Journal of Psychosomatic Research

Aims and Scope

2010-02-01

Revisiting causality in psychosomatic research

Susan M. McNair, Ripu D. Jindal — 2010-02-01

Circa 1884, the study of infectious disease was a still-emerging science. Only 30 years previously, Louis Pasteur had performed his famous experiments disproving spontaneous generation and promoting germ theory ; however, debate still raged over the best way to prove that certain germs really did cause specific diseases. Robert Koch presented a set of criteria for establishing etiology , which in time formed the cornerstone of microbiological research, and brought much-needed scientific rigor to the field. By conducting a set of experiments that prove that (1) an organism is present in every infected individual, (2) that organism could be isolated from an infected individual and grown in culture, (3) that organism, when introduced into a healthy individual, would lead to the development of the same disease, and (4) that the same organism could again be recovered from the experimentally infected individual, a researcher could confidently assert that she/he had found the causative agent.

Hostility and physiological responses to laboratory stress in acute coronary syndrome patients

2009-09-24

Abstract: Objective: Evidence suggests that emotional stress can trigger acute coronary syndromes in patients with advanced coronary artery disease (CAD), although the mechanisms involved remain unclear. Hostility is associated with heightened reactivity to stress in healthy individuals, and with an elevated risk of adverse cardiac events in CAD patients. This study set out to test whether hostile individuals with advanced CAD were also more stress responsive.Methods: Thirty-four men (aged 55.9±9.3 years) who had recently survived an acute coronary syndrome took part in laboratory testing. Trait hostility was assessed by the Cook Medley Hostility Scale, and cardiovascular activity, salivary cortisol, and plasma concentrations of interleukin-6 were assessed at baseline, during performance of two mental tasks, and during a 2-h recovery.Results: Participants with higher hostility scores had heightened systolic and diastolic blood pressure (BP) reactivity to tasks (both P<.05), as well as a more sustained increase in systolic BP at 2 h post-task (P=.024), independent of age, BMI, smoking status, medication, and baseline BP. Hostility was also associated with elevated plasma interleukin-6 (IL-6) levels at 75 min (P=.023) and 2 h (P=.016) poststress and was negatively correlated with salivary cortisol at 75 min (P=.034).Conclusion: Hostile individuals with advanced cardiovascular disease may be particularly susceptible to stress-induced increases in sympathetic activity and inflammation. These mechanisms may contribute to an elevated risk of emotionally triggered cardiac events in such patients.

Commentary on hostility and physiological responses to laboratory stress in acute coronary syndrome patients

Petra H. Wirtz, Laura S. Redwine — 2010-02-01

Hostility is a personality trait associated with higher risk of future cardiac events in both patients with coronary artery disease (CAD) and healthy individuals , but information on underlying mechanisms is scarce. Tendencies toward exaggerated physiological reactions to acute stressors predict both accelerated progression of atherosclerosis and the likelihood of having a future cardiac event . Therefore, testing of relationships between hostility and physiological stress reactivity may provide mechanistic insights. Hitherto, these associations have been investigated in healthy individuals but not in patients who suffered from acute coronary events. This is described in a recent meta-analysis that, in healthy individuals, higher hostility is related to increased cardiovascular stress reactivity . Heightened stress reactivity of intermediate biological risk factors for coronary heart disease (CHD) such as inflammatory activity may also be involved in mediation of elevated risk for acute stress-associated CHD morbidity and mortality . However, studies relating hostility with inflammatory stress reactivity are sparse and, to our knowledge, only one study in healthy individuals suggests that hostility is related to higher IL-6 reactivity following a nonconflictual interaction task .

Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis

Frank Doyle, Ronán Conroy, Hannah McGee, Mary Delaney — 2009-11-20

Abstract: Objective: To determine which particular depressive symptom scales, derived from three scales, predicted poorer prognosis in persons with acute coronary syndrome (ACS).Methods: Hospitalized ACS patients (n=408) completed questionnaires (depression, vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac events (cardiac mortality, ACS, unplanned revascularization) were assessed at median 67 weeks post event.Results: Only depressive symptoms of fatigue-sadness predicted prognosis in univariate (hazard ratio [HR]=1.8, 95% CI 1.1–3.0, P=.025) and multivariate analysis (HR=1.8, 95% CI 1.1–2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 0.9–2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7–2.2, P=.402) did not.Conclusion: Symptoms of fatigue-sadness, but not other symptoms, were associated with increased risk of major cardiac events. Depression should be considered as a multidimensional, rather than a unidimensional, entity when designing interventions.

Vital exhaustion increases the risk of ischemic stroke in women but not in men: Results from the Copenhagen City Heart Study

2009-11-04

Abstract: Background: Several studies have indicated an association between depression and the development of stroke, but few studies have focused on gender differences, although both depression and stroke are more common in women than in men. The aim of the present study was to describe whether vital exhaustion, a measure of fatigue and depression, prospectively predicts ischemic and hemorrhagic strokes in a large cohort, with particular focus on gender differences.Methods: The cohort was composed of 5219 women and 3967 men without cardiovascular disease who were examined in the Copenhagen City Heart Study in 1991–1994. Subjects were followed for 6–9 years. Fatal and nonfatal strokes were ascertained from the Danish National Register of Patients. Cox proportional hazards model was used to describe vital exhaustion as a potential risk factor for stroke.Results: Four hundred nine validated strokes occurred. A dose–response relationship between vital exhaustion score and the risk of stroke was found in women reaching a hazard ratio (HR) of 2.27 (95% confidence interval: 1.42–3.62) for the group with the highest score. HR was only slightly attenuated by multivariate adjustment. There was no association between vital exhaustion score and stroke in men. HR was strongest for ischemic stroke, whereas no association was seen for hemorrhagic stroke.Conclusion: Vital exhaustion, a measure of fatigue, conveyed an increased risk of ischemic stroke in women, but not in men, in this study sample.

Alexithymia, hypertension, and subclinical atherosclerosis in the general population

2009-11-18

Abstract: Objectives: As a personality trait, alexithymia is assumed to present a longstanding risk factor for emotional dysregulation that also affects the autonomic nervous system. Therefore, we hypothesize that alexithymia is associated with hypertension and carotid atherosclerosis in the general population.Methods: A total of 1168 subjects (age <65 years) from the Study of Health in Pomerania (SHIP) were eligible for complete case analyses. Alexithymia was assessed with the 20-item Toronto-Alexithymia-Scale (TAS-20). An extensive interview and physical examination were performed. Extracranial carotid arteries were examined bilaterally with B-mode ultrasonography. Regression models were adjusted for sociodemographic factors and classical risk factors for cardiovascular diseases and mental distress.Results: In the adjusted logistic regression models, alexithymia was significantly associated with hypertension (OR=1.60; 95% CI=1.14–2.25) and with atherosclerotic plaques (OR=1.70; 95% CI=1.14–2.54). Hypertension changed the effect of alexithymia on atherosclerosis only marginally (OR=1.76 to 1.70).Conclusion: Alexithymia may represent a relevant and independent risk factor for hypertension and carotid atherosclerosis at the population level. None of the putative confounders mediated a relevant proportion of the risk. Prospective studies are needed to confirm this association.

Joint effect of self-reported sleep problems and three components of the metabolic syndrome on risk of coronary heart disease

Minna Loponen, Christer Hublin, Raija Kalimo, Matti Mänttäri, Leena Tenkanen — 2009-11-04

Abstract: Objective: This study explored the joint effect of two epidemics, sleep problems and metabolic syndrome (MetS), on the risk of coronary heart disease (CHD).Methods: The study group is part of the Finnish middle-aged men who participated in the first screening for the Helsinki Heart Study (HHS) in 1981–1982. At that time, three components of MetS were measured: body mass index, HDL cholesterol, and blood pressure. Later, in 1986–1988, they were given a psychosocial questionnaire including items on sleep problems. Of the respondents, 2753 formed our study group and were followed up using population-based registers until 1995. The relative risks (RR) of CHD were estimated using Cox's regression models.Results: When several sleep problems were present simultaneously, some increased CHD risk was observed. However, when considered jointly with MetS, insomnia or daytime fatigue approximately doubled the CHD risk and the presence of insufficient sleep more than tripled the risk. Among those who had MetS only, the RR was 2.55, and among those with both insufficient sleep and MetS the RR was 9.36 (95% confidence interval: 4.60–19.04; P for interaction 0.09) when compared to those with no insufficient sleep and no components of MetS.Conclusion: The interaction occurred when all three measured MetS components were present, suggesting that co-occurrence of these two epidemics may predict growing public health problems.

Age as a moderator of the association between depressive symptoms and morningness–eveningness

Seog Ju Kim, Yu Jin Lee, Hyunkyung Kim, In Hee Cho, Jun-Young Lee, Seong-Jin Cho — 2009-10-05

Abstract: Objectives: We aimed to investigate the moderating effect of age on the association of morningness–eveningness with depression in subjects with a broad range of ages. The hypothesis of the current study was that there would be a relationship between depressive symptoms and eveningness, especially in young age groups.Methods: Three hundred sixty-one subjects (male/female=140/221) from 19 to 79 years of age participated in the study. Subjects were separated into five age groups: (1) ≤20s (n=70), (2) 30s (n=85), (3) 40s (n=97), (4) 50s (n=54) and 5) ≥60s (n=55). The Horne–Osteberg Morningness–Eveningness Questionnaire (MEQ) and the Center for Epidemiological Studies for Depression Scale (CES-D) were administered to all subjects.Results: MEQ showed a significantly independent and negative association with CES-D (β=−.27, P<.001), which meant the association between eveningness and depressive symptoms. The negative association between MEQ and CES-D were significant in ≤20s (β=−.31, P=.01), 50s (β=−.38, P<.01) and ≥60s (β=−.35, P<.01), while there was no significant association between MEQ and CES-D in 30s (β=−.06, P=.56) and 40s (β=−.10, P=.32).Conclusion: Our findings demonstrate an association of depressive symptoms with eveningness, which was more prominent in younger or older aged than in middle aged. Our findings suggest that the association between depressive symptoms and eveningness might be moderated by age.

Asthma and mental disorders in Canada: Impact on functional impairment and mental health service use

Renee D. Goodwin, Jina Pagura, Brian Cox, Jitender Sareen — 2009-10-05

Abstract: Objective: The goal of this study is to examine the association between asthma and mental disorders and the impact of asthma and mental disorder comorbidity on functional impairment and mental health care service use among adults in the community.Methods: Data came from the Canadian Community Health Survey Cycle 1.2 (N=36,984; age ≥15 years; response rate, 77%). Mental disorders were assessed using the Composite International Diagnostic Interview. Chronic physical health conditions, quality of life, and disability were also assessed. Asthma diagnoses were based on self-report of having been diagnosed with asthma by a health care professional.Results: Asthma was associated with a significantly increased likelihood of a range of mental disorders among adults in Canada, with the strongest links between asthma and posttraumatic stress disorder, mania, and panic disorder. Adults with both mental disorders and asthma had significantly higher rates of functional impairment and use of mental health services, compared with those with either asthma or mental disorders but not both.Conclusions: Our findings provide new information suggesting that adults in the community with asthma and mental disorders have higher levels of both short- and long-term health-condition-related functional disability and greater use of mental health services, compared with those with asthma without mental disorders. Results are also consistent with previous studies showing a significant link between asthma and mental disorders. Implications of these findings for efforts aimed at secondary prevention and improving treatment strategies for individuals with both asthma and mental disorders are discussed.

Psychological and self-management factors in near-fatal asthma

2009-06-29

Abstract: Background: Several studies that have analyzed differences in psychological and self-management variables between patients with a near-fatal asthma (NFA) attack and asthmatics without a NFA attack (non-NFA) have shown conflicting results, probably due to the heterogeneity of the events studied and the selection of comparison groups.Objective: To determine whether NFA patients, in stable situation, have greater psychological morbidity and worse self-management behavior than non-NFA patients with similar sociodemographic and clinical characteristics.Methods: A sample of 44 NFA patients (mean=5.65 years after the NFA episode) and 44 non-NFA patients matched for age, sex, and asthma severity was assessed. All patients were in clinical stable situation. Information about sociodemographic, clinical, functional, and morbidity variables was collected for each patient, and the Cognitive Depression Inventory, the Trait-Anxiety Scale, the Toronto Alexithymia Scale, the Practical Knowledge of Self-management questionnaire, and the Medication Adherence scale were administered.Results: In comparison with non-NFA patients, NFA patients showed higher levels of trait-anxiety (23.84 vs. 16.86; P=.001) and more difficulties describing and communicating feelings (11.36 vs. 8.90; P=.002). NFA and non-NFA patients did not differ in self-management variables. After adjustment in multivariate logistic regression analysis for age, sex, and asthma severity, significant differences were observed between NFA and control group patients in marital status [odds ratio (OR)=0.26; P=.017; 95% confidence interval (CI)=0.09–0.78], prescribed dose of inhaled corticoids (OR=4.48; P=.006;95% CI=1.53–13.09), and trait-anxiety (OR=1.071;P=.025;95%CI=1.01–1.14).Conclusions: NFA patients show higher psychological morbidity than non-NFA, even years after the NFA episode.

Arthritis and psychiatric disorders: Disentangling the relationship

Perry M. Nicassio — 2009-11-26

Various studies have demonstrated a link between having arthritis, particularly rheumatoid arthritis (RA) and osteoarthritis (OA), and psychiatric disorders. More than two decades ago, Wells et al. published data from the NIMH catchment area study in the United States showing that persons with arthritis had a lifetime prevalence rate of psychiatric disorders of 63.6% and a 6-month prevalence rate of 42.5%. These rates were alarming inasmuch as they exceeded those found in persons with potentially life-threatening illnesses such as COPD, diabetes, hypertension, and cardiovascular disease. While the authors found that having any chronic illness increased the risk of psychiatric disorder, these cross-sectional, epidemiological data did not address the important questions of whether arthritis preceded or followed the development of psychiatric disorders, or why these associations were found in the first place. Subsequently, corroborating evidence has been found in studies reporting rates of mood disturbance ranging from 15% to as high as 45% in persons with such conditions as RA, systemic lupus erythematosus, and fibromyalgia . Evidence is also accumulating that anxiety disorders are prevalent in persons with arthritis . Understanding the factors associated with the heightened psychiatric comorbidity in such studies represents an important challenge for behavioral medicine researchers and arthritis health professionals who serve these populations.

The association between arthritis and psychiatric disorders; results from a longitudinal population-based study

2009-10-05

Abstract: Background: To disentangle cross-sectionally and longitudinally the relationship between arthritis and psychiatric disorders, and to examine the relationship between age and incidence of (1) any psychiatric disorder among respondents with and without arthritis and (2) arthritis among respondents with and without any psychiatric disorder.Methods: Data are from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a nationally representative household survey with repeated measurements in 1996, 1997 and 1999. Self-report was used to ascertain arthritis. Psychiatric and substance use disorders were diagnosed with the WHO Composite International Diagnostic Interview.Results: Regarding the cross-sectional results, it was found that the strength of the association of arthritis with mood and anxiety disorders was similar [odds ratio (OR)=1.48, 95% confidence interval (CI)=1.09–1.99 and OR=1.42, 95% CI=1.11–1.81, respectively]. The longitudinal results showed that preexisting arthritis elevated the risk of developing any mood disorder (OR=1.94, 95% CI=1.23–3.07), whereas having any mood or any anxiety disorder did not predict new-onset arthritis. The incidence of any psychiatric disorder was significantly higher among younger persons (<45 years) with arthritis, compared to others in the same age category without arthritis.Conclusions: Arthritis is associated with psychiatric disorders. The temporal relationship points to one direction: arthritis predicts new onset of psychiatric disorder (mood disorder) instead of the reverse. Especially younger people (<45 years) with arthritis are at risk of developing a psychiatric disorder. Screening and simultaneous treatment of comorbid mood disorder and arthritis are recommended as part of routine in primary care.

Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease

Kang Sim, Yiong Huak Chan, Phui Nah Chong, Hong Choon Chua, Shok Wen Soon — 2009-05-18

Abstract: Objective: The psychological and coping responses of the noninfected community towards infectious disease outbreaks are relatively understudied. This cross-sectional study sought to determine the prevalence of severe acute respiratory syndrome (SARS)-related psychiatric and posttraumatic morbidities and associated coping styles within the general population visiting community health care services.Methods: It was conducted on individuals attending community polyclinics in Singapore within the first week of July 2003, 16 weeks after the first national outbreak of SARS. The General Health Questionnaire-28, Impact of Event Scale-Revised, and Brief COPE were used to determine the prevalence rates of psychiatric and posttraumatic morbidities and employed coping strategies respectively.Results: The overall response rate was 78.0%. Of the 415 community health care setting respondents, we found significant rates of SARS-related psychiatric (22.9%) and posttraumatic morbidities (25.8%). The presence of psychiatric morbidity was associated with the presence of high level of posttraumatic symptoms [adjusted odds ratio (OR) 2.26, 95% confidence interval (CI) 1.24–4.13, P=.008]. Psychiatric morbidity was further associated with being seen at fever stations (adjusted OR 1.90, 95% CI 1.08–3.34, P=.026), younger age (adjusted OR 0.97, 95% CI 0.94–0.98, P=.021), increased self blame (adjusted OR 1.67, 95% CI 1.22–2.28, P=.001), less substance use (adjusted OR 0.74, 95% CI 0.56–0.98, P=.034) and posttraumatic morbidity was associated with increased use of denial (adjusted OR 1.31, 95% CI 1.04–1.67, P=.024), and planning (adjusted OR 1.51, 95% CI 1.16–1.95, P=.002) as coping measures.Conclusion: These findings could potentially inform the development of practical community mental health programs for future infectious disease outbreaks.

Illness representations are associated with fluid nonadherence among hemodialysis patients

Joseph Chilcot, David Wellsted, Ken Farrington — 2009-11-04

Abstract: Objective: Patients with end-stage renal disease are required to limit fluid and salt intake. We examined illness representations [common-sense model (CSM)] among a sample of hemodialysis (HD) patients, investigating whether fluid-adherent patients held illness representations different from those of nonadherent patients. We also explored the utility of illness perceptions in predicting fluid nonadherence after controlling for clinical parameters, including residual renal function (KRU).Methods: Illness perceptions were assessed [Revised Illness Perception Questionnaire (IPQ-R)] in 99 HD patients. Clinical parameters were collected and averaged over a 3-month period prior to and including the month of IPQ-R assessment. Depression scores, functional status, and comorbidity were also collected. Fluid nonadherence was defined using interdialytic weight gain (IDWG) and dry weight (ideal weight). Patients in the upper quartile of percent weight gain were defined as nonadherent (IDWG≥3.21% dry weight).Results: Nonadherent patients had timeline perceptions significantly lower than those of adherent patients. Logistic regression models were computed in order to identify predictors of fluid nonadherence. After several demographic and clinical variables, including age, gender, and KRU, had been controlled for, lower consequence perceptions predicted nonadherence.Conclusions: Illness representations appear to predict fluid nonadherence among HD patients. Extending the CSM to investigate specific perceptions surrounding treatment behaviors may be useful and merits attention in this setting.

Breaking down the silos for integrated health care

Virginia M. Boquiren — 2009-11-04

“One of the characteristics of most chronic diseases is that the care required for them cuts across several different health-care disciplines. Multidisciplinary health-care teams, centred on primary health care, are an effective means in all settings of achieving this goal and of improving health-care outcomes.”— World Health Organization, 2005

Stefan G. Hofmann — 2009-10-05

Cognitive behavioral therapy (CBT) is arguably the most important development in the history of clinical psychology. Gillian Butler, Melanie Fennell, and Ann Hackmann, the three authors of the book Cognitive Behavioral Therapy for Anxiety Disorders: Mastering Clinical Challenges, are British psychologists who have contributed a significant amount of work toward the development of CBT for anxiety disorders, some of the most common psychiatric disorders. This well-written book, which is part of the series Guides to Individualized Evidence-Based Treatment, provides practical and user-friendly guidelines for clinicians in their daily work.

Keith J. Petrie — 2009-11-16

Outbreaks of mass psychogenic illness have always held fascination for researchers and clinicians working in the psychosomatic field. These incidents often arise suddenly and are bizarre examples of how the mind, given the right circumstances, can quickly create symptoms and illnesses. This new book presents more examples of mass psychogenic illness and panics than you could shake a faith healer at. There are many examples of the usual outbreaks at schools and factories but many other exotic ones involving slashers, phantoms, vampires, and various toxic substances. Even Bin Laden makes a cameo appearance. The book is organized alphabetically from outbreaks beginning with “A” such as the Amou Barking Mania through to beyond the Zimbabwe Zombie School. In between are fascinating examples of strange collective behavior.

2010-02-01

Title Page

2010-02-01

Copyright Page

2010-02-01

Instructions for Authors

2010-02-01

Journal of Psychosomatic Research

Aims and Scope

Revisiting causality in psychosomatic research

Hostility and physiological responses to laboratory stress in acute coronary syndrome patients

Commentary on hostility and physiological responses to laboratory stress in acute coronary syndrome patients

Depressive symptoms in persons with acute coronary syndrome: Specific symptom scales and prognosis

Vital exhaustion increases the risk of ischemic stroke in women but not in men: Results from the Copenhagen City Heart Study

Alexithymia, hypertension, and subclinical atherosclerosis in the general population

Joint effect of self-reported sleep problems and three components of the metabolic syndrome on risk of coronary heart disease

Age as a moderator of the association between depressive symptoms and morningness–eveningness

Asthma and mental disorders in Canada: Impact on functional impairment and mental health service use

Psychological and self-management factors in near-fatal asthma

Arthritis and psychiatric disorders: Disentangling the relationship

The association between arthritis and psychiatric disorders; results from a longitudinal population-based study

Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease

Illness representations are associated with fluid nonadherence among hemodialysis patients

Breaking down the silos for integrated health care

Contents

Title Page

Copyright Page

Instructions for Authors