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Sadino JM, Donaldson ZR. Prairie voles as a model for adaptive reward remodeling following loss of a bonded partner. Ann N Y Acad Sci 2024; 1535:20-30. [PMID: 38594916 PMCID: PMC11334365 DOI: 10.1111/nyas.15134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Loss of a loved one is a painful event that substantially elevates the risk for physical and mental illness and impaired daily function. Socially monogamous prairie voles are laboratory-amenable rodents that form life-long pair bonds and exhibit distress upon partner separation, mirroring phenotypes seen in humans. These attributes make voles an excellent model for studying the biology of loss. In this review, we highlight parallels between humans and prairie voles, focusing on reward system engagement during pair bonding and loss. As yearning is a unique feature that differentiates loss from other negative mental states, we posit a model in which the homeostatic reward mechanisms that help to maintain bonds are disrupted upon loss, resulting in yearning and other negative impacts. Finally, we synthesize studies in humans and voles that delineate the remodeling of reward systems during loss adaptation. The stalling of these processes likely contributes to prolonged grief disorder, a diagnosis recently added to the Diagnostic and Statistical Manual for Psychiatry.
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Affiliation(s)
- Julie M. Sadino
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Zoe R. Donaldson
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Psychology & Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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2
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Palitsky R, Chen ZJ, Rentscher KE, Friedman SE, Wilson DMT, Ruiz JM, Sullivan D, Grant GH, O'Connor M. Associations of religious and existential variables with psychosocial factors and biomarkers of cardiovascular risk in bereavement. Aging Cell 2024; 23:e14014. [PMID: 37840393 PMCID: PMC10776136 DOI: 10.1111/acel.14014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023] Open
Abstract
Bereavement increases in prevalence as people age and is associated with multiple psychological and health risks, including cardiovascular risk. Religious and existential variables may play an important role in the health impacts of bereavement. Theorized pathways linking religious and existential variables with health have suggested these associations are due to intermediary psychosocial variables, but have not been tested in bereavement. This research empirically tested these pathways in a bereaved population. In N = 73 adults within 1 year of bereavement (mean age = 64.36), this study examined associations between (1) religious and existential characteristics (religious and spiritual struggles, intrinsic religiosity, and existential quest) and intermediary psychosocial variables (depression, loneliness, and difficulties in emotion regulation), and between (2) intermediary psychosocial variables and bereavement-relevant health outcomes (self-reported health, change in health since last year, grief severity, and cardiovascular biomarkers). Cardiovascular biomarkers (heart rate, heart rate variability, and blood pressure) were collected before, during, and after a laboratory grief recall emotion elicitation. Anticipated associations between self-reported religious and existential characteristics and intermediary variables, and between intermediary variables and self-reported bereavement-relevant outcomes, were consistently observed. However, associations between intermediary variables and cardiovascular biomarkers were largely unobserved. This study examined the role of religious and existential variables in whole-person health after bereavement and is among the first to include biomarkers of cardiovascular risk. Results suggest that although religious and existential variables are associated with important bereavement-related outcomes, these associations may be "skin-deep," and extensions to cardiovascular functioning should be re-examined.
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Affiliation(s)
- Roman Palitsky
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
- Emory UniversitySpiritual Health, Woodruff Health Sciences CenterAtlantaGeorgiaUSA
| | - Zhuo Job Chen
- School of NursingUniversity of North Carolina, CharlotteCharlotteNorth CarolinaUSA
| | - Kelly E. Rentscher
- Department of Psychiatry and Behavioral MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
| | | | | | - John M. Ruiz
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - Daniel Sullivan
- Department of PsychologyUniversity of ArizonaTucsonArizonaUSA
| | - George H. Grant
- Emory UniversitySpiritual Health, Woodruff Health Sciences CenterAtlantaGeorgiaUSA
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Folayan MO, Zuniga RAA, Ezechi OC, Brown B, Nguyen AL, Aly NM, Ellakany P, Idigbe IE, Khan ATA, Lawal FB, Jafer M, Gaffar B, Popoola BO, Quadri MFA, Virtanen JI, Lusher J, El Tantawi M. Associations between Emotional Distress, Sleep Changes, Decreased Tooth Brushing Frequency, Self-Reported Oral Ulcers and SARS-Cov-2 Infection during the First Wave of the COVID-19 Pandemic: A Global Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11550. [PMID: 36141821 PMCID: PMC9516999 DOI: 10.3390/ijerph191811550] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/10/2022] [Accepted: 09/10/2022] [Indexed: 06/12/2023]
Abstract
This study assessed the association between emotional distress, sleep changes, decreased frequency of tooth brushing, and self-reported oral ulcers, and the association between COVID-19 status and decreased frequency of tooth brushing. Using a cross-sectional online survey, data were collected from adults in 152 countries between July and December 2020. Binary logistic regression analyses were conducted to determine the associations between dependent (decreased frequency of tooth brushing, oral ulcers, change in sleep pattern) and independent (tested positive for COVID-19, depression, anxiety, frustration/boredom, loneliness, anger, and grief/feeling of loss) variables after adjusting for confounders (age, sex, level of education, employment status). Of the 14,970 participants data analyzed, 1856 (12.4%) tested positive for COVID-19. Respondents who reported feeling depressed (AoR: 1.375), lonely (AoR: 1.185), angry (AoR: 1.299), and experienced sleep changes (AoR:1.466) had significantly higher odds of decreased tooth brushing frequency. Respondents who felt anxious (AoR: 1.255), angry (AoR: 1.510), grief/sense of loss (AoR: 1.236), and sleep changes (AoR: 1.262) had significantly higher odds of oral ulcers. Respondents who tested positive for COVID-19 had significantly higher odds of decreased tooth brushing frequency (AoR: 1.237) and oral ulcers (AoR: 2.780). These findings highlight that the relationship between emotional distress and oral health may intensify during a pandemic.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Roberto Ariel Abeldaño Zuniga
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Post Graduate School, University of Sierra Sur, Oaxaca 70805, Mexico
| | - Oliver C Ezechi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Brandon Brown
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Social Medicine, Population and Public Health, Riverside School of Medicine, University of California, Riverside, CA 92501, USA
| | - Annie L Nguyen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Nourhan M Aly
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21544, Egypt
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Ifeoma E Idigbe
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Biological Sciences, Faculty of Science, Superior University Lahore, Main Raiwind Road Punjab, Lahore 54590, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan 200132, Nigeria
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Preventive Dental Sciences Department, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam 31441, Saudi Arabia
| | - Bamidele Olubukola Popoola
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Child Oral Health, University of Ibadan, Ibadan 200132, Nigeria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA 98105, USA
| | - Jorma I Virtanen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Faculty of Medicine, University of Turku, 20014 Turku, Finland
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Provost's Group, Regent's University London, London NW1 4NS, UK
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21544, Egypt
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Does confidence in the future matter in life satisfaction among older people in widowhood in China? CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02931-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Davidow JB, Zide BS, Levin LL, Biddle KD, Urizar JC, Donovan NJ. A Scoping Review of Interventions for Spousal Bereavement in Older Adults. Am J Geriatr Psychiatry 2022; 30:404-418. [PMID: 34493416 DOI: 10.1016/j.jagp.2021.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 01/14/2023]
Abstract
The loss of a spouse is a common and natural life event for older adults. Nearly one of four older bereaved spouses experience prolonged grief, impaired function or chronic depression. Mechanisms underlying these and other long-term health risks are not well understood. We conducted a scoping literature review to examine the interventions and outcomes that have been studied for late-life spousal bereavement to date. We identified 22 studies of group and individual-level interventions with most studies concerning grief processes within the first year. Nearly all studies evaluated emotional and psychological symptoms of loss and a small number evaluated the restoration of adaptive functioning. Four interventions addressed the treatment of complicated grief or grief with major depressive disorder. Qualitative studies explored themes of spirituality and mindfulness. There were 17 controlled studies, including 13 randomized controlled trials. Findings were eclectic, with evidence supporting mindfulness techniques in a group format for emotional and life satisfaction outcomes; an individual, function-based therapy addressing sleep to improve emotion and function; an individual, writing-based emotional expression therapy for short-term improvement in emotion and function; nortriptyline for the treatment of bereavement-related major depressive disorder; a group-based, complicated grief therapy for this condition; an internet-based CBT intervention for prolonged grief; and pharmacotherapy for cardiovascular changes during bereavement. These findings highlight the small literature of methodologically strong intervention studies addressing spousal bereavement in older adults and the need for greater exploration of relevant biological, social, cognitive and behavioral factors to improve short and long term health outcomes.
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Affiliation(s)
- Jennie B Davidow
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA; Department of Psychiatry (NJD), Massachusetts General Hospital, Boston, MA
| | - Benjamin S Zide
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Dartmouth College (BSZ), Hanover, NH
| | - Leonard L Levin
- Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA
| | - Kelsey D Biddle
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA
| | - Juan Carlos Urizar
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA
| | - Nancy J Donovan
- Division of Geriatric Psychiatry (JBD, BSZ, KDB, JCU, NJD), Brigham and Women's Hospital, Boston, MA; Harvard Medical School (JBD, LLL, KDB, JCU, NJD), Boston, MA; Department of Psychiatry (NJD), Massachusetts General Hospital, Boston, MA; Department of Neurology (NJD), Brigham and Women's Hospital, MA.
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6
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Naito R, Kasai T. Bereavement of a child as a risk of heart failure. Eur J Heart Fail 2021; 24:190-191. [PMID: 34816534 DOI: 10.1002/ejhf.2388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ryo Naito
- Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, Japan
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7
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Wei D, Li J, Janszky I, Chen H, Fang F, Ljung R, László KD. Death of a child and the risk of heart failure: a population-based cohort study from Denmark and Sweden. Eur J Heart Fail 2021; 24:181-189. [PMID: 34693593 DOI: 10.1002/ejhf.2372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022] Open
Abstract
AIMS We aimed to investigate whether the death of a child, one of the most severe stressors, is associated with the risk of heart failure (HF). METHODS AND RESULTS We conducted a population-based cohort study involving parents of live-born children recorded in the Danish and Swedish Medical Birth Registers during 1973-2016 and 1973-2014, respectively (n = 6 717 349). We retrieved information on child death, HF diagnosis and sociodemographic characteristics of the parents from several nationwide registries. We performed Poisson regression models to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for HF in relation to bereavement. A total of 129 829 (1.9%) parents lost at least one child during the follow-up. Bereaved parents had a 35% higher risk of HF than the non-bereaved (IRR 1.35, 95% CI 1.29-1.41; p < 0.001). The increased HF risk was observed not only when the child died due to cardiovascular or other natural causes, but also when the loss was due to unnatural causes. The association tended to be U-shaped when we categorized the exposed parents by the number of remaining live children at loss or by the age of the deceased child. CONCLUSION We found that the death of a child was associated with an increased risk of HF. The finding that not only cardiovascular and other natural deaths, but also unnatural deaths were associated with HF suggests that stress-related mechanisms may contribute to the development of HF.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Imre Janszky
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Swedish Medical Products Agency, Uppsala, Sweden
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Bourassa KJ, Cornelius T, Birk JL. Bereavement is associated with reduced systemic inflammation: C-reactive protein before and after widowhood. Brain Behav Immun 2020; 88:925-929. [PMID: 32283288 PMCID: PMC7415735 DOI: 10.1016/j.bbi.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Bereavement is associated with poorer health and early mortality. Increased systemic inflammation is one pathophysiological pathway thought to explain this health risk. However, few studies have examined systemic inflammation before and after widowhood. PURPOSE The current study examined the associations between inflammation and widowhood status before and after bereavement in a sample of married adults who became widowed between assessments in the English Longitudinal Study of Ageing. METHODS We examined levels and change over time in systemic inflammation, as assessed by C-reactive protein (CRP), among participants who became bereaved (n = 199). We then compared these results to a sample of participants whose spouse remained living, selected using a propensity score matching algorithm (n = 199). RESULTS Contrary to expectations, widowed participants' CRP decreased following bereavement, d = -0.29, p < 0.001. Change in CRP was not associated with pre-loss depression levels, caregiving status, marital quality, number of chronic diseases, prescribed medications, body mass index, age, or sex. Compared to continuously married participants, widowed participants' evidenced a significantly greater decrease in CRP after their spouse's death, β = -0.14, p < 0.001. CONCLUSIONS Widowed adults' systemic inflammation decreased significantly following bereavement, both as a group and compared to people who remained married. We discuss possible explanations for this counterintuitive finding, including the measure of inflammation used in the study and the timing of the study measurements.
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Affiliation(s)
- Kyle J. Bourassa
- Duke University Medical Center, Center for the Study of Aging and Human Development
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Jeffrey L. Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
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Wei D, Janszky I, Ljung R, Leander K, Chen H, Fang F, Li J, László KD. Bereavement in the year before a first myocardial infarction: Impact on prognosis. Eur J Prev Cardiol 2020; 28:1229-1234. [PMID: 34551078 DOI: 10.1177/2047487320916958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/14/2021] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Death of the spouse in middle and old age is associated with an increased risk of cardiovascular and total mortality, particularly during the months after the loss. Knowledge regarding the effect of bereavement on prognosis in acute myocardial infarction (AMI) is limited. We analysed whether bereavement the year before the AMI is associated with prognosis.
Methods
We studied first AMI patients who participated in the Stockholm Heart Epidemiology Program (N = 1732). During or shortly after the hospitalization, patients or their family members completed a questionnaire regarding bereavement, sociodemographic, clinical and lifestyle factors; five months after their first infarction, surviving patients attended a clinical examination. Participants were followed for cardiovascular events and mortality for a median of 14 years.
Results
Overall bereavement, that is, death of a close friend or family member (including spouse/partner), the year before the first AMI was not associated with the combined outcome of non-fatal recurrent AMI and death due to ischaemic heart diseases. However, exposure to the loss of the spouse/partner was associated with an increased risk of the outcome (adjusted hazard ratio and (95% confidence interval): 1.55 (1.06–2.27)). We found no evidence that psychiatric disorders or blood lipids, glucose, coagulation and inflammatory markers mediated this association.
Conclusions
Loss of spouse/partner the year before the first AMI was associated with an increased risk of the combination of non-fatal recurrent AMI and death due to ischaemic heart disease. If confirmed by others, the findings may be informative for tertiary prevention of AMI.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Imre Janszky
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Leander
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Vala CH, Lorentzon M, Sundh V, Johansson H, Lewerin C, Sten S, Karlsson M, Ohlsson C, Johansson B, Kanis JA, Mellström D. Increased risk for hip fracture after death of a spouse-further support for bereavement frailty? Osteoporos Int 2020; 31:485-492. [PMID: 31832693 PMCID: PMC7075824 DOI: 10.1007/s00198-019-05242-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Death of a spouse is associated with poorer physical and mental health. We followed all married individuals, born from 1902 to 1942, during the period from 1987 to 2002, and found that widows and widowers had higher risk for hip fracture, compared with still married women and men. INTRODUCTION Spousal bereavement can lead to poorer physical and mental health. We aimed to determine whether married women and men had an elevated risk of hip fracture after death of a spouse. METHODS In a retrospective cohort study, we followed all Swedish married individuals aged 60 to 100 years (n = 1,783,035), from 1987 to 2002. Data are presented as mean with 95% confidence interval (CI). RESULTS During the follow-up period, 21,305 hip fractures among widows and 6538 hip fractures among widowers were noted. The hazard ratio (HR) for hip fracture in widows compared with married women was 1.34 (95% CI 1.31 to 1.37) and for widowers compared with married men 1.32 (95% CI 1.29 to 1.35). The HR for hip fracture in the first 6 months after death of a spouse was in widows compared with married women 1.62 (95% CI 1.53 to 1.71) and in widowers compared with married men 1.84 (95% CI 1.68 to 2.03). The elevated risk was especially prominent in young widowers in the age range 60-69 years. During the first 6 months they showed a HR of 2.76 (95% CI 1.66 to 4.58) for a hip fractvure compared with age matched married men. Widows aged 60-69 years showed a HR of 1.59 (95% CI 1.26 to 1.99) compared with age matched married women. CONCLUSION Our observation of a higher hip fracture risk in both genders in connection with the death of a spouse indicates a possible effect of bereavement on frailty.
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Affiliation(s)
- C H Vala
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden.
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden.
| | - M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - V Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
| | - H Johansson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - C Lewerin
- Section of Haematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - S Sten
- Department of Archaeology and Ancient History, Uppsala University-Campus Gotland, 621 57, Visby, Sweden
| | - M Karlsson
- Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - C Ohlsson
- Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - B Johansson
- Department of Psychology, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Disease, Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
- Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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11
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Biddle KD, Jacobs HIL, d’Oleire Uquillas F, Zide BS, Kirn DR, Properzi MR, Rentz DM, Johnson KA, Sperling RA, Donovan NJ. Associations of Widowhood and β-Amyloid With Cognitive Decline in Cognitively Unimpaired Older Adults. JAMA Netw Open 2020; 3:e200121. [PMID: 32101313 PMCID: PMC7099624 DOI: 10.1001/jamanetworkopen.2020.0121] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
IMPORTANCE To reduce the rising incidence of clinical impairment due to Alzheimer disease, it is essential to define older adults at highest risk. Widowhood may be an unrecognized factor contributing to accelerated clinical progression along the Alzheimer disease pathway among cognitively unimpaired older adults. OBJECTIVE To determine whether widowhood status and level of brain β-amyloid (ie, the Alzheimer disease pathologic protein) are additively or interactively associated with cognitive decline among cognitively unimpaired older adults. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, 257 married, widowed, and unmarried (ie, never married, divorced, or separated) participants from the Harvard Aging Brain Study longitudinal cohort underwent baseline evaluation of neocortical β-amyloid levels using Pittsburgh compound B positron emission tomography and 4 annual cognitive assessments. Data were collected from September 2010 to February 2017 and analyzed from July 2018 to July 2019. MAIN OUTCOMES AND MEASURES Cognitive performance was measured using the Preclinical Alzheimer Cognitive Composite. RESULTS Of the 257 participants, 153 (59.5%) were women, and the mean (SD) age was 73.5 (6.1) years; 145 participants (56.4%) were married (66 [45.5%] women), 77 (30.0%) were unmarried (56 [72.7%] women), and 35 (13.6%) were widowed (31 [88.6%] women). Compared with married participants, widowed participants demonstrated worsening cognitive performance after adjusting for age, sex, socioeconomic status, depression, and β-amyloid levels (β = -0.11; 95% CI, -0.19 to -0.04; P = .002) with no difference observed between married and unmarried participants. Furthermore, widowed participants with higher baseline β-amyloid levels exhibited steeper cognitive decline (β = -0.22; 95% CI, -0.42 to -0.03; P = .02), indicating both independent and interactive associations of β-amyloid levels and widowhood with cognition. In a secondary model using dichotomous β-amyloid-marital status groupings, the rate of cognitive decline among widowed participants with high β-amyloid was nearly 3 times faster than among married participants with high β-amyloid (widowed, high β-amyloid: β, -0.33; 95% CI, -0.46 to -0.19; P < .001; married, high β-amyloid: β, -0.12; 95% CI, -0.18 to -0.01; P < .001). CONCLUSIONS AND RELEVANCE In a sample of cognitively unimpaired older adults, being widowed was associated with accelerated β-amyloid-related cognitive decline during 3 years. Cognitively unimpaired, widowed older adults were particularly susceptible to Alzheimer disease clinical progression, emphasizing the need for increased research attention and evidenced-based interventions for this high-risk group.
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Affiliation(s)
- Kelsey D. Biddle
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heidi I. L. Jacobs
- School for Mental Health and Neuroscience, Alzheimer Centre, Limburg, Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Federico d’Oleire Uquillas
- Princeton Neuroscience Institute, Princeton, New Jersey
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Benjamin S. Zide
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dylan R. Kirn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael R. Properzi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Dorene M. Rentz
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Keith A. Johnson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Reisa A. Sperling
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Nancy J. Donovan
- Division of Geriatric Psychiatry, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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Tofler GH, Morel-Kopp MC, Spinaze M, Dent J, Ward C, McKinley S, Mihailidou AS, Havyatt J, Whitfield V, Bartrop R, Fethney J, Prigerson HG, Buckley T. The effect of metoprolol and aspirin on cardiovascular risk in bereavement: A randomized controlled trial. Am Heart J 2020; 220:264-272. [PMID: 31923768 DOI: 10.1016/j.ahj.2019.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 11/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bereavement is associated with an increased risk of cardiovascular disease; however, no reports exist of interventions to reduce risk. In a randomized, double-blind, placebo-controlled trial of 85 recently bereaved participants, we determined whether β-blocker (metoprolol 25 mg) and aspirin (100 mg) reduce cardiovascular risk markers and anxiety, without adversely affecting bereavement intensity. METHODS Participants were spouses (n = 73) or parents (n = 12) of deceased from 5 hospitals in Sydney, Australia, 55 females, 30 males, aged 66.1 ± 9.4 years. After assessment within 2 weeks of bereavement, subjects were randomized to 6 weeks of daily treatment or placebo, and the effect evaluated using ANCOVA, adjusted for baseline values (primary analysis). RESULTS Participants on metoprolol and aspirin had lower levels of home systolic pressure (P = .03), 24-hour average heart rate (P < .001) and anxiety (P = .01) platelet response to arachidonic acid (P < .001) and depression symptoms (P = .046) than placebo with no difference in standard deviation of NN intervals index (SDNNi), von Willebrand Factor antigen, platelet-granulocyte aggregates or bereavement intensity. No significant adverse safety impact was observed. CONCLUSIONS In early bereavement, low dose metoprolol and aspirin for 6 weeks reduces physiological and psychological surrogate measures of cardiovascular risk. Although further research is needed, results suggest a potential preventive benefit of this approach during heightened cardiovascular risk associated with early bereavement.
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Affiliation(s)
- Geoffrey H Tofler
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia.
| | - Marie-Christine Morel-Kopp
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia
| | - Monica Spinaze
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Jill Dent
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Christopher Ward
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | - Anastasia S Mihailidou
- Royal North Shore Hospital, St Leonards, NSW, Autralia; Kolling Institute, St Leonards, NSW, Autralia; Macquarie University, Sydney, NSW, Autralia
| | - Jennifer Havyatt
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Victoria Whitfield
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | - Roger Bartrop
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia
| | | | | | - Thomas Buckley
- Royal North Shore Hospital, St Leonards, NSW, Autralia; University of Sydney, Sydney, NSW, Autralia; Weill Cornell Medicine, New York, NY, U.S.A
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Seiler A, von Känel R, Slavich GM. The Psychobiology of Bereavement and Health: A Conceptual Review From the Perspective of Social Signal Transduction Theory of Depression. Front Psychiatry 2020; 11:565239. [PMID: 33343412 PMCID: PMC7744468 DOI: 10.3389/fpsyt.2020.565239] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022] Open
Abstract
Losing a spouse is considered one of the most stressful life events a person can experience. Particularly in the immediate weeks and months after the loss, bereavement is associated with a significantly increased risk of morbidity and mortality. Despite an abundance of research aimed at identifying risk factors for adverse health outcomes following marital death, the mechanisms through which mental and physical health problems emerge following bereavement remain poorly understood. To address this issue, the present review examines several pathways that may link bereavement and health, including inflammation and immune dysregulation, genetic and epigenetic changes, gut microbiota activity, and biological aging. We then describe how these processes may be viewed from the perspective of the Social Signal Transduction Theory of Depression to provide a novel framework for understanding individual differences in long-term trajectories of adjustment to interpersonal loss. Finally, we discuss several avenues for future research on psychobiological mechanisms linking bereavement with mental and physical health outcomes.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - George M Slavich
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Abstract
OBJECTIVE Using an integrative view of psychology, neuroscience, immunology, and psychophysiology, the present review of literature curates the findings that have had an impact on the field of bereavement research and shaped its development. METHODS Beginning with pivotal systematic descriptions of medical and psychological responses to the death of a loved one by Lindemann in the mid-1940s, this selective review integrates findings in bereavement research from studies that investigate medical outcomes after loss, their psychological predictors, and biopsychosocial mechanisms. RESULTS Morbidity and mortality after the death of a loved one have long been a topic of research. Early researchers characterized somatic and psychological symptoms and studied immune cell changes in bereaved samples. More recent research has repeatedly demonstrated increased rates of morbidity and mortality in bereaved samples, as compared with married controls, in large epidemiological studies. Recent developments also include the development of criteria for prolonged grief disorder (also termed complicated grief). Newer methods, including neuroimaging, have observed that the greatest impact of the death of a loved one is in those who have the most severe psychological grief reactions. Research addressing the mechanisms tying bereavement to medical outcomes is relatively scarce, but differences in rumination, in inflammation, and in cortisol dysregulation between those who adapt well and those who do not have been offered with some evidence. CONCLUSIONS Recommendations to propel the field forward include longitudinal studies to understand differences between acute reactions and later adaptation, comparing samples with grief disorders from those with more typical responses, and integrating responses in brain, mind, and body.
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Ennis J, Majid U. "Death from a broken heart": A systematic review of the relationship between spousal bereavement and physical and physiological health outcomes. DEATH STUDIES 2019; 45:538-551. [PMID: 31535594 DOI: 10.1080/07481187.2019.1661884] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The loss of a loved one is often associated with "death from a broken heart" for the survivor, and there is evidence that shows that widowers and widows are at risk for higher morbidity and mortality than the general population. This systematic review will summarize the physical and physiological health outcomes of spousal bereavement. A systematic database search was conducted, and 38 studies were analyzed. The majority of studies found a statistically significant and positive association between spousal bereavement and adverse physical and physiological health outcomes such as inflammation, cardiovascular risk, chronic pain, and mortality.
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Affiliation(s)
- Jeffrey Ennis
- Ennis Centre for Pain Management, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Umair Majid
- Ennis Centre for Pain Management, Hamilton, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of Clinical Decision-Making and Healthcare, University Health Network, Toronto, Canada
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Riegel M, Randall S, Buckley T. Memory making in end-of-life care in the adult intensive care unit: A scoping review of the research literature. Aust Crit Care 2019; 32:442-447. [DOI: 10.1016/j.aucc.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022] Open
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Abstract
OBJECTIVE Bereavement is associated with increased risk for morbidity and all-cause mortality across epidemiological, meta-analytic, and case-control studies. The body of research examining the association between bereavement and immune function, beginning in 1977, has yet to be reviewed. The current systematic review clarifies these findings, identifies limitations of the diverse literature, and suggests a model and directions for future research. METHODS The PRISMA guidelines for systematic reviews were used to synthesize 41 years of research. Compared with a meta-analysis, a systematic review is appropriate given the heterogeneous nature of the studies. We used the National Heart, Lung, and Blood Institute Study Quality Assessment Tool to assess the quality of select studies. RESULTS Thirty-three publications met inclusion criteria. Most studies support the association between bereavement and maladaptive changes in immune parameters in adults, with mixed findings on bereavement-related changes in cellular immunity. A handful of recent, good-quality studies show bereaved people demonstrate higher levels of systemic inflammation, maladaptive immune cell gene expression, and lower antibody response to vaccination compared with nonbereaved controls. Individual differences in psychological response to bereavement (e.g., depression, grief) seem to influence the association between bereavement and immune function. CONCLUSIONS Research examining the association between bereavement and biomarkers of immune function is heterogeneous in methods and quality. Despite these limitations, there is evidence supporting maladaptive changes in immune function after bereavement. The research area would benefit from longitudinal research with larger sample sizes, advanced immunological methods, and incorporating measures of psychological responses to bereavement. The field is poised to refine and scale up its investigation of this common and important phenomenon.
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18
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Impaired mental health and low-grade inflammation among fatigued bereaved individuals. J Psychosom Res 2018; 112:40-46. [PMID: 30097134 DOI: 10.1016/j.jpsychores.2018.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Fatigue is a common symptom in stressed individuals. Bereavement is a major life event that has been associated with impaired mental health. Little research has investigated the prevalence of fatigue and its inflammatory correlates in bereaved individuals. OBJECTIVES To assess fatigue prevalence and its relationship with mental health outcomes and markers of inflammation, as indexed by C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) in bereaved individuals. METHODS Seventy-eight-bereaved adults were examined for fatigue (SF-36 energy/vitality scale), perceived stress (PSS), depression (CES-D), sleep quality (PSQI), pain (SF-36 pain scale), and general health (SF-36 general), and their serum levels of CRP, IL-6 and TNF-α were measured. Group differences between fatigued versus non-fatigued individuals were estimated using analysis of covariance (ANCOVA), with adjustment for body mass index (BMI). RESULTS Fatigued bereaved individuals (33%; SF-36 energy/vitality score 0-45) had significantly higher CRP levels (p < .05) as compared to non-fatigued bereaved individuals and reported higher levels of pain (p < .001), greater stress (p < .001), depression (p < .001), and sleeping problems (p < .001), as well as poorer social functioning (p < .001) and general health (p < .001) than those in the non-fatigued group. No group differences were found for IL-6 and TNF-α. CONCLUSIONS Fatigued bereaved individuals showed elevated systemic inflammation as measured by CRP in comparison to non-fatigued bereaved individuals. They were also more likely to report mental health problems that co-occur with fatigue in the context of immune activation. Continued research is needed to help clarify the involvement of inflammatory markers in the development of fatigue in a larger sample of bereaved adults.
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Pan H, Cheung CK, Hu J. Intimacy and Complicated Grief among Chinese Elders Having Lost their Spouses: Mediating Role of Meaning Making. JOURNAL OF LOSS & TRAUMA 2018. [DOI: 10.1080/15325024.2018.1435367] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Haimin Pan
- Department of Applied Social Science, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Chau-Kiu Cheung
- Department of Applied Social Science, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Jieyi Hu
- Department of Applied Social Science, City University of Hong Kong, Kowloon, Hong Kong SAR, China
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20
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Hughes A, Kumari M, McMunn A, Bartley M. Unemployment and inflammatory markers in England, Wales and Scotland, 1998-2012: Meta-analysis of results from 12 studies. Brain Behav Immun 2017; 64:91-102. [PMID: 28365380 DOI: 10.1016/j.bbi.2017.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/02/2017] [Accepted: 03/28/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Unemployment represents for many affected individuals a substantial source of psychosocial stress, and is linked to both increased risk of morbidity and mortality and adverse health-related behaviours. Few studies have examined the association of unemployment with systemic inflammation, a plausible mediator of the associations of psychosocial stress and health, and results are mixed and context dependent. This study examines the association of unemployment with C-reactive protein (CRP) and fibrinogen, two markers of systemic inflammation. METHODS A random-effects meta-analysis was performed using a multilevel modelling approach, including 12 national UK surveys of working-age participants in which CRP and fibrinogen were measured between 1998 and 2012 (N=30,037 economically active participants). The moderating impact of participant age and UK country was explored. RESULTS CRP and fibrinogen were elevated in unemployed compared to employed participants; jobseekers were also more likely (Odds Ratio: 1.39, p<0.001) to have CRP levels corresponding to high cardiovascular risk (>3mg/L), after adjustment for age, gender, education, long-term illness, smoking, and body mass index. Associations were not explained by mental health. Associations peaked in middle-age, and were stronger in Scotland and Wales than in England. CONCLUSIONS Our study demonstrates that systemic inflammation is associated with an important but little-studied aspect of the social environment, as it is elevated in unemployed compared to employed survey participants. Modifications suggest the association of unemployment and inflammation is substantially influenced by contextual factors, and may be especially strong in Wales, where further investigation of this relationship is needed.
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Affiliation(s)
- Amanda Hughes
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ, UK.
| | - Meena Kumari
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex CO4 3SQ, UK.
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - Mel Bartley
- Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
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Does perceived stress increase the risk of atrial fibrillation? A population-based cohort study in Denmark. Am Heart J 2017; 188:26-34. [PMID: 28577678 DOI: 10.1016/j.ahj.2017.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/01/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Psychological stress is associated with increased risk of acute cardiovascular diseases, as myocardial infarction. We recently found a higher risk of atrial fibrillation following an acute stressful life event, but it remains unknown whether this also applies to common and less acute stress exposures. METHODS We investigated the risk of incident atrial fibrillation in people with high levels of perceived stress by following a population-based cohort of 114,337 participants from the Danish National Health Survey from 2010 to 2014. The survey holds information on lifestyle factors and perceived stress measured by Cohen's 10-item Perceived Stress Scale (PSS). We obtained information on atrial fibrillation, comorbidities and socioeconomic status from Danish nationwide registers. We identified 2172 persons with a first episode of atrial fibrillation during 424,839 person-years of follow-up. The hazard ratio (HR) of atrial fibrillation with 95% confidence interval (CI) was calculated with Cox proportional hazard model. RESULTS The risk of atrial fibrillation increased with increasing PSS score; persons in the highest perceived stress quintile had 28% (95% CI, 12%-46%) higher risk of atrial fibrillation compared with persons in the lowest perceived stress quintile. However, the association disappeared when adjusting for comorbidities, socioeconomic status and lifestyle factors; HR was 1.01 (95% CI, 0.88-1.16) when comparing persons in the highest and the lowest perceived stress quintile. CONCLUSIONS This large population-based cohort study did not reveal a higher risk of atrial fibrillation among persons with a high degree of perceived stress after adjustment for participants' baseline characteristics.
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23
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Van Humbeeck L, Dillen L, Piers R, Grypdonck M, Van Den Noortgate N. The suffering in silence of older parents whose child died of cancer: A qualitative study. DEATH STUDIES 2016; 40:607-617. [PMID: 27333540 DOI: 10.1080/07481187.2016.1198942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As life expectancy grows, the death of an adult child becomes a highly prevalent problem for older adults. The present study is based on nine interviews and explores the experience of parents (≥70 years) outliving an adult child. The bereaved parents described some silencing processes constraining their expression of grief. When an adult dies, the social support system nearly automatically directs its care towards the bereaved nuclear family. Parental grief at old age is therefore often not recognized and/or acknowledged. Health care providers should be sensitive to the silent grief of older parents both in geriatric and oncology care settings.
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Affiliation(s)
| | - Let Dillen
- b Oncology Centre and Department of Geriatric Medicine , Ghent University Hospital , Ghent , Belgium
| | - Ruth Piers
- a Department of Geriatric Medicine , Ghent University Hospital , Ghent , Belgium
| | - Mieke Grypdonck
- c Department of Public Health , University Centre for Nursing and Midwifery, Ghent University , Ghent , Belgium
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Cho J, Jung SH, Kim C, Suh M, Choi YJ, Sohn J, Cho SK, Suh I, Shin DC, Rexrode KM. Suicide loss, changes in medical care utilization, and hospitalization for cardiovascular disease and diabetes mellitus. Eur Heart J 2015; 37:764-70. [PMID: 26371117 DOI: 10.1093/eurheartj/ehv448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/17/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS The impact of suicide loss on family members' cardiometabolic health has little been evaluated in middle-aged and elderly people. We investigated the effect of suicide loss on risks for cardiovascular disease (CVD) and diabetes mellitus (DM) in suicide completers' family members using a national representative comparison group. METHODS AND RESULTS The study subjects were 4253 family members of suicide completers and 9467 non-bereaved family members of individuals who were age and gender matched with the suicide completers in the Republic of Korea. National health insurance data were used to identify medical care utilization during the year before and after a suicide loss. A recurrent-events survival analysis was performed to estimate the hazard ratios (HRs) of hospitalizations for CVD, DM, or psychiatric disorders, after adjusting for age, residence, and socioeconomic status. Among subjects without a past history of CVD, DM, or psychiatric disorders, the increased risks of recurrent hospitalizations were observed for CVD [HR 1.343, 95% confidence interval (CI) 1.001-1.800 in men; HR 1.240, 95% CI 1.025-1.500 in women] and DM (HR 2.238, 95% CI 1.379-3.362 in men; HR 1.786, 95% CI 1.263-2.527 in women). In subjects with a past history of CVD, DM, or psychiatric disorders, the number of medical care visits decreased after a suicide loss, and suicide completers' family members showed lower rates of hospitalization for CVD and DM than the comparison group. CONCLUSION Compared with non-bereaved family members, suicide completers' family members without a past history of CVD, DM, or psychiatric disorder showed a high risk of hospitalization for those conditions.
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Affiliation(s)
- Jaelim Cho
- Department of Occupational and Environmental Medicine, Gachon University Gil Medical Center, 774 Namdong-daero, Incheon, Republic of Korea
| | - Sang Hyuk Jung
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Anyangcheon-ro, Seoul, Republic of Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Mina Suh
- National Cancer Center, 323 Ilsan-ro, Goyang, Republic of Korea
| | - Yoon Jung Choi
- Research and Development Center, Health Insurance Review and Assessment Service, 267 Hyoryung-ro, Seoul, Republic of Korea
| | - Jungwoo Sohn
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea
| | - Seong-Kyung Cho
- Division of Environmental Health, Korea Environment Institute, 370 Sicheong-daero, Sejong, Republic of Korea
| | - Il Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea
| | - Dong Chun Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seoul, Republic of Korea
| | - Kathryn M Rexrode
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Mihailidou AS, Buckley T, Bune AJC, Tofler G. Impact of grief delivered via media technology. Med J Aust 2015; 203:198-8e.1. [DOI: 10.5694/mja15.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/12/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Anastasia S Mihailidou
- Royal North Shore Hospital, Sydney, NSW
- Kolling Institute, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Alexandra JC Bune
- Royal North Shore Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Geoffrey Tofler
- Royal North Shore Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
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Buckley T, Spinaze M, Bartrop R, McKinley S, Whitfield V, Havyatt J, Roche D, Fethney J, Tofler G. The nature of death, coping response and intensity of bereavement following death in the critical care environment. Aust Crit Care 2015; 28:64-70. [PMID: 25801350 DOI: 10.1016/j.aucc.2015.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 01/15/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Bereavement, defined as the situation of having recently lost a significant other, is recognised as one of life's greatest stressors and may lead to decrements in health status, psychological morbidity and excess risk of mortality. AIM The aim of this study was firstly to describe the relationships between the nature of death and bereavement intensity following death in the adult critical care environment and secondly to examine the modifying effects of coping responses on intensity of bereavement reaction. METHOD Prospective evaluation of the impact of the nature of death and coping responses on bereavement intensity. 78 participants completed a nature of death questionnaire within 2 weeks of bereavement and at 3 and 6 months completed the Core Bereavement Items Questionnaire (CBI-17) and Brief COPE Inventory. RESULTS At 6 months, univariate variables significantly associated with bereavement intensity were: being unprepared for the death (p<0.001), a drawn out death (p<0.001), a violent death (p=0.007) and if the deceased appeared to suffer more than expected (p=0.03). Multivariate analysis revealed being unprepared for the death appears to account for these relationships. Regarding coping, there were significant increases from 3 to 6 months in both acceptance scales (p=0.01) and planning (p=0.02) on The Brief COPE Inventory. Greater use of emotional support (p=0.02), self-blame (0.003) and denial (p<0.001) were multivariate variables associated with higher bereavement intensity at 6 months. CONCLUSION The results from this evaluation provide insight into the impact of bereavement after death in the critical care environment and inform potential preventative approaches at the time of death to reduce bereavement intensity.
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Affiliation(s)
- Thomas Buckley
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia.
| | | | - Roger Bartrop
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia
| | | | | | | | - Diane Roche
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia
| | | | - Geoffrey Tofler
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia
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Hughes A, McMunn A, Bartley M, Kumari M. Elevated inflammatory biomarkers during unemployment: modification by age and country in the UK. J Epidemiol Community Health 2015; 69:673-9. [PMID: 25700535 PMCID: PMC4483793 DOI: 10.1136/jech-2014-204404] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 01/25/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is raised risk of mortality following unemployment, and reviews have consistently found worse psychological health among the unemployed. Inflammation is increasingly implicated as a mediating factor relating stress to physical disease and is strongly linked to depression. Inflammation may, therefore, be implicated in processes associated with excess mortality and morbidity during unemployment. This study examined associations of unemployment with inflammatory markers among working-age men and women from England and Scotland. METHODS Cross-sectional analyses using data from the Health Survey for England and the Scottish Health Survey collected between 1998 and 2010. Systemic inflammation was indexed by serum concentrations of C reactive protein (CRP) and fibrinogen, and compared between participants currently employed/self-employed, currently unemployed and other groups. RESULTS CRP, fibrinogen and odds of CRP >3 mg/L were all significantly raised for the unemployed, as compared to the employed participants (eg, OR for CRP >3 mg/L=1.43, CI 1.15 to 1.78 N=23 025), following adjustment for age, gender, occupational social class, housing tenure, smoking, alcohol consumption, body mass index, long-term illness and depressive/anxiety symptoms. Strengths of associations varied considerably by both age and country/region, with effects mainly driven by participants aged ≥48 and participants from Scotland, which had comparatively high unemployment during this time. CONCLUSIONS Current unemployment is associated with elevated inflammatory markers using data from two large-scale, nationally representative UK studies. Effect modification by age suggests inflammation may be particularly involved in processes leading to ill-health among the older unemployed. Country/regional effects may suggest the relationship of unemployment with inflammation is strongly influenced by contextual factors, and/or reflect life course accumulation processes.
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Affiliation(s)
- Amanda Hughes
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anne McMunn
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mel Bartley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Meena Kumari
- Department of Epidemiology and Public Health, University College London, London, UK Institute for Social and Economic Research, University of Essex, Colchester, UK
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Whitfield V, Havyatt J, Buckley T, Bartrop R, McKinley S, Roche D, Spinaze M, Bramwell M, Tofler G. The complexities of recruiting bereaved family members into a research study in the critical care environment: a discussion paper. Aust Crit Care 2014; 28:77-81. [PMID: 25554542 DOI: 10.1016/j.aucc.2014.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 11/17/2022] Open
Abstract
Research on the effects of stressful events on human health and wellbeing has progressed in recent years. One such stress, bereavement, is considered one of life's greatest stresses, requiring significant readjustment. The Cardiovascular Risk in Bereavement study (CARBER) investigated in detail cardiovascular risk factors during the first weeks following the death of a partner or adult child in the critical care environment. The purpose of this paper is to explore the once held perception that the bereaved population should not be involved in research, using an actual illustrative project. The paper specifically focuses on the challenges regarding acceptability and feasibility of recruitment of recently bereaved individuals from the critical care environment. The question of whether bereaved individuals have capacity to consent to involvement in research immediately after loss is considered. The appropriateness of asking newly bereaved individuals to participate in research immediately after the death of their relative is also discussed. The work of the research team demonstrates that early recruitment of bereaved family members into a research project is feasible and acceptable to participants, especially when a multidisciplinary collaborative approach is employed and a personal mode of recruitment used.
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Affiliation(s)
| | | | - Thomas Buckley
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia
| | - Roger Bartrop
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia
| | | | - Diane Roche
- Royal North Shore Hospital, Sydney, Australia
| | | | | | - Geoffrey Tofler
- Royal North Shore Hospital, Sydney, Australia; University of Sydney, Australia
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Zisook S, Iglewicz A, Avanzino J, Maglione J, Glorioso D, Zetumer S, Seay K, Vahia I, Young I, Lebowitz B, Pies R, Reynolds C, Simon N, Shear MK. Bereavement: course, consequences, and care. Curr Psychiatry Rep 2014; 16:482. [PMID: 25135781 DOI: 10.1007/s11920-014-0482-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper discusses each of several potential consequences of bereavement. First, we describe ordinary grief, followed by a discussion of grief gone awry, or complicated grief (CG). Then, we cover other potential adverse outcomes of bereavement, each of which may contribute to, but are not identical with, CG: general medical comorbidity, mood disorders, post-traumatic stress disorder, anxiety, and substance use.
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Affiliation(s)
- Sidney Zisook
- Department of Psychiatry, University of California, 3350 La Jolla Village Dr, San Diego, CA, 92161-116A, USA,
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Ballocca F, D'Ascenzo F, Moretti C, Omedè P, Cerrato E, Barbero U, Abbate A, Bertero MT, Zoccai GB, Gaita F. Predictors of cardiovascular events in patients with systemic lupus erythematosus (SLE): a systematic review and meta-analysis. Eur J Prev Cardiol 2014; 22:1435-41. [PMID: 25139772 DOI: 10.1177/2047487314546826] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/21/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cardiovascular disease represents an important cause of morbidity and mortality in patients with a diagnosis of systemic lupus erythematosus (SLE), due to a complex interplay between traditional risk factors and disregulation of autoimmunity but uncertainty is still present about the most important predictors of cardiovascular events. OBJECTIVES The aim of our work was to perform a collaborative systematic review on the main predictors of cardiovascular events in SLE patients. METHODS PubMed and Cochrane were systematically searched for eligible studies on SLE and cardiovascular events between January 2008 and December 2012. Study features, patient characteristics and incidence of stent thrombosis were abstracted and pooled, when appropriate, with random-effect methods (point estimate - 95% confidence intervals) and consistency of predictors was formally appraised. RESULTS A total of 17,187 patients was included; of those, 93.1% were female and the median age was 39 years. After a median follow-up period of 8 years, cardiovascular events presented in 25.4%, including acute myocardial infarction (4.1%) and stroke (7.3%). The most important predictors may be divided into traditional risk factors, such as male gender (OR 6.2, CI 95% 1.49-25), hyperlipidaemia (OR 3.9, CI 95% 1.57-9.71), familiar history of cardiac disease (OR 3.6, CI 95% 1.15-11.32) and hypertension (OR 3.5, CI 95% 1.65-7.54), and SLE-related features, such as the presence of auto-antibodies (OR 5.8 and 5.0, CI 95% 3.28-7.78) and neurological disorders (OR 5.2, CI 95% 2.0-13.9). A low correlation was shown for the importance of organ damage and SLE activity (respectively OR 1.4, CI 95% 1.09-4.44 and OR 1.2, CI 95% 1.2-1.2), as well as for age at diagnosis (OR 1.1, CI 95% 1.07-1.17). CONCLUSIONS Cardiovascular events in SLE patients are caused by a multifactorial mechanism, including both traditional and disease-specific risk factors. A global valuation with an individual risk stratification based on both these features is important to correctly manage these patients in order to reduce negative outcomes.
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Affiliation(s)
- Flavia Ballocca
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
| | - Umberto Barbero
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Italy
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Smile--It's in your blood! Biochem Pharmacol 2014; 91:287-92. [PMID: 25107703 DOI: 10.1016/j.bcp.2014.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 01/28/2023]
Abstract
Emotions and feelings are the bricks of our social life and yet we often forget that they have a significant impact on our physical wellbeing. Indeed, a growing number of studies have shown that both an imbalanced or improved emotional state can significantly influence the way our immune system responds. In this commentary, we have summarized the most recent studies on the effects of different types of emotional states on the immune system and we have also explored the effects of mood modulator approaches on the immune response. We hope this commentary will prompt scientists and clinicians to think about the therapeutic value and potential of emotions and feelings in immune-related diseases. At the same time, we think that this commentary will shed some light on the scientific truth behind the very famous expression "It's in my blood" when we talk about feelings and personality.
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A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behav Res Ther 2014; 61:23-34. [PMID: 25113524 DOI: 10.1016/j.brat.2014.07.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/30/2014] [Accepted: 07/15/2014] [Indexed: 11/20/2022]
Abstract
This trial assessed the feasibility, acceptability, tolerability, and efficacy of an Internet-based therapist-assisted cognitive-behavioral indicated prevention intervention for prolonged grief disorder (PGD) called Healthy Experiences After Loss (HEAL). Eighty-four bereaved individuals at risk for PGD were randomized to either an immediate treatment group (n = 41) or a waitlist control group (n = 43). Assessments were conducted at four time-points: prior to the wait-interval (for the waitlist group), pre-intervention, post-intervention, 6 weeks later, and 3 months later (for the immediate group only). Intent-to-treat analyses indicated that HEAL was associated with large reductions in prolonged grief (d = 1.10), depression (d = .71), anxiety (d = .51), and posttraumatic stress (d = .91). Also, significantly fewer participants in the immediate group met PGD criteria post-intervention than in the waitlist group. Pooled data from both groups also yielded significant reductions and large effect sizes in PGD symptom severity at each follow-up assessment. The intervention required minimal professional oversight and ratings of satisfaction with treatment and usability of the Internet interface were high. HEAL has the potential to be an effective, well-tolerated tool to reduce the burden of significant pre-clinical PGD. Further research is needed to refine HEAL and to assess its efficacy and mechanisms of action in a large-scale trial.
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Abstract
Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7 % of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition and evidenced-based treatments for CG. Greater attention to CG detection and treatment in older adults is needed.
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