Journal of Psychosomatic Research

Aims and Scope

2010-08-01

Emotional distress and social relationship dysfunction: The clinical implications of Type D?

Mark W. Ketterer — 2010-08-01

This month's issue of JPR contains two studies on the Type D personality, one finding a surprising degree of temporal inconsistency pre and post-cardiac surgery for what is argued to be a personality characteristic, and the other confirming its existence in a chinese population . These are interesting studies, deepening our understanding of this syndrome. But more fundamental questions remain unanswered about Type D.

Relaxation response and spirituality: Pathways to improve psychological outcomes in cardiac rehabilitation

Bei-Hung Chang, Aggie Casey, Jeffery A. Dusek, Herbert Benson — 2010-03-02

Abstract: Objectives: Studies have shown beneficial effects from practicing the relaxation response (RR). Various pathways for these effects have been investigated. Previous small studies suggest that spirituality might be a pathway for the health effects of the RR. In this study, we tested the hypothesis that increased spiritual well-being by eliciting the RR is one pathway resulting in improved psychological outcomes.Methods: This observational study included 845 outpatients who completed a 13-week mind/body Cardiac Rehabilitation Program. Patients self-reported RR practice time in a questionnaire before and after the 13-week program. Similarly, data on spiritual well-being, measured by the subscale of Spiritual Growth of the Health-Promoting Lifestyle Profile II, were collected. The psychological distress levels were measured by the Symptom Checklist-90-Revised. We tested the mediation effect of spiritual well-being using regression analyses.Results: Significant increases in RR practice time (75 min/week, effect size/ES=1.05) and spiritual well-being scores (ES=0.71) were observed after participants completed the program (P<.0001). Patients also improved on measures of depression, anxiety, hostility and the global severity index with medium effect sizes (0.25 to 0.48, P<.0001). Greater increases in RR practice time were associated with enhanced spiritual well-being (β=.08, P=.01); and enhanced spiritual well-being was associated with improvements in psychological outcomes (β=−0.14 to −0.22, P<.0001).Conclusion: Our data demonstrated a possible dose–response relationship among RR practice, spiritual and psychological well-being. Furthermore, the data support the hypothesis that spiritual well-being may serve as a pathway of how RR elicitation improves psychological outcomes. These findings might contribute to improved psychological care of cardiac patients.

Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery

2010-04-12

Abstract: Objective: Type-D personality—negative affectivity and social inhibition—are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery.Methods: One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12).Results: Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery.Conclusion: Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

Validating the Type D personality construct in Chinese patients with coronary heart disease

2010-04-20

Abstract: Objective: Type D personality predicts poor prognosis in coronary heart disease (CHD) but little is known about Type D in non-Western cultures. We examined the (a) validity of the Type D construct and its assessment with the DS14 scale in the Chinese culture, (b) prevalence of Type D, and (c) gender vs. Type D discrepancies in depression/anxiety, among Chinese patients with CHD.Method: Patients with CHD (N=326) completed the Chinese version of the DS14. The NEO Five Factor Inventory (NEO-FFI), Hospital Anxiety and Depression Scale (HADS), and Stress Symptom Checklist (SSC) were administered to subsamples to establish construct and discriminant validity.Administration of the DS14, HADS, and SSC was repeated at 1 month after hospital discharge in 66 patients, and stability of the DS14 was examined in another subsample of 100 patients.Results: The theoretical structure of the Type D construct in the Chinese culture was supported (χ2/df=2.89, root mean square error of approximation=0.08, normal fit index=0.91, non-normal fit index=0.91, comparative fit index=0.93). The Negative Affectivity (NA) and Social Inhibition (SI) subscales of the DS14 in the entire sample were internally consistent (Cronbach's alpha=0.89/0.81), measured stable traits (3-month test–retest ICC=0.76/0.74), and correlated significantly with the neuroticism (NA/neuroticism, r=0.78, P<.001) and extraversion subscales (SI/extraversion, r=−0.64, P<.001) of the NEO-FFI, respectively. The prevalence of Type D personality was 31%. Type D was not related to transient emotional states. However, Chinese patients with a Type D personality were at increased concurrent risk of anxiety (P=.002) and depression (P=.016).Conclusion: Type D personality is a cross-culturally valid construct, is associated with an increased risk of anxiety and depression, and deserves prompt attention in estimating the prognostic risk of Chinese CHD patients.

Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure

2010-03-15

Abstract: Objective: The purpose of this study is to compare the effectiveness of a combined 12-week home-based exercise (EX)/cognitive behavioral therapy (CBT) program (n=18) with CBT alone (n=19), EX alone (n=20), and with usual care (UC, n=17) in stable New York Heart Association Class II to III heart failure (HF) patients diagnosed with depression.Methods: Depressive symptom severity [Hamilton Rating Scale for Depression (HAM-D)], physical function [6-min walk test (6MWT)], and health-related quality of life (HRQOL) (Minnesota Living with Heart Failure Questionnaire) were evaluated at baseline (T1), after the 12-week intervention/control (T2), and following a 3-month telephone follow-up (T3). A repeated measures analysis of variance was used to determine group differences. Depression severity was dichotomized as minor (HAM-D, 11–14) and moderate-to-major depression (HAM-D, ≥15), and group intervention and control responses were also evaluated on that basis.Results: The greatest reduction in HAM-D scores over time occurred in the EX/CBT group (−10.4) followed by CBT (−9.6), EX (−7.3), and UC (−6.2), but none were statistically significant. The combined group showed a significant increase in 6-min walk distance at 24 weeks (F=13.5, P<.001). Among all groups with moderate-to-major depression, only those in CBT/EX had sustained lower HAM-D scores at 12 and 24 weeks, 6MWT distances were significantly greater at 12 (P=.018) and 24 (P=.013) weeks, and the greatest improvement in HRQOL also occurred.Conclusions: Interventions designed to improve both physical and psychological symptoms may provide the best method for optimizing functioning and enhancing HRQOL in patients with HF.

First episode of major depressive disorder and vascular factors in coronary artery disease patients: Baseline characteristics and response to antidepressant treatment in the CREATE trial

2010-04-08

Abstract: Objective: The CREATE trial reported that coronary artery disease (CAD) patients suffering from a first depression derived less benefit from citalopram relative to placebo than those with a recurrent depression. The present investigation sought to determine whether the differential benefit of citalopram between those with a first depression and those with recurrent depression could be explained by indicators of vascular depression and cardiac disease severity.Methods: Secondary analyses of data from CREATE, a 12-week, randomized placebo-controlled trial of 284 patients with major depressive disorder and CAD were used. Recurrence subgroups were compared on baseline characteristics reflecting vascular depression and cardiac disease severity. Outcome measures were the mean change from baseline to 12 weeks on the 24-item Hamilton Depression Rating Scale administered centrally by telephone. ANCOVA was used to assess the potential interaction of each baseline variable with citalopram/placebo treatment in predicting outcomes.Results: Few baseline differences differentiated patients with a first versus recurrent depression, and none accounted for the differential treatment efficacy in these subgroups. Patients with a cardiac event in the past 6 months (P=.02) and taking angiotensin-converting enzyme inhibitors (P=.03) experienced less change with citalopram relative to placebo. Older age, worse functional status, taking β-blockers, presence of angina (all P<.05), and later age of first depression (P=.05) predicted smaller changes in depression, independent of treatment assignment.Conclusions: There was limited evidence that the lack of improvement with citalopram relative to placebo in CAD patients with a first depression can be attributed to vascular depression.

Change over time in posttraumatic stress caused by myocardial infarction and predicting variables

2010-08-01

Abstract: Objective: The traumatic experience of a heart attack may evolve into symptoms of posttraumatic stress disorder, which can be diagnosed at the earliest 1 month after myocardial infarction (MI). While several predictors of posttraumatic stress in the first year after MI have been described, we particularly sought to identify longer-term predictors and predictors of change in posttraumatic stress over time.Methods: We studied 274 post-MI patients with complete data (mean 61±10 years, 84% men). After a median of 60 days (range 30–365) following the index MI (study entry), they were asked to rate MI-related posttraumatic stress as well as psychological distress perceived during MI. After a median of 32 months (range 19–45) later, all patients were asked to rate posttraumatic stress again (follow-up).Results: Female gender (P=.038) as well as greater helplessness (P<.001) and pain (P=.049) during MI predicted greater posttraumatic stress at study entry. Greater posttraumatic stress at follow-up was predicted by greater posttraumatic stress at study entry (P<.001), shorter duration of follow-up (P=.046), and greater pain during MI (P=.030). The decrease in posttraumatic stress over time (P<.001) was greater in patients with greater posttraumatic stress at study entry (P<.001) and in those with less pain during MI (P=.032).Conclusions: Demographic characteristics and perceived distress during MI were predictors of shorter-term posttraumatic stress. Although posttraumatic stress decreased over time and strongest in patients showing the greatest levels initially, greater short-term posttraumatic stress predicted maintenance of posttraumatic stress. Intense pain during MI adversely impacted both longer-term posttraumatic stress and its recovery.

The fruits of ones labor: Effort–reward imbalance but not job strain is related to heart rate variability across the day in 35–44-year-old workers

2010-04-12

Abstract: Objective: Previous research has suggested that the association between work stress and heart disease is more pronounced in young than in old employees. Similar age specificity may apply to the relation between work stress and heart rate variability (HRV), but data on this issue is sparse. We aimed to assess the age-specificity of the work stress-HRV association in greater detail.Methods: We used cross-sectional data from an occupational cohort (n=591) from Germany. Work stress was assessed using the job content and the effort-reward-imbalance (ERI) questionnaires. HRV was recorded over 24 h and was divided into three periods of the day (work time, leisure time, sleep time). Partial correlation coefficients (PCCs) were calculated for four age groups (17–34, 35–44, 45–54, and 55–65 years). Further, multilevel growth curve models (GCM) were run to examine whether age may modify potential work stress-HRV associations in a non-linear fashion.Results: Job strain and HRV were unrelated in either analytical approach and this association was not modified by age. In contrast, using PCCs ERI was only related to HRV during work (PCC=−0.231, P<.01) and leisure time (PCC=−0.195, P<.05) in employees aged 35–44. Multilevel GCM models confirmed this finding.Conclusion: The inverse association between work stress as measured by ERI and HRV appears to be most pronounced in workers aged 35–44. These findings may partly be explained by age-dependent HRV declines, age-related differences in career attitudes or increased susceptibility among those aged 35–44 due to facing multiple different stressors at the same time.

Father bonding and blood pressure in young adults from intact and divorced families

Danielle S. Roubinov, Linda J. Luecken — 2010-04-30

Abstract: Objective: The father–child relationship may uniquely affect offspring's physical and psychological health. Divorce may change the nature of the father–child bond and the long-term health consequences of paternal parenting behaviors. The current study investigated a possible biological pathway from father–child relationship quality to physical health outcomes in young adults.Methods: Cardiovascular stress reactivity to a lab-based challenge task and ambulatory blood pressure (ABP) were measured in young adults (mean age=20.1 years) from divorced (n=50) and intact, married (n=49) families. Participants completed self-report measures of paternal control and caring during childhood.Results: Higher perceived father control was associated with elevated BP reactivity to the task and higher ABP among participants from divorced families. Young adults from intact families who reported lower paternal caring demonstrated higher ABP.Conclusions: The family context may provide an important backdrop for evaluating the long-term physiological consequences of fathers' parenting behaviors.

Antilipidemic adherence post-coronary artery disease diagnosis among those with and without an ICD-9 diagnosis of depression

2010-03-18

Abstract: Objectives: An association between depression and coronary artery disease (CAD) is well established. Poor adherence to cardiac treatments may be one way depression could contribute to the increased risk of coronary events among depressed patients. We sought to evaluate whether adherence to antilipid medication, a therapy shown to be beneficial in secondary prevention of coronary events, differs among CAD patients with and without an ICD-9 depression diagnosis.Methods: Patients were included if, at angiography, they were determined to have CAD (stenosis ≥70%), were discharged on an antilipid medication, and re-filled their prescriptions at a participating pharmacy. A patient was determined to have depression (ICD-9 codes 296.2–296.36, 311) if the diagnosis occurred prior to angiography or within 6 months of the CAD diagnosis. Adherence and long-term outcomes were evaluated at 6 months, 1 year, 18 months and 2 years.Results: A total of 585 patients were included, with 73 (12.5%) having a diagnosis of depression prior to or within 6 months of CAD diagnosis. At all time-points, those with depression had a lower mean adherence compared to those without depression. Differences in adherence rates after adjustment were 7% (P=.001), 6% (P=.02), 13% (P<.0001) and 5% (P=.18) at 6 months, 1 year, 18 months, and 2 years, respectively. Though not statistically significant, there were clinically important associations between adherence and depression on the combined outcome of death, myocardial infarction, and revascularization.Conclusion: Depression was the strongest predictor of antilipidemic medication adherence after 2 years of follow-up among CAD patients. Such results suggest that poor antilipid adherence may be one mechanism by which depression contributes to CAD events.

Depression and poor adherence to lipid-lowering medications among patients with coronary artery disease

Roy C. Ziegelstein, Brian Howard — 2010-06-14

In an article published in the Journal of the American Medical Association in 1975, the Coronary Drug Project Research Group reported that “there is no evidence of significant efficacy of clofibrate with regard to total mortality or cause-specific mortality.” The study showed that patients treated with the lipid-lowering drug clofibrate had a 20.0% mortality rate at 5 years compared to a 20.9% rate in those given placebo. Five years later in The New England Journal of Medicine, evidence from the same study showed that patients who were “good adherers” to clofibrate (i.e., those who took 80% or more of their prescribed pills) had a significantly lower mortality (15.0%) than those who were “poor adherers” to clofibrate (24.6%) . This observation seemed to provide evidence that clofibrate was valuable in the treatment of heart disease. However, it was only part of the story. Similar findings were noted in those assigned to placebo; those who were “good adherers” to an inactive tablet had a much lower mortality (15.1%) than those who were “poor adherers” (28.3%).

Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study

2010-03-31

Abstract: Objective: Delirium after cardiac surgery is a serious complication that results in higher morbidity and mortality rates, and prolongs hospitalisation. However, the knowledge base regarding the issue of postoperative delirium is still limited. Therefore, in the current study, we evaluated the incidence and independent perioperative risk factors of delirium after cardiac surgery.Methods: The IPDACS Study recruited 563 consecutive patients undergoing cardiac surgery with cardiopulmonary bypass. The subjects were preoperatively examined by psychiatrists using the Mini-Mental State Examination and the Mini International Neuropsychiatric Interview to assess psychiatric comorbidity. Additionally, other variables connected to the patients' medical condition and surgical and anaesthetic procedures were evaluated. A diagnosis of delirium following surgical intervention was based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria.Results: The incidence of postoperative delirium according to DSM-IV criteria was 16.3% (95% confidence interval: 13.5–19.6). Multivariate stepwise logistic regression analysis revealed that advanced age, preoperative cognitive impairment, an ongoing episode of major depression, anaemia, atrial fibrillation, prolonged intubation and postoperative hypoxia were independently associated with delirium after cardiac surgery.Conclusion: According to the current analysis, the aforementioned conditions independently predispose to delirium following cardiac surgery. Since some of these factors can be successfully treated and eliminated preoperatively and postoperatively, this study should be helpful in reducing the risk of delirium and in improving the medical care of patients undergoing cardiac surgery (Clinical Trials Identifier: NCT00784576).

Delirium among children and adolescents in an urban sub-Saharan African setting

Sean Hatherill, Alan J. Flisher, Rene Nassen — 2010-04-20

Abstract: Objectives: The purpose of this study is to describe the demographic and clinical profile, mortality rates, and effectiveness of a multifaceted treatment approach in hospitalized children and adolescents with delirium referred to psychiatry.Methods: We report a series of 23 children and adolescents prospectively diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, delirium after referral to a consultation–liaison psychiatry service based in a large, regional, dedicated children's hospital in South Africa.Results: Children and adolescents with delirium referred to psychiatrists appear to represent a subgroup of delirious patients with a high risk of mortality, an underrepresentation of hypoactive cases, and complex, multifactorial, and often uncertain etiologies. A significant minority of these cases may be managed without the use of psychotropic medications. Uncontrolled data provide supportive evidence for the moderate effectiveness of both haloperidol and risperidone in childhood delirium when explicit criteria guiding the use of antipsychotic medications are utilized.Conclusions: Delirium is an important and underresearched disorder in children and adolescents. Although the evidence base for the use of antipsychotic medications in childhood delirium remains relatively slim, tentative threshold criteria for the use of such medications are suggested by this study. Controlled studies comparing different antipsychotic medications with each other and with nonpharmacological strategies are urgently required.

Neuroticism, cognitive ability, and the metabolic syndrome: The Vietnam Experience Study

2010-03-15

Abstract: Objectives: The purpose of this study is to explore the association of neuroticism with the metabolic syndrome, separate components of the metabolic syndrome, and the number of components of metabolic syndrome an individual possesses. The purpose of this study is to examine also the extent to which any associations are accounted for by sociodemographic factors, health behaviors, and cognitive ability.Method: Participants were 4208 men drawn from the Vietnam Experience Study. From military archives, and a later telephone interview and psychological and medical examination, sociodemographic, health behavior, cognitive ability, neuroticism, and health data were collected. Neuroticism and cognitive ability were assessed with standardized tests during the medical examination. Presence of the metabolic syndrome was based on body mass index, fasting blood glucose or a diagnosis of diabetes, high blood pressure or taking antihypertensive medication, high-density lipoprotein cholesterol, and triglyceride levels.Results: Neuroticism was positively associated with the occurrence of the metabolic syndrome and several of its components in both age-, and sociodemographic- and health behavior-adjusted analyses. Many associations were accounted for by individual difference in cognitive ability. Neuroticism was robustly associated with the number of components of the metabolic syndrome after adjustment.Conclusions: Individuals with higher neuroticism scores had a higher prevalence of the metabolic syndrome and a larger number of its components. On the whole, differences in cognitive ability appeared to partially mediate the relationship between neuroticism and the metabolic syndrome.

Depressive and anxiety disorders and risk of subclinical atherosclerosis: Findings from the Netherlands Study of Depression and Anxiety (NESDA)

2010-03-22

Abstract: Objective: Current evidence regarding the association between psychopathology and subclinical atherosclerosis show inconsistent results. The present study examined whether subclinical atherosclerosis was more prevalent in a large cohort of persons with depressive or anxiety disorders as compared to non-depressed and non-anxious controls.Methods: Baseline data from the Netherlands Study of Depression and Anxiety were used, including 2717 persons, free of clinical cardiovascular disease. Participants had a DSM-IV-based current or remitted depressive (major depressive disorder, dysthymia) or anxiety (social phobia, generalized anxiety disorder, panic disorder, agoraphobia) disorder (n=2115) or were healthy controls (n=602). Additional clinical characteristics (severity, duration, age of onset and medication) were assessed. Ankle-brachial index (ABI) was used as a measure of vascular risk and was categorized as low (≤0.90) and mildly low ABI (0.90–1.11) indicating subclinical atherosclerosis, and high ABI (>1.40), which was previously designated as a cardiovascular risk factor, reflecting arterial stiffness and wall calcification.Results: As compared to normal controls, persons with current (i.e., past year) depressive, anxiety or comorbid depressive and anxiety disorders showed a two- to threefold increased odds of low ABI (OR=2.78, 95% CI=1.05–7.35; OR=3.14, 95% CI=1.25–7.85; OR=2.67, 95% CI=1.09–6.51, respectively). No associations were found with mildly low or high ABI. Also, we did not further find a differential role for symptoms severity, duration, age of onset, and use of psychotropic medication in the link between psychopathology and subclinical atherosclerosis.Conclusion: Persons with current depressive or anxiety disorders were more likely to have subclinical atherosclerosis compared to healthy controls.

Measures of stress in epidemiological research

2009-11-26

Abstract: A comprehensive assessment of psychosocial stress often poses significant challenges due to diversity in conceptualization of stress. Consequently, a number of instruments that measure psychosocial stress, its stressors, and its impact at the individual, organizational, and societal levels have been developed. This article aims to provide a brief review of such instruments, focusing on established questionnaire and interview measures in line with the environmentalist and psychological conceptualizations of stress. This includes measures of major life events; work, marital, and social stress; the individual's coping abilities; and psychological and somatic outcomes of stress. We provide a general description of selected instruments and discuss their administration, scoring, and psychometric properties. Appropriate application of these instruments in epidemiological and clinical research, as well as in inpatient care, can aid the detection of psychosocial stress, support thorough assessment and management of the individual's illness, and ensure accurate identification of individuals who would benefit from specific behavioral (psychotherapeutic) interventions.

2010-08-01

Title page

2010-08-01

Copyright page

2010-08-01

Instructions for Authors

2010-08-01

Journal of Psychosomatic Research

Aims and Scope

Emotional distress and social relationship dysfunction: The clinical implications of Type D?

Relaxation response and spirituality: Pathways to improve psychological outcomes in cardiac rehabilitation

Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery

Validating the Type D personality construct in Chinese patients with coronary heart disease

Combined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure

First episode of major depressive disorder and vascular factors in coronary artery disease patients: Baseline characteristics and response to antidepressant treatment in the CREATE trial

Change over time in posttraumatic stress caused by myocardial infarction and predicting variables

The fruits of ones labor: Effort–reward imbalance but not job strain is related to heart rate variability across the day in 35–44-year-old workers

Father bonding and blood pressure in young adults from intact and divorced families

Antilipidemic adherence post-coronary artery disease diagnosis among those with and without an ICD-9 diagnosis of depression

Depression and poor adherence to lipid-lowering medications among patients with coronary artery disease

Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study

Delirium among children and adolescents in an urban sub-Saharan African setting

Neuroticism, cognitive ability, and the metabolic syndrome: The Vietnam Experience Study

Depressive and anxiety disorders and risk of subclinical atherosclerosis: Findings from the Netherlands Study of Depression and Anxiety (NESDA)

Measures of stress in epidemiological research

Table of Contents

Title page

Copyright page

Instructions for Authors