Exploring timing and delivery of lifestyle advice following an acute cardiac event hospitalization: The cardiac patient's perspective

OBJECTIVE

To explore the perspective of cardiac patients regarding the timing and manner of delivering lifestyle advice following an acute cardiac event hospitalization.

METHODS

Dutch cardiac patients who experienced a cardiac event hospitalization participated in a semi-structured interview (n = 14) or a cross-sectional survey study (n = 119).

RESULTS

Our findings indicate that cardiac patients are receptive to lifestyle advice throughout the care trajectory. Advice delivered by a cardiologist had the highest self-reported impact. Furthermore, receiving advice at multiple phases during the care trajectory was associated with a greater intention to change lifestyle (B = 0.37, CI = 0.17 - 0.57). Patients favored clear-cut, feasible, and friendly but confronting advice. Moreover, they stressed the importance of advice being aligned with their identity and beliefs about the causes of their disease.

CONCLUSION

The period following an acute cardiac event provides a unique opportunity to offer tailored and patient-centered lifestyle advice. This "teachable window" for lifestyle change, when used wisely, may improve health outcomes for cardiac patients.

PRACTICE IMPLICATIONS

Healthcare professionals should initiate lifestyle advice already during hospitalization and continue during follow-up appointments and cardiac rehabilitation. Advice should be feasible and empathy-based, as well as tailored to the patient's needs, values, and perceptions of the causes of their cardiovascular disease.

The mediating role of depressive symptoms and subjective cognitive dysfunction in the relationship between stressful life events and functional disability in adult community volunteers

BACKGROUND

Stressful life events (SLE) impact psychosocial functioning. However, the psychological mechanism underlying the association between SLE and functional disability (FD) has not been fully elucidated. This study focused on whether depressive symptoms (DS) and subjective cognitive dysfunction (SCD) mediated the influence of SLE, comprising negative SLE (NSLE) and positive SLE (PSLE), on FD.

METHODS

A total of 514 adults from Tokyo, Japan, completed the self-administered questionnaires to evaluate DS, SCD, SLE, and FD. We investigated the relationships among the variables using path analysis.

RESULTS

Path analyses showed that NSLE positively affected FD directly (β = 0.253, p < .001), and indirectly via DS and SCD (β = 0.192, p < .001). PSLE negatively affected FD indirectly via DS and SCD (β = -0.068, p = .010), although PSLE did not affect FD directly (β = -0.049, p = .163).

LIMITATIONS

Causal relationships could not be determined owing to the cross-sectional design. All participants were recruited in Japan, which limits the generalization of findings to other countries.

CONCLUSIONS

DS and SCD, in this order, may partially mediate the positive effect of NSLE on FD. DS and SCD may fully mediate the negative effect of PSLE on FD. When considering the impact of SLE on FD, evaluating the mediating role of DS and SCD could be useful. Our findings may elucidate how perceived life stress affects daily functioning via depressive and cognitive symptoms. In the future, it is desirable to conduct a longitudinal study based on our results.

The association of social, economic, and health-related variables with suicidal and/or self-harm thoughts in individuals admitted to a psychiatric inpatient unit during the COVID-19 pandemic: An exploratory study

Individuals with pre-existing psychiatric diagnoses appear to be vulnerable to worsening mental health symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Furthermore, psychiatric hospitalizations during the pandemic may be complicated by increased risk of SARS-Cov-2 infection and limited social engagement due to changes in hospital policies. The objective of our exploratory study was to determine whether social, economic, and health-related variables were associated with thoughts of suicide and/or self-harm since March 2020 in individuals admitted to a psychiatric inpatient unit during the COVID-19 pandemic. Chi-square tests revealed four variables were significantly associated with thoughts of suicide and/or self-harm: 1) difficulty with cancellation of important events, 2) some form of loneliness, 3) decreased time spent in green spaces, and 4) increased time spent using devices with screens. The logistic regression model showed a significant association between suicidal and/or self-harm thoughts and cancellation of important events. Further investigation of the loneliness variable components revealed a significant association between suicidal and/or self-harm thoughts and feeling a lack of companionship, feeling isolated, and feeling alone. These results suggest that social challenges experienced during the pandemic were associated with negative mental health symptoms of individuals admitted to a psychiatric inpatient unit.

Prevalence and Correlates of Embitterment in a National Representative Sample

INTRODUCTION

Embitterment may occur after stressful but normal life events, such as job loss, divorce, or unjust events. Embitterment is a normal affect, but it may become clinically relevant in case it becomes very strong and long-lasting, and impairs daily functioning.

OBJECTIVE

Until now, no epidemiological data on the frequency of high embitterment in the general population have been available.

METHODS

A national representative survey of 2,531 people was carried out in Germany in 2019. The participants gave ratings for their embitterment due to perceived events (Posttraumatic Embitterment Scale), their psychological capacity profile (Mini-ICF-APP-S), sick leave duration, and sociodemographics.

RESULTS

About 11.7% of the investigated representative population report moderate embitterment, and another 3.8% high embitterment. Embitterment was only low correlated with other psychopathology, here work anxiety (r = 0.281**). There are no differences between embittered and nonembittered in respect to age, sex, household members, and professional distribution. Those with the highest embitterment have been unemployed more often and have lower income. At least 7.2% of those with high embitterment have a severe psychological capacity impairment and are in need of support by thirds to fulfill daily duties. In 55% of the 802 who reported a stressful event, injustice by an important person has been reported. Injustice by an institution (14%) or societal injustice (12%) was least often reported as a relevant stressful event.

CONCLUSION

Physicians, therapists, and public health must be aware of embitterment as a specific mental health problem which occurs frequently and may become chronic with work and life participation problems.

Effects of ambient air pollution, fresh fruit and vegetable intakes as well as maternal psychosocial stress on the outcome of newborn otoacoustic emission hearing screening

BACKGROUND

Newborn hearing screening results indicated that more than 40% of the detected infants had no recognized risk factors. To determine whether maternal exposure to ambient air pollutants and experience of stressful life event, as well as lack of fresh fruit and vegetable during pregnancy are associated with the abnormal hearing development among newborns.

METHODS

A total of 1193 newborns and their mothers were recruited in this study. Personal information and covariates were collected by face to face interview. Medical examination results of newborns and their mothers were extracted from medical record. We estimated personal air pollutant exposure level through inverse distance weighted method based on data from air quality monitoring stations and assessed the auditory development of newborns via distortion product otoacoustic emission (DPOAE). Unconditional logistic regression model was used to estimate the relationship between DPOAE screening result and the potential influential factors as well as the combined effect.

RESULTS

The results indicated that PM₁₀ exposure during the second trimester and stressful life event during the third trimester could increase the risk of not passing DPOAE test among newborns. However, frequent intakes of fruit and vegetable significantly reduced the risk. There was a synergetic interaction between PM₁₀ exposure and stressful life event on neonatal hearing development.

CONCLUSIONS

To alleviate abnormal auditory development among fetus, pregnant woman should decrease the exposures to ambient air pollutant and negative life event and at the same time, intake sufficient fresh fruit and vegetable.

Psychological Distress During the Retirement Transition and the Role of Psychosocial Working Conditions and Social Living Environment

Objectives

Mental health is determined by social, biological, and cultural factors and is sensitive to life transitions. We examine how psychosocial working conditions, social living environment, and cumulative risk factors are associated with mental health changes during the retirement transition.

Method

We use data from the Finnish Retirement and Aging study on public sector employees (n = 3,338) retiring between 2014 and 2019 in Finland. Psychological distress was measured with the General Health Questionnaire annually before and after retirement and psychosocial working conditions, social living environment, and accumulation of risk factors at the study wave prior to retirement.

Results

Psychological distress decreased during the retirement transition, but the magnitude of the change was dependent on the contexts individuals retire from. Psychological distress was higher among those from poorer psychosocial working conditions (high job demands, low decision authority, job strain), poorer social living environment (low neighborhood social cohesion, small social network), and more cumulative risk factors (work/social/both). During the retirement transition, greatest reductions in psychological distress were observed among those with poorer conditions (work: absolute and relative changes, p [Group × Time interactions] < .05; social living environment and cumulative risk factors: absolute changes, p [Group × Time interactions] < .05).

Discussion

Psychosocial work-related stressors lead to quick recovery during the retirement transition but the social and cumulative stressors have longer-term prevailing effects on psychological distress. More studies are urged incorporating exposures across multiple levels or contexts to clarify the determinants of mental health during the retirement transition and more generally at older ages.

What makes adolescents psychologically distressed? Life events as risk factors for depression and suicide

Adolescence is a vulnerable period for psychological distress. This study aimed to comprehensively investigate the distribution of major stress-causing factors and their correlates in a large population of adolescents. A computerized self-report questionnaire was completed by 291,110 participating adolescents over a 4-year period using a cross-sectional study design. The questionnaire included items assessing demographic variables, major stressors, severity of perceived stress, and mental health outcomes such as depressed mood, suicidal ideation, and attempts. Among the major stressors, schoolwork/career was the most predominant (54.7%). However, the odds ratios for depressed mood and suicidal ideation were the highest in the stressor of conflict with peers (OR = 1.97 for depressed mood and OR = 2.00 for suicidal ideation), followed by family circumstances (OR = 1.77 and 1.94 for depressed mood and suicidal ideation, respectively). Conversely, schoolwork/career presented significantly lower odds ratios of 0.87 and 0.87 for depressed mood and suicidal ideation, respectively. This study provides important information on psychological distress related to adolescents' mental health. Although school/career was the most prevalent source of psychological stress, the odds ratios for negative health outcomes of adolescents were higher in interpersonal problems such as conflicts with parents and peers and family circumstances. The present findings might help parents and clinicians understand the psychological distress of adolescents and improve their mental health.

Testing Age Differences in the links between Recent Financial Difficulties and Cognitive Deficits: Longitudinal Evidence from the PATH Through Life Study

OBJECTIVE

This study investigates whether the within-person associations between a recent major financial crisis and deficits in cognitive performance vary across the lifecourse.

METHOD

Four waves of data from 7442 participants (49% men) spanning 12-years and comprising three narrow age birth cohorts (baseline age: 20-25, 40-45, and 60-65) were drawn from a representative prospective survey from Canberra, Australia (1999-2014). Cognitive performance was assessed by the California Verbal Leaning Test (CVLT) immediate recall trails, Symbol Digit Modalities Test (SDMT), Backwards Digitspan (BDS), and Trail Making Test B (TMT B). A single item from the Threatening Life Experiences Questionnaire assessed self-reported major financial crisis in the past 6-months. Multi-variable adjusted fixed effect regression models tested the time-dependent association between financial crisis and cognition.

RESULTS

A recent financial crisis coincided with contemporaneous declines in CVLT (Mean change = -0.14, 95% CI = -0.262, -0.025), SDMT (Mean change = -0.08, 95% CI = -0.147,-0.004) and TMT-B (Mean change = -0.17, 95% CI = -0.293,-0.039) for adults in the oldest age group, and these associations were larger than in the younger age groups. In contrast, there was an overall association between financial crisis and deficits in BDS (Mean change = -0.06, 95% CI = -0.105, -0.007), with weak evidence of stronger associations in mid-life relative to other age groups. These associations were independent of changes in health and socio-economic circumstances.

DISCUSSION

This study provides important new evidence that financial difficulties in later life are potent stressors associated with occasion specific deficits in cognitive performance.

Changes in views on aging in later adulthood: the role of cardiovascular events

A number of longitudinal studies have pointed to the long-term impact of different views on aging (VoA) on health in later life, whereas the reverse relationship has rarely been examined. Serious cardiovascular events such as myocardial infarction or stroke are life-threatening events which might in turn lead to changes in VoA. The present longitudinal study examined the effect of a cardiovascular event (CVE) on VoA over a three-year period using pooled data from three waves of the German Ageing Survey (2008, 2011, 2014, age range: 40-95 years). In order to account for alternative explanations for changes in VoA, individuals without CVE (n = 200) were matched to individuals who experienced a CVE (n = 202) using a propensity score matching procedure. Compared to individuals without CVE, individuals who experienced a CVE showed adverse changes in three VoA indicators (self-perceptions of aging as associated with physical losses/with ongoing development; subjective age). These results suggest that CVE can in fact change how individuals view their own aging. According to previous studies, this can lead to future health changes and thus become a health-related downward spiral. Health promotion programs could, therefore, profit by adding specific VoA interventions for individuals who experienced a CVE.

Who becomes addicted and to what? psychosocial predictors of substance and behavioral addictive disorders

A multitude of psychological and social factors likely contribute to the development and maintenance of addictive disorders. As different people develop different addictions, it is important to understand whether psychosocial factors are related differently to different types of addictive disorders. In this study, we examined the unique interaction of personality traits, family environment, and life events in predicting substance (drugs, alcohol) and behavioral (gambling, sex) addictive disorders, among 207 participants suffering from an addictive disorder and 79 controls. Results identified several psychosocial factors, including impulsivity and reported negative life events, that predicted all types of addictive disorders. There was also a unique prediction model for each addiction. Drug and alcohol use disorders were predicted by lower agreeableness and less intellectual-cultural family orientation, with alcohol use disorder further predicted by lower extraversion and higher family organization. Gambling disorder was predicted by a family with lower intellectual-cultural orientation and higher organization and control, whereas compulsive sexual behavior was predicted by lower extraversion and agreeableness and higher neuroticism, and by higher family control. These findings suggest that the complex interplay among psychosocial factors is manifested differently across addictive disorders and may thus have important implications for research, prevention, and intervention.

Negative and positive life events and their relation to substance and behavioral addictions

BACKGROUND

Research has shown that negative life events (LEs) may be connected to the development and maintenance of addictions. However, few studies have examined the potential relationship between positive events and addictive disorders, and even fewer studies evaluated the subjective perception of LEs that may underlie these relationships. Importantly, addictive disorders include both substance-related and behavioral addictions, but the relative relationship of each type of addiction with LEs remains unclear.

METHODS

The present study compared 212 participants suffering from an addiction (drugs, alcohol, gambling, and sex) and 79 controls on self-report measures of negative and positive LEs.

RESULTS

Compared with controls, individuals with an addiction reported experiencing a larger number of both negative and positive LEs and also tended to be more influenced by negative LEs. Findings also demonstrated differential patterns across addiction types, such that participants with compulsive sexual behavior (CSB) reported experiencing less negative events than those with drug use disorders (DUD) and were less influenced by these events than participants with alcohol use disorder (AUD). Finally, analyses within each group further revealed differences in the way each group experienced negative compared to positive events. Controls and participants with CSB reported experiencing a similar number of positive and negative events, whereas participants with DUD, AUD, and gambling disorder reported more negative events in their lives.

CONCLUSIONS

These findings suggest a unique profile among different types of addictions, which should be taken into account when planning personalized prevention and intervention approaches.

How to integrate proxy data from two informants in life event assessment in psychological autopsy

BACKGROUND

Life event assessment is an important part in psychological autopsy, and how to integrate its proxy data from two informants is a major methodological issue which needs solving.

METHODS

Totally 416 living subjects and their two informants were interviewed by psychological autopsy, and life events were assessed with Paykel's Interview for Recent Life Events. Validities of integrated proxy data using six psychological autopsy information reconstruction methods were evaluated, with living subjects' self-reports used as gold-standard criteria.

RESULTS

For all the life events, average value of Youden Indexes for proxy data by type C information reconstruction method (choosing positive value from two informants) was larger than other five methods'. For family life related events, proxy data by type 1st information reconstruction method were not significantly different from living subjects' self-reports (P = 0.828). For all other life events, proxy data by type C information reconstruction method were not significantly different from the gold-standard.

CONCLUSIONS

Choosing positive value is a relatively better method for integrating dichotomous (positive vs. negative) proxy data from two informants in life event assessment in psychological autopsy, except for family life related events. In that case, using information provided by 1st informants (mainly family member) is recommended.

Assessing the interplay of childhood adversities with more recent stressful life events and conditions in predicting panic pathology among adults from the general population

BACKGROUND

Although research suggests that (a) childhood adversities and more recent stressful life events/conditions are risk factors for panic pathology and that (b) early life stress increases vulnerability to later psychopathology, it remains unclear whether childhood adversities amplify the association between more recent stressful life events/conditions and panic pathology.

METHODS

Data were derived from a general population sample (Study of Health in Pomerania, SHIP). Lifetime panic pathology was assessed with the Munich Composite International Diagnostic Interview (M-CIDI). Childhood adversities (emotional, physical and sexual abuse; emotional and physical neglect) were assessed with the Childhood Trauma Questionnaire (CTQ). More recent separation/loss events and long-lasting stressful conditions were assessed with the Stralsund Life Event List (SEL). Individuals with lifetime panic pathology (fearful spell, panic attack or panic disorder, N = 286) were compared to controls without any psychopathology (N = 286, matched for sex and age).

RESULTS

Conditional logistic regressions revealed that childhood adversities as well as more recent separation/loss events and long-lasting stressful conditions were associated with panic pathology (OR 1.1-2.5). Moreover, more recent separation/loss events - but not long-lasting stressful conditions - interacted statistically with each of the examined childhood adversities except for sexual abuse in predicting panic pathology (OR 1.1-1.3). That is, separation/loss events were associated more strongly with panic pathology among individuals with higher childhood adversities.

LIMITATIONS

Data were assessed retrospectively and might be subject to recall biases.

CONCLUSIONS

Findings suggest that early childhood adversities amplify the risk of developing panic pathology after experiencing separation or loss events.

Recent life events and psychosis: The role of childhood adversities

Life events are commonly reported to be related to psychosis. However, less attention has been given to the role that recent events play on psychosis, in relation to exposure to childhood adversity. The current study aimed to evaluate the relationship between recent events and psychosis, taking into account the role of early adversities. 78 psychotic patients and 156 controls were enrolled. Childhood adversity was evaluated using a validated semi-structured interview and the Childhood Experience of Care and Abuse Questionnaire. Recent events were recorded using a semi-structured interview with a normative and contextual approach. The diagnosis of psychosis was made according to Jablenski's criteria. Chi-square, t-test, odds ratio, and binary logistic regression statistical analyses were performed. Psychotic patients reported an excess of recent events. The occurrence of more than one recent event increased the risk of psychosis; there was a cumulative effect between recent and childhood events on psychosis. Recent events were significantly related to psychosis, even in the absence of childhood adversity or when adjusted for it. Our findings suggested that the effect of recent events on psychosis may be amplified by previous exposure to early adversity. Recent events alone, could be also linked to psychosis independently of childhood adversity.

Does retirement benefit health?

Currently large postwar baby-boomer generations are retiring from labor market. Transition to retirement is considered an important turning point in life which is accompanied by changes in many aspects of life such as time availability, daily routines, income streams and social networks. Recent longitudinal studies suggest that retirement can have a major influence on people's health behaviors, health and quality of life. Retirement could also be an opportune time at which to intervene with health-promotion activities and support healthy and active aging.

Does stress play a significant role in bipolar disorder? A meta-analysis

BACKGROUND

There is evidence that stressful life events (LE) play a crucial role in the etiology of bipolar affective disorder (BD). However, primary studies, as well as narrative reviews, have provided mixed results. The present meta-analysis combined and analyzed previous data in order to address these inconsistencies.

METHOD

Forty-two studies published in 53 records were identified by systematically searching MEDLINE, PsychINFO, and PSYCHINDEX using the terms "bipolar disorder" OR "manic-depressive" OR "bipolar affective disorder" OR "mania" AND "stress" OR "life event" OR "daily hassles" OR "goal attainment". Then, meta-analyses were conducted.

RESULTS

Individuals diagnosed with BD reported more LE before relapse when compared to euthymic phases. They also experienced more LE relative to healthy individuals and to physically ill patients. No significant difference in the number of LE was found when BD was compared to unipolar depression and schizophrenia.

LIMITATIONS

When interpreting the present meta-analytic findings one should keep in mind that most included studies were retrospective and often did not specify relevant information, e.g., if the LE were chronic or acute or if the individuals were diagnosed with BD I or II. We could not entirely rule out a publication bias.

CONCLUSION

The present meta-analyses found that individuals with BD were sensitive to LE, which corroborates recent theoretical models and psychosocial treatment approaches of BD. Childbirth, as a specific LE, affected individuals with BD more than individuals with unipolar depression. Future studies that investigate specific LE are warranted.

Life-stress and reactivity by gender in a longitudinal birth cohort at 30 and 35 years

PURPOSE

Previous literature has shown gender differences in reactivity to stressful life events. However, it is unclear whether gender differences in stress reactivity are consistent across a series of life event domains among longitudinal adult sample populations.

METHODS

Data were gathered from the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal birth cohort of 1265 children born in 1977 in Christchurch, New Zealand. Cohort members were questioned on their experience of, and distress from, a series of life event domains (interpersonal problems; victimization; illness/death; pregnancy/parenthood; employment/finance problems) spanning two age-periods 25-30 years (data collected in 2007) and 30-35 years (data collected in 2012). The data were pooled across observations and analyzed using population-averaged repeated-measures regression methods.

RESULTS

Overall, men and women reported experiencing similar numbers of life events for each domain. However, men reported more victimization and more employment/financial problems; women reported more illness/death events. Women reported experiencing more distress per life event for the domains of interpersonal problems, illness/death and pregnancy/parenthood. Men and women reported similar distress per life event for the victimization and employment/finance domains. The results were robust to control for: child and adolescent factors (childhood abuse exposure; adolescent personality; mental health) and adult factors (mental health; self-esteem).

CONCLUSION

These findings are consistent with a growing body of evidence indicating that some life events including interpersonal problems, illness/death and pregnancy/parenthood may be intrinsically more distressing for women. Detection of life event distress is important to aid in the prevention of mental/physical health problems.

Understanding the relationship between schematic beliefs, bullying, and unusual experiences in 8-14 year olds

BACKGROUND

Cognitive models of adult psychosis propose that negative schematic beliefs (NSBs) mediate the established association between victimisation and psychotic symptoms. In childhood, unusual, or psychotic-like, experiences are associated with bullying (a common form of victimisation) and NSBs. This study tests the mediating role of NSBs in the relationship between bullying and distressing unusual experiences (UEDs) in childhood.

METHOD

Ninety-four 8-14 year olds referred to community Child and Adolescent Mental Health Services completed self-report assessments of UEDs, bullying, and NSBs about the self (NS) and others (NO).

RESULTS

Both NS and NO were associated with bullying (NS: r=.40, P<.001; NO: r=.33, P=.002), and with UEDs (NS: r=.51, P<.001; NO: r=.43, P<.001). Both NS and NO significantly mediated the relationship between bullying and UEDs (NS: z=3.15, P=.002; NO: z=2.35, P=.019).

CONCLUSIONS

Children's NSBs may mediate the adverse psychological impact of victimisation, and are appropriate treatment targets for young people with UEDs. Early educational intervention to reduce negative appraisals of the self and others may increase resilience to future adverse experiences and reduce later mental health risk.

The prevalence and effect of life events in 222 bipolar I and II patients: a prospective, naturalistic 4 year follow-up study

BACKGROUND

Life events may very well increase the likelihood of affective episodes in bipolar disorder, but prospective data on survival are inconsistent.

METHODS

The authors examined the prevalence of negative and goal-attainment life events within 6 months prior to the index episode and after the index episode and their impact on the risk of relapse. Two hundred twenty-two consecutively admitted ICD-10 bipolar I (n=126) and II (n=96) patients were followed-up naturalistically over a period of 4 years.

RESULTS

One-hundred thirty-eight (62.2%) of the patients had at least one life event 6 month before the index episode. Seventy patients (31.5%) experienced one, 48 (21.6%) two, and 20 (9.0%) three (or more) life events. Regarding life events after the index episode, 110 (49.5%) patients had at least one life event. Fifty-four patients (24.3%) experienced one, 31 (14.0%) two, and 25 (11.3%) three (or more) life events. The number of life events was larger in patients with bipolar II disorder than in patients with bipolar I disorder (p=0.004). Using a Cox regression analysis, the risk of a depressive relapse in bipolar I patients was associated with the number of life events after the index episode (p=0.002). This was independent of the quality of the life event.

LIMITATIONS

Standardized life event scales, defined dosages of drugs or blood sampling during all visits were not performed.

CONCLUSIONS

Our data suggest a high and continuous number of life events prior to affective episodes. Life events after the index episode worsened the course of bipolar I patients with more depressive episodes. This underlines the importance of detection and treatment of emerging life events.

The effects of lifestyle and type a behavior on the life-stress process

To evaluate the effects of personal factors such as lifestyle and Thpe A behavior on the life-stress process, we analyzed data randomly collected from 428 metropolitan Tokyo residents. Path analysis techniques were implemented to examine the direct and indirect effects of lifestyle and the Type A behavior pattern between life events, subjective stress and depressive symptoms. The following results were obtained: 1. Persons with a healthy lifestyle perceived a lower subjective stress level. 2. Although females with a healthy lifestyle had fewer direct depressive symptoms, males with a healthy lifestyle had fewer indirect depressive symptoms due to alleviation of subjective stress. 3. Type A males perceived a lower subjective stress level and Type A females experienced more life events. It is suggested that mental health is modified not only by lifestyle but also by Type A behavior in the life-stress process. In particular, the preservation and promotion of a healthy lifestyle appear to reduce subjective stress and may be an important factor for the improvement of mental ill health.