Regular exercise behaviour and intention and symptoms of anxiety and depression in coronary heart disease patients across Europe: Results from the EUROASPIRE III survey

Is serum homocysteine level a biomarker of suicide attempts: A preliminary study

Suicide is a global public health concern, and understanding its multifaceted determinants is crucial for effective prevention. This study was designed to find an answer to the question of whether serum homocysteine level can be a biomarker of suicide attempts. This preliminary study involving 90 participants (45 suicide attempt cases and 45 controls) was conducted at Elazig Fethi Sekin City Hospital. Biochemical analyses were performed to assess serum homocysteine, vitamin B12, and folic acid levels. Statistical analyses, including t-tests, Mann-Whitney U tests, and ROC analysis, were employed to explore differences between groups and assess the diagnostic potential of homocysteine. Elevated homocysteine levels were found in individuals who attempted suicide compared to the control group (p= <0.001). Additionally, lower levels of vitamin B12 (p=<0.001) and folic acid (p=<0.001) were observed in the suicide attempt group. ROC analysis indicated a significant diagnostic potential for homocysteine in predicting suicide attempts (AUC = 0.845, sensitivity = 91%, specificity = 71%). This study establishes a significant association between high homocysteine levels and suicide attempts, accompanied by lower vitamin B12 and folic acid levels. The findings suggest a potential link between disturbances in homocysteine metabolism and suicidal tendencies, urging further research to establish causation and explore therapeutic implications. Consideration of the study's limitations and directions for future research are warranted.

The role of daily adjustment disorder, depression and anxiety symptoms for the physical activity of cardiac patients

BACKGROUND

Physical activity (PA) is crucial in the treatment of cardiac disease. There is a high prevalence of stress-response and affective disorders among cardiac patients, which might be negatively associated with their PA. This study aimed at investigating daily differential associations of International Classification of Diseases (ICD)-11 adjustment disorder, depression and anxiety symptoms with PA and sedentary behaviour (SB) during and right after inpatient cardiac rehabilitation.

METHODS

The sample included N = 129 inpatients in cardiac rehabilitation, Mage = 62.2, s.d.age = 11.3, 84.5% male, n = 2845 days. Adjustment disorder, depression and anxiety symptoms were measured daily during the last 7 days of rehabilitation and for 3 weeks after discharge. Moderate-to-vigorous PA (MVPA), light PA (LPA) and SB were measured with an accelerometer. Bayesian lagged multilevel regressions including all three symptoms to obtain their unique effects were conducted.

RESULTS

On days with higher adjustment disorder symptoms than usual, patients engaged in less MVPA, and more SB. Patients with overall higher depression symptoms engaged in less MVPA, less LPA and more SB. On days with higher depression symptoms than usual, there was less MVPA and LPA, and more SB. Patients with higher anxiety symptoms engaged in more LPA and less SB.

CONCLUSIONS

Results highlight the necessity to screen for and treat adjustment disorder and depression symptoms during cardiac rehabilitation.

Do Attitudes, Mental Health Status, and Interpersonal Factors Predict COVID-19 Vaccine Hesitancy at the Early Phase of the Pandemic? A Longitudinal Study in Chinese College Students

Purpose

The present study examined whether and how attitudes toward the COVID-19 vaccine (i.e., safety, efficacy, and price), mental health statuses (i.e., perceived stress and depression), and interpersonal factors (i.e., online social support, perceived social support) would predict COVID-19 vaccine hesitancy.

Patients and methods

The two-wave longitudinal surveys were conducted in December 2019 and 2020 in Chinese medical college students (N = 194). Well- validated measures were used, including the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale, the Online Social Support Questionnaire, and the Perceived Social Support Scale. Perceived safety, efficacy, price of COVID-19 vaccine, vaccine hesitancy, and actual intake were also measured.

Results

Only 2.1% of participants had been vaccinated against COVID-19 in the early stages of the pandemic; 13.4% intended to get vaccinated in the next 3 months, and 66% intended to have it in the next 12 months upon follow-up. Multiple regression analyses revealed that perceived stress (βm = -0.15, p < 0.05) and depression (βm = -0.15, p < 0.05) were risk factors for positive attitudes toward the COVID-19 vaccine; online social support (ORm = 1.41, p < 0.01) and positive attitudes toward the COVID-19 vaccine (ORm = 1.83, p < 0.01) were protective factors of intention to get vaccinated in future.

Conclusion

Findings suggest that intervention efforts should be made to reduce negative attitudes toward the COVID-19 vaccine among people with poor mental health and enhance online social support to promote COVID-19 vaccination.

Depressive Symptoms After Acute Myocardial Infarction and Its Association With Low Functional Capacity and Physical Activity

PURPOSE

Depressive symptoms after acute myocardial infarction (AMI) are related with adverse health outcomes. However, the risk factors and course of depressive symptoms after AMI have not been widely investigated, especially in Asian populations. We aimed to evaluate changes in the prevalence of depressive symptoms and the associated risk factors at 3 mo after AMI. We also investigated the associations among functional capacity, physical activity (PA), and depressive symptoms.

METHODS

This cross-sectional study was conducted for 1545 patients who were admitted for AMI and referred to cardiac rehabilitation (CR) between August 2015 and March 2019. Of these patients, 626 patients completed the Patient Health Questionnaire-9 (PHQ-9), the Korean Activity Scale Index (KASI), and the International Physical Activity Questionnaire (IPAQ) 3 mo following AMI. A PHQ-9 score of ≥5 was considered to indicate depressive symptoms.

RESULTS

The prevalence of depressive symptoms was 30% at baseline and decreased to 12% at 3 mo after AMI. Depressive symptoms were significantly associated with low functional capacity (OR = 2.20, P = .004) and unemployment status (OR = 1.82, P = .023). After adjusting for variables including functional capacity, depressive symptoms exhibited a significant relationship with low PA after AMI (OR = 1.80, P = .023).

CONCLUSION

Systematic screening and treatment for depressive symptoms and efforts to promote CR may help to improve PA and functional capacity in Korean patients with AMI. Such efforts may aid in reducing the depressive symptoms and related adverse outcomes.

Physical Activity and Factors Affecting Its Maintenance Among Patients With Coronary Heart Disease Not Undergoing Cardiac Rehabilitation in China

BACKGROUND

The level of physical activity (PA) among patients with coronary heart disease (CHD) living in Chinese communities who do not participate in cardiac rehabilitation programs and the factors contributing to patient maintenance of PA are unclear.

OBJECTIVE

This cross-sectional study, guided by the Transtheoretical Model, evaluated (1) the maintenance of PA in Chinese patients with CHD 12 months after hospital discharge and (2) the demographic, clinical, and psychological characteristics associated with maintenance of PA.

METHODS

A total of 1162 patients completed 6 questionnaires at 12 months posthospitalization to assess their maintenance of PA, stage of change, symptoms of depression and anxiety, and health-related quality of life and sleep.

RESULTS

Only 40% of patients with CHD maintained regular PA 12 months after hospital discharge. Walking was their primary PA. Thirty-seven percent of patients reported no intention of having regular PA. Male sex (odds ratio [OR], 1.69), awareness of PA's cardiac benefit (OR, 4.12), a history of regular PA before the cardiac event (OR, 6.08), history of chronic disease (OR, 1.43), mild depressive symptoms (OR, 1.40), moderate and severe depressive symptoms (OR, 0.41), smoking (OR, 0.54), and years of CHD (OR, 0.96) were related to maintenance of regular PA. Patients with CHD who maintained regular PA had better quality of life and sleep (P < .001) and fewer unplanned clinic visits (P = .001) and cardiac cause readmissions (P = .012) and reported fewer declines in PA capacity (P < .001).

CONCLUSIONS

Walking is the most common form of PA 12 months posthospitalization among patients with CHD in China. Patient education and counseling about the cardiac benefits of PA, taking into account stage of change, are important considerations to improve maintenance of PA.

Depressive symptoms interfere with the improvement in exercise capacity by cardiac rehabilitation after left ventricular assist device implantation

BACKGROUND

Although depressive symptoms are associated with an increased risk of readmission after left ventricular assist device (LVAD) implantation, it is unclear whether they affect the efficacy of exercise-based cardiac rehabilitation (EBCR). This study aimed to investigate the effect of depressive symptoms on EBCR efficacy.

METHODS

We analyzed 48 patients who participated in EBCR after LVAD implantation (mean age 45 ± 12 years; 60% male). Patients were classified into two groups using the Zung Self-Rating Depression Scale (SDS): depressive group (SDS ≥40, n = 27) and non-depressive group (SDS <40, n = 21). We examined changes in peak oxygen uptake (VO₂ ), knee extensor muscular strength (KEMS), and quality of life (QOL) during EBCR using analysis of covariance.

RESULTS

Although baseline characteristics were similar between the two groups, the non-depressive group was less likely to receive diuretics (22% vs. 52%, p = 0.030). Peak VO₂ , KEMS, and QOL significantly increased over time in both groups (all p < 0.05). The depressive group had a significantly lower change in peak VO₂ than the non-depressive group (2.7 vs. 1.6 ml/kg/min; mean difference: -1.1 ml/kg/min, 95% confidence interval [CI]: -0.045 to -2.17; p = 0.041, d = 0.59). There was no between-group difference regarding the change in KEMS or QOL. Adjusting for the baseline value, a significant difference between groups was observed only in peak VO₂ (p = 0.045).

CONCLUSIONS

Although EBCR significantly improved exercise capacity after LVAD implantation, depressive symptoms interfered with this improvement. Further studies are needed to determine whether psychological interventions for depression, in addition to EBCR, would improve the response to EBCR after LVAD implantation.

Positive psychological profiles based on perceived health clustering in patients with cardiovascular disease: a longitudinal study

OBJECTIVES

Psychological well-being and sociodemographic factors have been associated with cardiovascular health. Positive psychological well-being research is limited in the literature; as such, this study aimed to investigate how patients with cardiovascular disease could be classified according to their perceived mental and physical health, and to identify positive psychological profiles based on this classification and test their stability over time.

DESIGN AND SETTING

Longitudinal study with patients from a public hospital located in Córdoba (Spain).

PARTICIPANTS

This study comprised 379 cardiovascular patients (87.3% men) tested at three measurement points.

OUTCOME MEASURES

Participants reported their sociodemographic variables (age, sex, educational level, employment and socioeconomic status) at phase 1, while their perceived health and variables relating to positive psychological well-being were tested at this and two subsequent time points (average interval time: 9 months).

RESULTS

The two-step cluster analysis classified participants into three groups according to their mental and physical health levels, p<0.001: high (n=76), moderate (n=113) and low (n=189) perceived health clusters. Low perceived health was the largest cluster, comprising almost half of patients. Clusters significantly differed according to sex, p=0.002, and socioeconomic level, p=0.004. The profile analysis indicated that participants in the high perceived health cluster showed high positive affect, positivity, life satisfaction, and self-efficacy in emotion regulation, and less negative affect and use of passive strategies over the three measurement points (95% CI, all ps<0.01). Moreover, psychological profile stability for each cluster was generally found over an 18-month period, all ps<0.05.

CONCLUSION

Cardiovascular patients may differ in terms of their perceived health and, accordingly, in terms of other relevant variables. Perceived health clusters generated varying and generally stable psychological profiles based on positive psychological well-being variables. Psychological interventions should be adapted to patients' requirements.

The association between serum homocysteine and depression: A systematic review and meta-analysis of observational studies

BACKGROUND

Hyperhomocysteinaemia is known to interfere with neurological functions; however, there is a controversy regarding the relationship between homocysteine and depression.

MATERIALS AND METHODS

Science Direct, MEDLINE and ISI Web of Science were searched to find relevant articles, published up to August 2020. Studies were included if they compared homocysteine levels in healthy subjects with subjects with depression. Also, articles that reported the association between hyperhomocysteinaemia and risk of depression were included. Odds ratios of depression and means of homocysteine were used to ascertain the overall effect size.

RESULTS

Homocysteine level was higher in subjects with depression in comparison with healthy controls (weight mean difference = 2.53 µmol/L, 95% confidence interval: 1.77, 3.30), and the depression diagnostic tool was a source of heterogeneity. Homocysteine level was significantly higher in subjects with depression in studies that used Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), Geriatric Depression Scale (GDS), Zung Self-Rating Depression Scale (ZDRS) and Beck Depression Index II (BDI-II) as depression diagnostic tools. Also, participants with hyperhomocysteinaemia had a higher chance of depression (Pooled risk = 1.34, 95% confidence interval: 1.19, 1.52), where the depression diagnostic tool was a source of heterogeneity. In contrast to ZDRS and Patient Health Questionnaire (PHQ) subgroups, hyperhomocysteinaemia yielded a significantly higher risk of depression in DSM-IV, GDS and 'other' subgroups.

CONCLUSION

Homocysteinemia level is higher in individuals with depression. However, the depression diagnostic tool used is instrumental in influencing their association, and thus, future studies should focus on the tools for depression assessment.

COVID-19 pandemic response behaviors: a Singapore experience of the "circuit breaker"

Preventive health behaviors such as hand hygiene are crucial amidst pandemics like COVID-19 but reports on nonadherence persist. This could be due to the lack of Consideration of Future Consequences (CFC), a cognitive-motivational construct known to improve health-related behaviors. Therefore, we examined the relationship between CFC and five behaviors—mask-wearing, social distancing, hand hygiene, excessive necessities buying, and COVID-19 information searching using an internet-based Singapore-wide survey conducted from April 20 to May 4, 2020. Behavioral differences 2 weeks before and after the state-wide confinement were examined using paired t-tests. Relationships between CFC and COVID-19 behaviors were examined using regression analyses adjusted for depression and anxiety. Participants were regrouped into three categories—increased behavior performance, maintained high performance, and maintained low performance where mean differences were analysed using MANOVA. Three hundred and thirty-six participants completed the survey (mean age, SD = 32.9 years [SD = 12.6]; 38.7% males). CFCfuture predicted mask wearing (B = 0.16; p < .05), social distancing (B = 0.0.19; p < .01), hand hygiene (B = 0.17; p < .01), and information searching (B = 0.21; p < .001). CFCimmediate predicted hand hygiene (B = 0.09; p < .05), excessive necessities buying (B = 0.07; p < .05) and information searching (B = 0.08; p < .05). Anxiety predicted excessive buying (B = 0.08; p < .05) and hand hygiene (B = 0.13; p < .01). Post-hoc test showed significantly higher CFCfuture (p < .01) in participants who increased and maintained high behavioral performance.

Psychometric Features of the Polish Version of TSK Heart in Elderly Patients with Coronary Artery Disease

Background and objectives: Recommendations for the control of stable patients with coronary artery disease (CAD) related to an adequate level of physical activity (PA). Practical experience shows that the PA level in most people with CAD is definitely too low in relation to the guidelines. The cause may be psychological factors and among them the fear of movement-kinesiophobia. The aim of this project was to examine the evaluation of psychometric features of the Polish version of the Tampa Scale for Kinesiophobia Heart (TSK Heart), used in people with CAD. Materials and methods: The study involved 287 patients with stable CAD: 112 women and 175 men. Age: 63.50 (SD = 11.49) years. Kinesiophobia was assessed using TSK Heart, physical activity (PA)-using the International Physical Activity Questionnaire (IPAQ), and anxiety and depression was examined using the Hospital Anxiety and Depression Scale (HADS). The structure of TSK was examined using principal component analysis (PCA), internal cohesion (Cronbach's alpha, AC), and content validity was calculated by linear regression. Results: PCA showed a three-factor TSK structure. One-dimensionality and satisfactory reliability were found: TSK Heart: AC = 0.878. Kinesiophobia as a predictor of PA: R2 = 0.162 (p = 0.000000). Anxiety and depression-TSK: R2 = 0.093 (p = 0.00000). Conclusions: The Polish version of TSK Heart for cardiac patients is characterized by good psychometric features. The use of it can improve the cooperation of rehabilitation teams for patients with CAD.

Association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease

OBJECTIVE

To analyze the association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease (CHD).

METHODS

N = 1007 patients with CHD were recruited in hospital and followed for one year in a two-site cohort study. Heart focused anxiety (Cardiac Anxiety Questionnaire [CAQ] with the three subscales fear, attention, and avoidance), depressive symptoms (depression module from the Patient Health Questionnaire [PHQ-9]), health behaviors and healthcare utilization (smoking status, alcohol consumption, physical activity, outpatient physician/psychotherapist visits) were assessed six months after the initial hospitalization. Multiple regression models were used for statistical analysis.

RESULTS

About one third of the sample exhibited clinically significant CAQ scores. Higher CAQ-avoidance scores were associated with current smoking (OR = 1.62; 95%CI: 1.33-1.98), reduced alcohol intake (OR = 0.83; 95%CI: 0.71-0.98), non-participation in a coronary exercise group (OR = 1.76; 95%CI: 1.42-2.17), less regular physical activity (OR = 2.69; 95%CI: 2.32-3.12), and more frequent contact to general practitioners (GPs; b = 0.07, SE: 0.03). CAQ-attention was associated with non-smoking (OR = 0.51; 95%CI: 0.37-0.70), exercise group participation (OR = 0.69; 95%CI: 0.51-0.94), more frequent regular physical activity (OR = 0.55; 95%CI: 0.44-0.68), and more frequent contact to specialists for internal medicine (b = 0.09, SE: 0.04). CAQ-fear was not associated with any of the health behavior or healthcare use measures. Depressive symptoms were associated with reduced regular physical activity (OR = 1.05; 95%CI: 1.02-1.08) and increased contact to mental care specialists (b = 0.03, SE: 0.01) and GPs (b = 0.02, SE: 0.01).

CONCLUSIONS

Heart-focused anxiety and depressive symptoms may impede secondary prevention in patients with CHD and increase outpatient healthcare utilization.

Do Depressive Symptoms Moderate the Effects of Exercise Self-efficacy on Physical Activity Among Patients With Coronary Heart Disease?

BACKGROUND

Exercise self-efficacy is an important predictor of physical activity. Patients with coronary heart disease are at risk of developing depressive symptoms that could further weaken their self-efficacy and interfere with their ability to engage in physical activity.

OBJECTIVE

The aim of this study was to examine the relationship between depressive symptoms, exercise self-efficacy, and physical activity among patients with coronary heart disease and how the efficacy-activity relationship is affected by the patient's level of depression.

METHODS

A survey was conducted on 149 participants at the time of discharge from the emergency and in-patient medical wards at 2 regional hospitals.

RESULTS

The sample was mostly male, married, living with families, and of lower socioeconomic status. The mean exercise self-efficacy was 4.26 ± 2.73, and the median physical activity was 12 (interquartile range, 6-21). Approximately 26% of participants had high depressive symptoms. Those with more depressive symptoms reported lower self-efficacy scores and lower physical activity. In multivariate regressions, self-efficacy was an independent predictor of physical activity (b = 1.48, P < .001). After including depressive symptoms as the interaction term, exercise self-efficacy had a significantly stronger and positive relationship with physical activity (b = 0.14, P = .043).

CONCLUSION

Exercise self-efficacy had a positive association with physical activity, and this relationship was stronger among coronary heart disease patients with depressive symptoms. This finding suggests that self-efficacy might be important in encouraging individuals with depressive symptoms to participate in physical activity. More efforts should target the development of effective strategies to improve exercise self-efficacy as a way of promoting physical activity among depressed coronary heart disease patients.

The burden of mood-disorder/cerebrovascular disease comorbidity: essential neurobiology, psychopharmacology, and physical activity interventions

Cardio-vascular diseases (CVDs) and CVD-related disorders (including cerebrovascular diseases; CBVDs) are a major public health concern as they represent the leading cause of mortality and morbidity in developed countries. Patients with CVDs and CBVDs co-morbid with mood disorders, especially bipolar disorder (BD) and major depressive disorder (MDD), suffer reduced quality-of-life and significant disability adjusted for years of life and mortality. The relationship between CVDs/CBVDs and mood disorders is likely to be bidirectional. Evidence for shared genetic risk of pathways involved in stress reaction, serotonin or dopamine signalling, circadian rhythms, and energy balance was reported in genome-wide association studies. There is some evidence of a neuroprotective effect of various antidepressants, which may be boosted by physical exercise, especially by aerobic ones. Patients with CVDs/CBVDs should be routinely attentively evaluated for the presence of mood disorders, with tools aimed at detecting both symptoms of depression and of hypomania/mania. Behavioural lifestyle interventions targeting nutrition and exercise, coping strategies, and attitudes towards health should be routinely provided to patients with mood disorders, to prevent the risk of CVDs/CBVDs. A narrative review of the evidence is herein provided, focusing on pharmacological and physical therapy interventions.