute, 641 av du Doyen Gaston Giraud, 34 093 Montpellier, France
- LIRMM, UMR 5506, Montpellier University, 860 rue de Saint Priest – Bât 5, 34 095 Montpellier Cedex 5, France
| | - Jérôme Azé
- LIRMM, UMR 5506, Montpellier University, 860 rue de Saint Priest – Bât 5, 34 095 Montpellier Cedex 5, France
| | - Sandra Bringay
- LIRMM, UMR 5506, Montpellier University, 860 rue de Saint Priest – Bât 5, 34 095 Montpellier Cedex 5, France
- AMIS, Paul Valéry University, Montpellier, France
| | - Paul Landais
- Biostatistics, Epidemiology and Public Health Department, Nîmes University Hospital, Place R Debré, 30 029 Nîmes, France
- UPRES EA 2415, Clinical Research University Institute, 641 av du Doyen Gaston Giraud, 34 093 Montpellier, France
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Cohen R, Bavishi C, Haider S, Thankachen J, Rozanski A. Meta-Analysis of Relation of Vital Exhaustion to Cardiovascular Disease Events. Am J Cardiol 2017; 119:1211-1216. [PMID: 28215416 DOI: 10.1016/j.amjcard.2017.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 01/25/2023]
Abstract
To assess the net impact of vital exhaustion on cardiovascular events and all-cause mortality, we conducted a systematic search of PubMed, EMBASE, and PsychINFO (through April 2016) to identify all studies which investigated the relation between vital exhaustion (VE) and health outcomes. Inclusion criteria were as follows: (1) a cohort study (prospective cohort or historical cohort) consisting of adults (>18 years); (2) at least 1 self-reported or interview-based assessment of VE or exhaustion; (3) evaluated the association between vital exhaustion or exhaustion and relevant outcomes; and (4) reported adjusted risk estimates of vital exhaustion/exhaustion for outcomes. Maximally adjusted effect estimates with 95% CIs along with variables used for adjustment in multivariate analysis were also abstracted. Primary study outcome was cardiovascular events. Secondary outcomes were stroke and all-cause mortality. Seventeen studies (19 comparisons) with a total of 107,175 participants were included in the analysis. Mean follow-up was 6 years. VE was significantly associated with an increased risk for cardiovascular events (relative risk 1.53, 95% CI 1.28 to 1.83, p <0.001) and all-cause mortality (relative risk 1.48, 95% CI 1.28 to 1.72, p <0.001). VE also showed a trend for increased incident stroke (relative risk 1.46, 95% CI 0.97 to 2.21, p = 0.07). Subgroup analyses yielded similar results. VE is a significant risk factor for cardiovascular events, comparable in potency to common psychosocial risk factors. Our results imply a need to more closely study VE, and potentially related states of exhaustion, such as occupational burnout.
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Abstract
OBJECTIVE The construct of vital exhaustion has been identified as a potential independent psychological risk factor for incident and recurrent coronary heart disease (CHD). Despite several decades of research, no systematic review or meta-analysis has previously attempted to collate the empirical evidence in this field. The purpose of this study was to review and quantify the impact of vital exhaustion on the development and progression of CHD. METHODS Prospective and case-control studies reporting vital exhaustion at baseline and CHD outcomes at follow-up were derived from PubMed, PsycINFO (1980 to July 2015; articles in English and published articles only), and bibliographies. Information on aim, study design, sample size, inclusion and exclusion criteria, assessment methods of psychological risk factors, and results of crude and adjusted regression analyses were abstracted independently by two authors. RESULTS Thirteen prospective (n = 52,636) and three case-control (cases, n = 244; controls, n = 457) studies assessed vital exhaustion and could be summarized in meta-analyses. The pooled adjusted risk of CHD in healthy populations was 1.50 (95% confidence interval [CI] = 1.22-1.85) for prospective studies, and 2.61 (95% CI = 1.66-4.10) for case-control studies using hospital controls. Risk of recurrent events in patients with CHD was 2.03 (95% CI = 1.54-2.68). The pooled adjusted risk of chronic heart failure in healthy populations was 1.37 (95% CI = 1.21-1.56), but this was based on results from only two studies. CONCLUSIONS Vital exhaustion is associated with increased risk of incident and recurrent CHD.
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Zhang M, Shi Y, Yang Y, Liu L, Xiao J, Guo T, Li J. Burnout is associated with poor recovery of physical performance and low quality of life in patients after their first episode of acute coronary syndrome: A hospital-based prospective cohort study. Int J Cardiol 2016; 227:503-507. [PMID: 27836301 DOI: 10.1016/j.ijcard.2016.10.114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES "Burnout" is an affective response that is different to depression or anxiety. Studies on the relationship between burnout and physical recovery after acute coronary syndrome (ACS) in the long-term are lacking, hence the rationale of this study. METHODS Participants were patients after their first onset of ACS divided into the high burnout group (HBG) and low burnout group (LBG) based on the upper quartile of their burnout score on the day before discharge. At three times (1month, 6months, and 1year) after ACS, participants were scheduled for assessment of physical function and quality of life (QoL). To determine the association between burnout and physical function at different times, as well as for burnout and the QoL scores, generalized estimating equations were conducted. RESULTS Of the 208 participants, 68 participants were assigned to HBG, and 140 were assigned to LBG. QoL scores in both groups at three times showed that HBG had lower scores than LBG (p<0.01). HBG had lower physical scores at three times (z=7.28, p<0.001). Even after adjustment for confounding factors (age, sex, marital status, socioeconomic status, cigarette/alcohol consumption, ACS type, Killip class upon hospital admission), the difference was significant (z=7.78, p<0.001). CONCLUSIONS Patients with high burnout have poor physical recovery and low quality of life after ACS.
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Affiliation(s)
- Min Zhang
- Cardiology Department, 1(st) Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
| | - Yunke Shi
- Cardiology Department, 1(st) Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yanfei Yang
- Cardiology Department, Kunming Children's Hospital, Kunming, Yunnan 650228, China
| | - Ling Liu
- Cardiology Department, 1(st) Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jianming Xiao
- Cardiology Department, 1(st) Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Tuo Guo
- Cardiology Department, 1(st) Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf 40225, Germany
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Symptom Trajectories After an Emergency Department Visit for Potential Acute Coronary Syndrome. Nurs Res 2016; 65:268-78. [PMID: 27362513 DOI: 10.1097/nnr.0000000000000167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many patients evaluated for acute coronary syndrome (ACS) in emergency departments (EDs) continue to experience troubling symptoms after discharge-regardless of their ultimate medical diagnosis. However, comprehensive understanding of common post-ED symptom trajectories is lacking. OBJECTIVES The aim of this study was to identify common trajectories of symptom severity in the 6 months after an ED visit for potential ACS. METHODS This was a secondary analysis of data from a larger observational, prospective study conducted in five U.S. EDs. Patients (N = 1005) who had electrocardiogram and biomarker testing ordered, and were identified by the triage nurse as potentially having ACS, were enrolled. Symptom severity was assessed in the hospital after initial stabilization and by telephone at 30 days and 6 months using the validated 13-item ACS Symptom Checklist. Growth mixture modeling was used for the secondary analysis. The eight most commonly reported symptoms (chest discomfort, chest pain, chest pressure, light-headedness, shortness of breath, shoulder pain, unusual fatigue, and upper back pain) were modeled across the three study time points. Models with increasing numbers of classes were compared, and final model selection was based on a combination of interpretability, theoretical justification, and statistical fit indices. RESULTS The sample was 62.6% male with a mean age of 60.2 years (SD = 14.17 years), and 57.1% ruled out for ACS. Between two and four distinct trajectory classes were identified for each symptom. The seven different types of trajectories identified across the eight symptoms were labeled "tapering off," "mild/persistent," "moderate/persistent," "moderate/worsening," "moderate/improving," "late onset, "and "severe/improving." Trajectories differed on age, gender, and diagnosis. DISCUSSION Research on the individual nature of symptom trajectories can contribute to patient-centered, rather than disease-centered, care. Further research is needed to verify the existence of multiple symptoms trajectories in diverse populations and to assess the antecedents and consequences of individual symptom trajectories.
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Crane PB, Efird JT, Abel WM. Fatigue in Older Adults Postmyocardial Infarction. Front Public Health 2016; 4:55. [PMID: 27148509 PMCID: PMC4826886 DOI: 10.3389/fpubh.2016.00055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to comprehensively examine putative factors that may independently contribute to fatigue and subsequent persistence of fatigue in elderly adults 6-8 months post-myocardial infarction (MI). Studies suggest cardiac function, comorbidities, daytime sleepiness, depression, anemia, interleukins, and social support are correlates of fatigue; however, no studies have systematically examined these factors 6 months post-MI in an aging population. METHODS Study participants included 49 women and men (N = 98) ages 65-91 who were 6-8 months post-MI. Data collection included the demographic health status questionnaire (heart rate, blood pressure, body mass index, and medications), fatigue-related comorbidity scale, revised Piper fatigue scale, Epworth sleepiness scale, geriatric depression scale, social provisions scale, and venous blood tests (B-natriuretic peptide, hemoglobin, and interleukin-6). RESULTS Fatigue persisted after MI in 76% of older men and women with no difference by sex. Only depression scores (P trend = 0.0004) and mean arterial pressure (P trend = 0.015) were found to be linearly independent predictors for fatigue, controlling for age, Il-6 levels, and body mass index. CONCLUSION Post-MI depression and mean arterial blood pressure are important to assess when examining fatigue post-MI in older populations.
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Affiliation(s)
| | - Jimmy T. Efird
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Willie Mae Abel
- Department of Nursing, University of North Carolina at Charlotte, Charlotte, NC, USA
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Klijn SL, Weijenberg MP, Lemmens P, van den Brandt PA, Lima Passos V. Introducing the fit-criteria assessment plot - A visualisation tool to assist class enumeration in group-based trajectory modelling. Stat Methods Med Res 2015; 26:2424-2436. [PMID: 26265768 DOI: 10.1177/0962280215598665] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background and objective Group-based trajectory modelling is a model-based clustering technique applied for the identification of latent patterns of temporal changes. Despite its manifold applications in clinical and health sciences, potential problems of the model selection procedure are often overlooked. The choice of the number of latent trajectories (class-enumeration), for instance, is to a large degree based on statistical criteria that are not fail-safe. Moreover, the process as a whole is not transparent. To facilitate class enumeration, we introduce a graphical summary display of several fit and model adequacy criteria, the fit-criteria assessment plot. Methods An R-code that accepts universal data input is presented. The programme condenses relevant group-based trajectory modelling output information of model fit indices in automated graphical displays. Examples based on real and simulated data are provided to illustrate, assess and validate fit-criteria assessment plot's utility. Results Fit-criteria assessment plot provides an overview of fit criteria on a single page, placing users in an informed position to make a decision. Fit-criteria assessment plot does not automatically select the most appropriate model but eases the model assessment procedure. Conclusions Fit-criteria assessment plot is an exploratory, visualisation tool that can be employed to assist decisions in the initial and decisive phase of group-based trajectory modelling analysis. Considering group-based trajectory modelling's widespread resonance in medical and epidemiological sciences, a more comprehensive, easily interpretable and transparent display of the iterative process of class enumeration may foster group-based trajectory modelling's adequate use.
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Affiliation(s)
- Sven L Klijn
- 1 Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Matty P Weijenberg
- 2 Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Paul Lemmens
- 3 Department of Health Promotion, Maastricht, the Netherlands
| | - Piet A van den Brandt
- 4 Department of Epidemiology, GROW School for Oncology and Developmental Biology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Valéria Lima Passos
- 1 Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
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Stauber S, Schmid JP, Saner H, Znoj H, Saner G, Grolimund J, von Känel R. Change in positive affect during outpatient cardiac rehabilitation predicts vital exhaustion in patients with coronary heart disease. Behav Med 2014; 39:122-8. [PMID: 24236809 DOI: 10.1080/08964289.2013.813435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Vital exhaustion is an acknowledged psychosocial risk factor of incident coronary heart disease (CHD) and recurrent CHD events. Little is known about trajectories in vital exhaustion in patients with CHD and the factors predicting this change. We hypothesized that vital exhaustion would decrease during outpatient cardiac rehabilitation and that an increase in positive affect over time would be associated with decreased vital exhaustion at discharge from cardiac rehabilitation. We also explored the role of the patient's sex in this context. Vital exhaustion was reduced during outpatient cardiac rehabilitation, especially in patients who experienced an increase in positive affect over time (p < .001). This relationship was significant in men (p < .001) but not in women (p = .11).
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Skodova Z, Lajciakova P. The effect of personality traits and psychosocial training on burnout syndrome among healthcare students. NURSE EDUCATION TODAY 2013; 33:1311-5. [PMID: 23545453 DOI: 10.1016/j.nedt.2013.02.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 02/26/2013] [Accepted: 02/28/2013] [Indexed: 05/16/2023]
Abstract
AIMS The aims of this paper were to explore the influence of personality factors on student burnout syndrome and to explore the effect of psychosocial training on burnout and personality predictors among university students in health care professions. DESIGN AND METHOD A quasi-experimental pre-test/post-test design was used to evaluate the effect of psychosocial training. A sample of 111 university students were divided into experimental and control groups (average age 20.7 years, SD=2.8 years; 86.1% females). The School Burnout Inventory (SBI), Sense of Coherence (SOC) questionnaire, and Rosenberg's Self-esteem scale were employed. Linear regression and analysis of variance were applied for statistical analysis. RESULTS The results show that socio-psychological training had a positive impact on the level of burnout and on personality factors that are related to burnout. After completing the training, the level of burnout in the experimental group significantly decreased (95% confidence interval: 0.93, 9.25), and no significant change was observed in the control group. Furthermore, respondents' sense of coherence increased in the experimental group (95% confidence interval: -9.11, 2.64), but there were no significant changes in respondents' self-esteem levels in either group. CONCLUSIONS Psychosocial training positively influenced burnout among students in health care professions. Because the coping strategies that were used during the study are similar to effective work coping strategies, psychosocial training can be considered to be an effective tool to prevent burnout in the helping professions.
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Affiliation(s)
- Zuzana Skodova
- Comenius University, Jessenius Faculty of Medicine, Department of Non-medical Study Programmes, Martin, Slovakia.
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Zimmermann-Viehoff F, Wang HX, Kirkeeide R, Schneiderman N, Erdur L, Deter HC, Orth-Gomér K. Women's exhaustion and coronary artery atherosclerosis progression: The Stockholm Female Coronary Angiography Study. Psychosom Med 2013; 75:478-85. [PMID: 23697468 DOI: 10.1097/psy.0b013e3182928c28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Vital exhaustion (VE) has been associated with incident and recurrent cardiac events. The present study investigated the impact of VE on coronary atherosclerosis progression for 3 years. We further aimed to detect the relative importance of the VE subcomponents, fatigue, and depressed mood. METHODS 103 women (age range, 30-65 years) who had experienced an acute coronary event underwent quantitative coronary angiography at baseline and again after 3 years. VE and subcomponents were assessed using the Maastricht Questionnaire. RESULTS VE correlated significantly with coronary artery diameter change for 3 years (r = -0.239, p = .015). When analyzed in quartiles, women of the highest VE level showed the most pronounced coronary artery luminal diameter narrowing (mean = 0.21 mm, 95% confidence interval [CI] = 0.15-0.27), women in the third quartile were intermediate (mean = 0.11 mm, 95% CI = 0.05-0.17), and women within the two lower quartiles showed no significant change. High levels of the depressed mood and fatigue subscales were also associated with coronary artery diameter narrowing (mean = 0.19 mm, 95% CI = 0.12-0.26, p = .003; and mean = 0.17 mm, 95% CI = 0.08-0.26, p = .03, respectively). However, the associations were attenuated when both variables were entered into the model simultaneously: 0.17 mm (95% CI = 0.09-0.25, p = .05) and 0.14 mm (95% CI = 0.03-0.25, p = .67), respectively. CONCLUSIONS VE was associated with accelerated coronary atherosclerosis progression in relatively young women who had experienced an acute coronary event. This association was mainly driven by depressed mood.
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Affiliation(s)
- Frank Zimmermann-Viehoff
- Department of Psychosomatic Medicine and Psychotherapy, Charité Universitätsmedizin Berlin, Germany
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Miller PS, Evangelista LS, Giger JN, Dracup K, Doering LV. Clinical and socio-demographic predictors of postoperative vital exhaustion in patients after cardiac surgery. Heart Lung 2013; 42:98-104. [PMID: 23453010 PMCID: PMC4455925 DOI: 10.1016/j.hrtlng.2013.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 01/04/2013] [Accepted: 01/04/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Vital exhaustion, a psychological state characterized by extreme fatigue, is an independent predictor of future cardiac events. However, the attributes of vital exhaustion following coronary artery bypass (CABG) surgery are poorly understood. OBJECTIVE The study objective was to assess correlates of vital exhaustion following CABG surgery. METHODS In a descriptive, exploratory study, 42 patients who had CABG surgery were evaluated for exhaustion 4-8 weeks post-hospital discharge. Demographic and clinical data were obtained from self-report and medical chart review. RESULTS Of the total sample (mean age 67.9 ± 12.5, 90% male, 70% Caucasian, 3.12 ± 1.3 grafts), approximately 41% reported exhaustion. When compared to their exhausted post-CABG counterpart, non-exhausted post-CABG patients had a significantly higher frequency of preoperative insulin use. Exhausted patients were significantly more likely to have higher left ventricular ejection fraction ([LVEF], OR: 1.07, p = 0.04), and elevated hemoglobin (OR: 2.98, p = 0.03) and eosinophils (OR: 1.02, p = 0.02) than those who were not exhausted. CONCLUSION Clinicians should evaluate all patients for exhaustion post-CABG surgery; patients with elevated LVEF, hemoglobin, and eosinophil levels warrant increased scrutiny.
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Affiliation(s)
- Pamela S. Miller
- Postdoctoral Scholar, School of Nursing, University of California, San Francisco, 2 Koret Way, N411Y, Box 0606, San Francisco, California, USA 94143-0606
| | - Lorraine S. Evangelista
- Associate Professor, Program in Nursing Science, College of Health Sciences, University of California, Irvine, 231 Irvine Hall, Irvine, California, USA 92697-3959
| | - Joyce Newman Giger
- Professor, School of Nursing, University of California, Los Angeles BOX 956919, 5-234 Factor Los Angeles, California, USA, 90095-6919
| | - Kathleen Dracup
- Professor, School of Nursing, University of California, San Francisco, 2 Koret Way, N631, Box 0610, San Francisco, California, USA 94143-0610
| | - Lynn V. Doering
- Professor, School of Nursing, University of California, Los Angeles BOX 956918, 4-250 Factor Los Angeles, California, USA, 90095-6918
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A comparison of psychosocial risk factors between 3 groups of cardiovascular disease patients referred for outpatient cardiac rehabilitation. J Cardiopulm Rehabil Prev 2012; 32:175-81. [PMID: 22426505 DOI: 10.1097/hcr.0b013e31824cc1f7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Few studies have examined psychosocial risk factors for cardiovascular disease (CVD) between diagnostic groups of CVD patients. We compared levels of depression, anxiety, hostility, exhaustion, positive affect, and social support, and the prevalence of type D personality between patient groups with a primary diagnosis of coronary heart disease (CHD), chronic heart failure (CHF), or peripheral arterial disease (PAD). METHODS We examined 548 CHD patients, 105 CHF patients, and 79 PAD patients who completed the Hospital Anxiety and Depression Scale, the cynical hostility subscale of the Minnesota Multiphasic Personality Inventory-2, the short form of the Maastricht Vital Exhaustion Questionnaire, the type D personality questionnaire, the positive mood scale of the Global Mood Scale, and the Enhancing Recovery in CHD Social Support Inventory, all in the first week of cardiac rehabilitation. Group differences in psychosocial factors were adjusted for sociodemographic factors, previous myocardial infarction, traditional cardiovascular risk factors, and medications. RESULTS Relative to patients with PAD, those with CHD and those with CHF both showed greater exhaustion (P ≤ .001) and lower positive affect (P ≤ .03). The effect sizes of these differences were clinically relevant (Cohen's d between 0.32 and 0.49). There were no significant differences in psychosocial risk factors between CHD and CHF patients. CONCLUSIONS The profile of psychosocial risk factors for CVD revealed clinically relevant variability between different diagnostic groups of CVD patients. The findings imply that patients with distinct cardiac diagnosis might additionally benefit from comprehensive cardiac rehabilitation if the program includes psychosocial risk factor-specific interventions.
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Norton S, Sacker A, Young A, Done J. Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort. J Psychosom Res 2011; 71:290-5. [PMID: 21999971 DOI: 10.1016/j.jpsychores.2011.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 04/21/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE As with other chronic physical illness, rates of depressive disorder are high in rheumatoid arthritis (RA). The aim of the current study was to identify distinct trajectories of psychological distress over 10 years in a cohort of RA patients recruited very early in the course of the disease. METHODS Psychological distress as measured by the Hospital Anxiety and Depression Scale total score was assessed annually in a subgroup of 784 patients enrolled in a multi-centre RA inception cohort (Early RA Study). A latent growth mixture modelling (GMM) approach was used to identify distinct psychological distress patterns. RESULTS Four distinct psychological distress trajectories were observed: low-stable (68%), high-stable (12%), high-decreasing (9%) and low-increasing (11%). Symptoms of pain, stiffness and functional impairment were significantly associated with levels of psychological distress at the time of diagnosis and after 3 years; serological markers of disease activity (ESR and CRP) were not. CONCLUSIONS Although the majority of individuals developing RA experience little or no impact of the effects of the disease on their psychological well-being, a significant proportion experience high levels of distress at some point which may be related to their subjective appraisal of their condition. Assessment and treatment of psychological distress should occur synchronously with somatic symptoms.
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Affiliation(s)
- Sam Norton
- Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, UK.
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Rod NH, Andersen I, Prescott E. Psychosocial risk factors and heart failure hospitalization: a prospective cohort study. Am J Epidemiol 2011; 174:672-80. [PMID: 21821541 DOI: 10.1093/aje/kwr144] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective studies on the role of psychosocial factors in heart failure development are virtually nonexistent. The authors aimed to address the effect of psychosocial factors on the risk of heart failure hospitalization in men and women free of cardiovascular disease. In 1991-1993, the 8,670 participants of the Copenhagen City Heart Study (Denmark) were asked comprehensive questions on major life events, work-related stress, social network, vital exhaustion, and sleep medication and were followed in nationwide registries until 2007, with less than 0.2% loss to follow-up. Almost one-fourth of the population reported some degree of vital exhaustion. The vital exhaustion score was associated with a higher risk of heart failure in a dose-response manner (P < 0.002), with high vital exhaustion being associated with a 2-fold higher risk of heart failure in both men (hazard ratio = 1.93, 95% confidence interval: 1.20, 3.10) and women (hazard ratio = 2.56, 95% confidence interval: 1.80, 3.65). Contrary to expectation, major life events, social network, and sleeping medication did not play an individual role for heart failure hospitalization. Because of the high prevalence of vital exhaustion in the population, even a modestly higher risk of heart failure associated with vital exhaustion may be of importance in the planning of future preventive strategies for heart failure.
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Affiliation(s)
- Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014 Copenhagen K, Denmark.
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Poole L, Dickens C, Steptoe A. The puzzle of depression and acute coronary syndrome: reviewing the role of acute inflammation. J Psychosom Res 2011; 71:61-8. [PMID: 21767684 PMCID: PMC3143279 DOI: 10.1016/j.jpsychores.2010.12.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/12/2010] [Accepted: 12/14/2010] [Indexed: 12/27/2022]
Abstract
The relationship between depression and coronary heart disease is well-established, but causal mechanisms are poorly understood. The aim of this review is to stimulate different ways of viewing the relationship between depression and adverse outcomes following acute coronary syndrome (ACS) and coronary artery bypass graft (CABG) surgery patients. We present an argument for depression in ACS and CABG patients being a qualitatively distinct form from that observed in psychiatric populations. This is based on three features: (1) depression developing after cardiac events has been linked in many studies to poorer outcomes than recurrent depression; (2) somatic symptoms of depression following cardiac events are particularly cardiotoxic; (3) depression following an ACS does not respond well to antidepressant treatments. We propose that inflammation is a common causal process responsible in part both for the development of depressive symptoms and for adverse cardiac outcomes, and we draw parallels with inflammation-induced sickness behaviour. Clinical implications of our observations are discussed along with suggestions for further work to advance the field.
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Affiliation(s)
- Lydia Poole
- Department of Epidemiology and Public Health, University College London, London, UK.
| | | | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, UK
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Doyle F, McGee H, Delaney M, Motterlini N, Conroy R. Depressive vulnerabilities predict depression status and trajectories of depression over 1 year in persons with acute coronary syndrome. Gen Hosp Psychiatry 2011; 33:224-31. [PMID: 21601718 DOI: 10.1016/j.genhosppsych.2011.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Depression is prevalent in patients hospitalized with acute coronary syndrome (ACS). We determined whether theoretical vulnerabilities for depression (interpersonal life events, reinforcing events, cognitive distortions, Type D personality) predicted depression, or depression trajectories, post-hospitalization. METHODS We followed 375 ACS patients who completed depression scales during hospital admission and at least once during three follow-up intervals over 1 year (949 observations). Questionnaires assessing vulnerabilities were completed at baseline. Logistic regression for panel/longitudinal data predicted depression status during follow-up. Latent class analysis determined depression trajectories. Multinomial logistic regression modeled the relationship between vulnerabilities and trajectories. RESULTS Vulnerabilities predicted depression status over time in univariate and multivariate analysis, even when controlling for baseline depression. Proportions in each depression trajectory category were as follows: persistent (15%), subthreshold (37%), never depressed (48%). Vulnerabilities independently predicted each of these trajectories, with effect sizes significantly highest for the persistent depression group. CONCLUSIONS Self-reported vulnerabilities - stressful life events, reduced reinforcing events, cognitive distortions, personality - measured during hospitalization can identify those at risk for depression post-ACS and especially those with persistent depressive episodes. Interventions should focus on these vulnerabilities.
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Affiliation(s)
- Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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