Defensive coping in relation to casual blood pressure and self-reported daily hassles and life events

Psychological Profiles in the Prediction of Leukocyte Telomere Length in Healthy Individuals

BACKGROUND

Shorter telomere length (TL) may signal premature cellular aging and increased risk for disease. While depression and psychosocial stress have been associated with shorter telomeres, other psychological risk factors for cardiovascular disease have received less attention.

PURPOSE

To evaluate the association between TL and psychological risk factors (symptoms of anxiety and depression, hostility and defensiveness traits) for heart disease, and to examine whether chronological age and sex moderate the associations observed.

METHODS

132 healthy men and women (Mage = 45.34 years) completed the Marlowe-Crowne Social Desirability Scale, the Beck Depression Inventory II, The Beck Anxiety Inventory and the Cook-Medley Hostility Scale. Relative TL was measured by quantitative polymerase chain reaction (PCR) of total genomic DNA samples. A series of hierarchical linear regressions were performed controlling for pertinent covariates.

RESULTS

Shorter TL was observed among individuals high in defensiveness (β = -.221) and depressive symptoms (β = -.213), as well as in those with less hostility (β =.256) and anxiety (β =.220)(all Ps<.05). Psychological variables explained 19% of the variance over and above that explained by covariates (age, sex, exercise, alcohol consumption, systemic inflammation, and 24-hr mean arterial pressure). Age moderated the relation between TL and defensiveness (β =.179, p =.03). Sex did not influence any of the relations.

CONCLUSIONS

Telomere length is associated with psychological burden though the direction of effect differs depending on the psychological variables under study. Further research is needed to determine the reasons for and implications of these seemingly contradictory findings.

Rethinking Social Desirability Scales: From Impression Management to Interpersonally Oriented Self-Control

Social desirability (specifically, impression management) scales are widely used by researchers and practitioners to screen individuals who bias self-reports in a self-favoring manner. These scales also serve to identify individuals at risk for psychological and health problems. The present review explores the evidence with regard to the ability of these scales to achieve these objectives. In the first part of the review, I present six criteria to evaluate impression management scales and conclude that they are unsatisfactory as measures of response style. Next, I explore what individual differences in impression management scores actually do measure. I compare two approaches: a defensiveness approach, which argues that these scales measure defensiveness that stems from vulnerable self-esteem, and an adjustment approach, which suggests that impression management is associated with personal well-being and interpersonal adjustment. Data from a wide variety of fields including social behavior, affect and well-being, health, and job performance tend to favor the adjustment approach. Finally, I argue that scales measuring impression management should be redefined as measures of interpersonally oriented self-control that identify individuals who demonstrate high levels of self-control, especially in social contexts.

Psychological distress across twelve months in patients with rheumatoid arthritis: the role of disease activity, disability, and mindfulness

OBJECTIVE

Mindfulness may diminish effects of adversities on psychological well-being in medical patients, but studies are scarce, especially in patients with rheumatoid arthritis (RA). The purpose was to examine the prospective moderating effect of mindfulness regarding psychological distress associated with disease activity and disability in patients with RA.

METHODS

Two-hundred-and-one patients with RA (mean age 57.4 ± 11.7, 55% women) completed questionnaires at baseline and at six and twelve month follow-up. Disease activity score was assessed by the rheumatologist.

RESULTS

Controlled for potential confounders, mixed linear model analyses showed a strong prospective association of higher baseline mindfulness with lower psychological distress up to the twelve month follow-up (p<.001). In addition, a mindfulness by disability by time interaction showed that higher baseline mindfulness was associated with lower disability related psychological distress at follow-up (p=.022).

CONCLUSION

Findings are in line with the hypothesis that mindfulness may protect against psychological distress associated with disability in RA. Potential benefits of mindfulness-based interventions for prevention should be examined in this population.

Does the control of negative emotions influence blood pressure control and its variability?

The aim was to assess the control of negative emotions in treated patients with hypertension in comparison with normotensive individuals and to evaluate the association between suppression of negative emotions, control of blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) and blood pressure variability (BPV). We studied 195 patients (women/men: 89/106); mean age 45.4 ± 15.9 years. All patients had ABPM and completed the Courtauld Emotional Control Scale (CECS). The total CECS score and scores for subscales for anger, depression and anxiety were analyzed together with mean BP values from ABPM, and their SD and coefficient of variation as BPV measures. The mean CECS score was 54 ± 12 in all subjects; highest in uncontrolled hypertension 56 ± 11, intermediate 53 ± 12 in controlled hypertension and lowest 48 ± 12 in normotensive subjects. The reference value for the Polish population is 50 ± 11. Significant differences of mean CECS scores among groups were observed (p = 0.0165) also in multivariate analysis. The difference between uncontrolled hypertension and normotension was significant (p = 0.0262). Few significant, weak correlations were observed between CECS score or its subscales and ABPM derivates in all subjects. Conclusion. Suppression of negative emotions may adversely affect BP control in treated hypertensive patients and it should be considered a cause of uncontrolled hypertension.

Racial/ethnic and gender differences in the association between self-reported experiences of racial/ethnic discrimination and inflammation in the CARDIA cohort of 4 US communities

Inflammation is etiologically implicated in cardiometabolic diseases for which there are known racial/ethnic disparities. Prior studies suggest there may be an association between self-reported experiences of racial/ethnic discrimination and inflammation, particularly C-reactive protein (CRP). It is not known whether that association is influenced by race/ethnicity and gender. In separate hierarchical linear models with time-varying covariates, we examined that association among 901 Black women, 614 Black men, 958 White women, and 863 White men in the Coronary Artery Risk Development in Young Adults (CARDIA) study in four US communities. Self-reported experiences of racial/ethnic discrimination were ascertained in 1992-93 and 2000-01. Inflammation was measured as log-transformed CRP in those years and 2005-06. All analyses were adjusted for blood pressure, plasma total cholesterol, triglycerides, homeostatic model assessment for insulin resistance (HOMA-IR), age, education, and community. Our findings extend prior research by suggesting that, broadly speaking, self-reported experiences of racial/ethnic discrimination are associated with inflammation; however, this association is complex and varies for Black and White women and men. Black women reporting 1 or 2 experiences of discrimination had higher levels of CRP compared to Black women reporting no experiences of discrimination (β = 0.141, SE = 0.062, P < 0.05). This association was not statistically significant among Black women reporting 3 or more experiences of discrimination and not independent of modifiable risks (smoking and obesity) in the final model. White women reporting 3 or more experiences of discrimination had significantly higher levels of CRP compared to White women reporting no experiences of discrimination independent of modifiable risks in the final model (β = 0.300, SE = 0.113, P < 0.01). The association between self-reported experiences of racial/ethnic discrimination and CRP was not statistically significant among Black and White men reporting 1 or 2 experiences of discrimination. Further research in other populations is needed.

Neighborhood stressors and race/ethnic differences in hypertension prevalence (the Multi-Ethnic Study of Atherosclerosis)

BACKGROUND

The reasons for racial/ethnic disparities in hypertension (HTN) prevalence in the United States are poorly understood.

METHODS

Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), we investigated whether individual- and neighborhood-level chronic stressors contribute to these disparities in cross-sectional analyses. The sample consisted of 2,679 MESA participants (45-84 years) residing in Baltimore, New York, and North Carolina. HTN was defined as systolic or diastolic blood pressure ≥140 or 90 mm Hg, or taking antihypertensive medications. Individual-level chronic stress was measured by self-reported chronic burden and perceived major and everyday discrimination. A measure of neighborhood (census tract) chronic stressors (i.e., physical disorder, violence) was developed using data from a telephone survey conducted with other residents of MESA neighborhoods. Binomial regression was used to estimate associations between HTN and race/ethnicity before and after adjustment for individual and neighborhood stressors.

RESULTS

The prevalence of HTN was 59.5% in African Americans (AAs), 43.9% in Hispanics, and 42.0% in whites. Age- and sex-adjusted relative prevalences of HTN (compared to whites) were 1.30 (95% confidence interval (CI): 1.22-1.38) for AA and 1.16 (95% CI: 1.04-1.31) for Hispanics. Adjustment for neighborhood stressors reduced these to 1.17 (95% CI: 1.11-1.22) and 1.09 (95% CI: 1.00-1.18), respectively. Additional adjustment for individual-level stressors, acculturation, income, education, and other neighborhood features only slightly reduced these associations.

CONCLUSION

Neighborhood chronic stressors may contribute to race/ethnic differences in HTN prevalence in the United States.

Physiological stress responses in defensive individuals: age and sex matter

The association between defensiveness and physiological responses to stress were evaluated in 81 healthy working men and 118 women, aged 20 to 64 years (M=41; SD=11.45). Participants underwent laboratory testing during which they were exposed to interpersonal stressors. Heart rate (HR), heart rate variability (HRV), blood pressure (BP), and salivary cortisol were measured. Defensiveness was evaluated using the Marlowe-Crowne Social Desirability Scale. In women, higher defensiveness was associated with greater BP and HR reactivity to stress (p<.05). In older men, lower defensiveness was associated with increased systolic BP reactivity to stress (p<.02), delayed HRV recovery (p<.02), and greater salivary cortisol levels (p<.02). In conclusion, greater defensiveness was associated with increased reactivity to stress in women whereas in older men, lower defensiveness was associated with elevated cardiovascular, autonomic, and endocrine responses to stress.

Defensiveness and metabolic syndrome: impact of sex and age

The association between defensiveness and metabolic burden, as well as the moderating effects of sex and age were evaluated in 199 healthy working men (N=81) and women (N=118), aged 20-64 years (M=41; S.D.=11.45). Defensiveness (Marlowe-Crowne Social Desirability Scale) and parameters of metabolic syndrome (MS; waist circumference, HDL, triglycerides, glucose, 24h ambulatory blood pressure) were obtained. In men, defensiveness was inversely related to MS burden (Beta=-.288; p=.001), as well as to individual measures of SBP, DBP, glucose and waist circumference (p<.05). In older women, high defensiveness was associated with a greater MS burden (p=.050) and glucose level (p=.005) while the reverse was true in younger women (p=.012). In conclusion, defensiveness was associated with a worse metabolic profile in older women but may be protective for men and younger women. Understanding the pathophysiological processes underlying these associations could elucidate sex and age differences and inform prevention efforts.

Elevated blood pressure and self-reported symptom complaints, daily hassles, and defensiveness

The association between elevated blood pressure and low rates of self-reported problems has been hypothesized to be mediated by defensiveness. In a population screening study in which 1,120 women and 903 men between 20 and 55 years of age participated, multiple resting home blood pressure measurements were performed and questionnaires were administered measuring symptom complaints, daily hassles, and defensiveness. In women, after control for potential confounders, a low number of self-reported symptoms was associated with elevated blood pressure. However, this effect was not mediated by defensiveness, although repressive defensiveness predicted independently elevated blood pressure in women. In men, no significant associations were obtained. Furthermore, no relations emerged between daily hassles and elevated blood pressure. In conclusion, although defensiveness was more prevalent among women with elevated blood pressure, it does not provide a good explanation for the low rates of self-reported symptoms found in these women.

Occupational stressors and hypertension: a multi-method study using observer-based job analysis and self-reports in urban transit operators

This multi-method study aimed to disentangle objective and subjective components of job stressors and determine the role of each for hypertension risk. Because research on job stressors and hypertension has been exclusively based on self-reports of stressors, the tendency of some individuals to use denial and repressive coping might be responsible for the inconclusive results in previous studies. Stressor measures with different degrees of objectivity were contrasted, including (1) an observer-based measure of stressors (job barriers, time pressure) obtained from experts, (2) self-reported frequency and appraised intensity of job problems and time pressures averaged per workplace (group level), (3) self-reported frequency of job problems and time pressures at the individual level, and (4) self-reported appraised intensity of job problems and time pressures at the individual level. The sample consisted of 274 transit operators working on 27 different transit lines and four different vehicle types. Objective stressors (job barriers and time pressure) were each significantly associated with hypertension (casual blood pressure readings and/or currently taking anti-hypertensive medication) after adjustment for age, gender and seniority. Self-reported stressors at the individual level were positively but not significantly associated with hypertension. At the group level, only appraisal of job problems significantly predicted hypertension. In a composite regression model, both observer-based job barriers and self-reported intensity of job problems were independently and significantly associated with hypertension. Associations between self-reported job problems (individual level) and hypertension were dependent on the level of objective stressors. When observer-based stressor level was low, the association between self-reported frequency of stressors and hypertension was high. When the observer-based stressor level was high the association was inverse; this might be indicative of denial of stress or alexithymia. We feel that multi-method studies are useful for disentangling the relations between objective and subjective stress and hypertension.

Adaptive defense use and resting blood pressure in a population-based sample

OBJECTIVES

There is an accumulating body of research related to the psychosomatic study of blood pressure. One variable that has received attention is defense use. We examined the relation between defense use and blood pressure in men and women of different ages.

METHODS

A random sample of 667 participants was selected from a population-based study. Resting blood pressure was obtained, and each participant was rated for defense use by a trained observer using Defense-Q. An Adaptive Defense Profile (ADP) score was calculated for each participant, and this score was related to blood pressure.

RESULTS

Regression analyses revealed a significant main effect for the ADP score for both diastolic and systolic blood pressure. Those persons with higher ADP scores had lower diastolic and systolic blood pressure. As well, a significant Age x Sex x ADP score interaction was found for diastolic blood pressure. Older women with a less ADP score had higher diastolic blood pressure.

CONCLUSIONS

These findings suggest the continued investigation of defense use and blood pressure.

Perceived racism and blood pressure: a review of the literature and conceptual and methodological critique

Racial disparities in health, including elevated rates of hypertension (HT) among Blacks, are widely recognized and a matter of serious concern. Researchers have hypothesized that social stress, and in particular exposure to racism, may account for some of the between-group differences in the prevalence of HT and a portion of the within-group variations in risk for HT. However, there have been surprisingly few empirical studies of the relationship between perceived racism and blood pressure (BP) or cardiovascular reactivity (CVR), a possible marker of mechanisms culminating in cardiovascular disease. This article reviews published literature investigating the relationship of perceived racism to HT-related variables, including self-reported history of HT, BP level, or CVR. Strengths and weaknesses of the existing research are discussed to permit the identification of research areas that may elucidate the biopsychosocial mechanisms potentially linking racism to HT. We hope to encourage investigators to invest in research on the health effects of racism because a sound and detailed knowledge base in this area is necessary to address racial disparities in health.

Type D personality. A potential risk factor refined

OBJECTIVE

Acute and chronic psychological distress have been associated with coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Broad and stable personality traits may have much explanatory power; this article selectively focuses on negative affectivity (NA; tendency to experience negative emotions) and social inhibition (SI; tendency to inhibit self-expression in social interaction) in the context of CHD.

METHODS

The first part of this article reviews research on NA and SI in patients with CHD. The second part presents new findings on NA and SI in 734 patients with hypertension.

RESULTS

Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype ("distressed" type or type D) of coronary patients who are at risk for clustering of psychosocial risk factors and incidence of long-term cardiac events. Type D and its contributing low-order traits (dysphoria/tension and reticence/withdrawal) could also be reliably assessed in a community-based sample of patients with hypertension. This finding was replicated in men and women, and in Dutch- and French-speaking subjects. Type D hypertensives reported more depressive affect than their non type D counterparts.

CONCLUSIONS

There is an urgent need to adopt a personality approach in the identification of patients at risk for cardiac events. NA and SI are broad and stable personality traits that may be of special interest not only in CHD, but in other chronic medical conditions as well.

An overview of essential hypertension in Americans as a multifactorial phenomenon: interaction of biologic and environmental factors

This paper reviews the current literature on essential/primary hypertension in terms of its expression as a multifactorial phenomenon. The genetic and environmental risk factors involved in expression of hypertension and their interactions are discussed. A specific mutation in epithelial sodium channels, T549M, is presented as a genetic risk factor for primary hypertension as expression of this mutation has been reported to result in hyperabsorption of sodium in homozygous individuals. T549M is used in this report to illustrate the multifactorial nature of primary hypertension. Possible interactions of T549M with environmental factors known to promote hypertension and the outcome of these interactions are discussed. Data indicates that both genetic and environmental risk factors must be considered to understand and intervene effectively with patients who have primary or essential hypertension.

The role of stressors and psychosocial variables in the stress process: a study of chronic caregiver stress

OBJECTIVE

An investigation was conducted 1) to examine the relative importance of stressor types (ie, daily hassles, caregiving-specific stressors, and life events) on the stress response, 2) to assess the stability of relationships between psychosocial variables and stress over a 6-month period, and 3) to explore how the nature and magnitude of the contributions made by stressors and psychosocial factors to the stress process varied according to the qualitative characteristics of the stress response (ie, anxiety, depression, and stress).

METHODS

Fifty spousal caregivers of patients with dementia were recruited and asked to participate in a detailed psychosocial evaluation at 3-month intervals; the evaluation involved measurement of stressor frequency, psychosocial variables, and indices of the stress response (ie, anxiety, depression, and stress).

RESULTS

The data revealed that the effects of stressors and psychosocial factors on the stress response were considerable (accounting for 49-63% of the variance in stress response measures). Furthermore, there was some evidence of stability in the effects of the stressor and mediator variables on the stress response. Specifically, the contributions of life events and caregiver difficulties were largely consistent at both 3 and 6 months, and the psychosocial factor of "reactive coping and self-appraisal" influenced all three stress response indices at both 3 and 6 months.

CONCLUSIONS

There is some evidence of stability in the effects of stressors and psychosocial variables on the stress process over a 6-month period. However, it would also seem that the nature of the stress process differs according to the qualitative characteristics of the stress response.

Life event exposure, physiological reactivity, and psychological strain

The study tested the prediction that the experience of life events would be reflected in greater autonomic reactivity and that this might play a moderating role between reported stress and psychological symptoms. Eighty-seven undergraduates were screened with a life events scale and thirty-nine were allocated to three groups representing high, medium, and low life event scores. The General Health Questionnaire, Profile of Mood States, the Spielberger Trait Anxiety Scale, and the Marlowe-Crowne Scale were administered. Electrodermal activity and heart rate were recorded during an habituation series of tones and a digit-symbol substitution task. The groups differed both on the GHQ and the POMS and, also, in their physiological responses to the tones. Unexpectedly, the high life event group, compared to the other groups, appeared to display smaller physiological responses. The cognitive task resulted in elevated physiological activity but no consistent group differences. Cardiovascular reactivity moderated the relationship between life event scores and reported distress. These findings are discussed in relation to theories of psychophysiological adaptation to negative events.

Defensiveness status predicts 3-year incidence of hypertension

OBJECTIVE

A growing body of research indicates that defensive personality styles (in particular, self-deception) may be related to higher resting blood pressure and stress reactivity levels. This study is the first, however, to examine the value of defensiveness as a prognostic indicator for the development of clinical hypertension.

METHODS

Participants were 127 initially normotensive male and female adults who completed a comprehensive protocol including psychological testing, assessment of smoking, physical activity and body fat levels, and 8-12 h ambulatory blood pressure monitoring. Participants returned 3-years later for an identical follow-up protocol. Defensiveness was assessed using the Balanced Inventory of Desirable Responding.

RESULTS

At 3-year testing, 15 of 127 participants (12%) met criteria for hypertension (i.e. ambulatory mean blood pressure > 140/90). Comparisons between defensiveness groups showed that 12 of 60 (20%) high defensiveness participants met hypertension criteria, whereas only three of 67 (4.5%) low defensiveness participants were hypertensive. Logistic regression equations adjusted for age, alcohol usage, bodyfat, self-reported exercise levels, smoking, and year-1 ambulatory blood pressure, revealed that membership in the high defensiveness group was associated with more than a sevenfold risk of 3-year hypertension (adjusted risk ratio, 7.5; 95% confidence interval, 1.5-39.2).

CONCLUSIONS

These findings link defensive characteristics to an increased prospective risk of hypertension using state of the art ambulatory monitoring techniques, and were robust after controlling for established risk factors. We conclude that the current results add to the hypertension literature by demonstrating associations between personality and clinically relevant blood pressure criteria.