Journal of Psychosomatic Research

Aims and Scope

2012-05-01

When prevention is a bad idea: Problems with the DECARD trial and the premise behind it

Brett D. Thombs, Roy C. Ziegelstein — 2012-03-19

In the January 2012 issue of the Journal of Psychosomatic Research, Hansen et al. reported results from the DEpression in patients with Coronary ARtery Disease (DECARD) trial. DECARD was designed to test the hypothesis that treating patients who are not depressed with the antidepressant escitalopram for 1year after an acute coronary syndrome (ACS) would reduce the number of patients who develop depression. Patients were randomized within 8weeks of the ACS to receive escitalopram (n=120) or placebo (n=119) and were assessed 9 times over the course of the 12-month study period. The authors reported that 2 patients treated with escitalopram developed depression versus 10 in the placebo group and concluded that escitalopram prevented depression in post-ACS patients. The way in which this trial was designed, conducted, and reported, however, raises questions about whether these findings could be reproduced in an adequately powered trial and suggests that considerable caution should be used in their interpretation. More generally, the appropriateness of exposing ACS patients without depression to antidepressants must be questioned, even if one were to accept these findings.

Associations between dimensional personality measures and preclinical atherosclerosis: The cardiovascular risk in Young Finns study

2012-03-19

Abstract: Objective: To assess how multidimensional personality–trait theories, such as the Psychobiological Model of Temperament and Character, and the Five-factor Model of Personality, are associated with subclinical atherosclerosis as indicated by carotid intima-media thickness (IMT). The analysis was designed to tolerate non-linear development in which the same personality profiles can have multiple final outcomes and different antecedent profiles can have the same final outcome.Methods: 605 men and 844 women (average age 31.6year, s.d.=5.0, range=24–39) provided data on IMT and traits of the psychobiological model, 725 men and 1011 women were assessed for IMT and the five-factor model (age 37.7year, s.d.=5.0, range=30–45). Robust multidimensional Hotelling’s T2 statistic was used to detect personality differences between participants with high IMT and others. Model-based clustering method further explored the effect.Results: Those with a high level of subclinical atherosclerosis within the sample (highest IMT-decile) had a combined higher persistence (i.e., were perseverative or perfectionistic), more disorganized (schizotypal) character, and more antisocial temperamental configuration than others (P=0.019). No effect was found for the five-factor model (P=0.978). Traditional methods that did not account for multidimensionality and nonlinearity did not detect an association.Conclusion: Psychological well-being may have positive effects on health that reduce atherosclerosis in the population as a whole. Increased subclinical atherosclerosis was associated with a profile that combines known risk factors, such as cynical distrust and hostile tendencies. More frequent use of statistical procedures that can cope with non-linear interactions in complex psychobiological systems may facilitate scientific advances in health promotion.

Parental cancer: Factors associated with children's psychosocial adjustment — a systematic review

2012-03-16

Abstract: Objective: Children of cancer patients have an increased risk of developing psychosocial problems. But not all children are alike vulnerable to this stressful event. Thus, knowledge of risk and protective factors is required to design specific diagnostic tools and interventions for this vulnerable population. This study aims to provide a review and methodological evaluation of current studies examining factors associated with children's psychosocial adjustment when a parent has cancer.Methods: Four databases were systematically searched for quantitative research articles examining associative factors of children's adjustment. Study characteristics were analyzed and methodological quality was assessed by two independent reviewers.Results: 28 studies examining associative factors in 2896 families were identified. The included studies used a broad range of instruments assessing children's adjustment. Most patients were female breast cancer patients with middle to high socio-economic status. The majority of included studies used correlational approaches and cross-sectional designs. None of the studies examined toddlers or assessed children's quality of life. Across studies with low to high quality, we found no evidence of illness-related factors, except worse disease status that was related to lower adjustment. Evidence from moderate to high quality studies suggest that better family functioning indicates better adjustment, whereas parent's depressive mood indicates worse adjustment of the children. Child-related factors were inconsistent.Conclusion: Health professionals should pay attention to cancer patients' dependent children. In order to identify this at-risk population, parent's depressive mood and poor family functioning should be considered. Future studies should also assess children's quality of life and child-related factors.

Role of older adult's illness schemata in coping with Mild Cognitive Impairment

Feng Lin, Susan M. Heidrich — 2012-03-14

Abstract: Objective: 1) To describe the illness representations of older persons with Mild Cognitive Impairment (MCI); 2) to describe how older adults cope with MCI; 3) to examine the relationships between illness representations and coping.Methods: Sixty-three older adults with MCI completed questionnaires on demographic and health information, beliefs about MCI (Illness Perception Questionnaire-MCI), and coping with MCI (brief COPE and Self-care Behaviors Checklist).Results: Participants endorsed an average of 7 symptoms that they experienced and believed were related to MCI and an average of 7 potential causes of MCI. Participants tended to believe MCI was chronic, not cyclic, and controllable, but they differed in their beliefs about the consequences, understandability and emotional impact of MCI. Participants used many dementia prevention behaviors and memory aids, some problem-focused and emotion-focused coping strategies, and few dysfunctional coping strategies. Cluster analysis identified three clusters of beliefs about MCI: “few symptoms and positive beliefs,” “moderate symptoms and positive beliefs,” and “many symptoms and negative beliefs.” Those in the “many symptoms and negative beliefs” cluster had significantly more negative beliefs about the consequences, unpredictability (cyclic timeline), and emotional impact of MCI than those in the other clusters. Participants in the “few symptoms and positive beliefs” cluster used significantly fewer memory aids, problem-focused coping strategies, emotion-focused coping strategies, and dysfunctional coping than those in the other two clusters.Conclusion: As suggested by the Common Sense Model, older adults with MCI have beliefs about their MCI and these beliefs are associated with how older adults cope with MCI.

Associations between adult attachment style and health risk behaviors in an adult female primary care population

Kym R. Ahrens, Paul Ciechanowski, Wayne Katon — 2012-03-14

Abstract: Objective: To examine the relationship between adult attachment style and health risk behaviors among adult women in a primary care setting.Methods: In this analysis of a population of women enrolled in a large health maintenance organization (N=701), we examined the relationship between anxious and avoidant dimensions of adult attachment style and a variety of sexual, substance-related, and other health risk behaviors. After conducting descriptive statistics of the entire population, we determined the relationships between the two attachment dimensions and health behaviors using multiple regression analyses in which we controlled for demographic and socioeconomic factors.Results: After adjustment for covariates, the anxious dimension of attachment style was significantly associated with increased odds of self-report of having sex without knowing a partner's history, having multiple (≥2) male partners in the past year, and history of having a sexually transmitted infection (ORs [95% CIs]=1.11 [1.03, 1.20], 1.23 [1.04, 1.45]; and 1.17 [1.05, 1.30], respectively). The avoidant attachment dimension was associated with increased odds of being a smoker and not reporting regular seatbelt use (ORs [95% CIs]=1.15 [1.01, 1.30] and 1.16 [1.01, 1.33], respectively).Conclusions: Both anxious and avoidant dimensions of attachment were associated with health risk behaviors in this study. This framework may be a useful tool to allow primary care clinicians to guide screening and intervention efforts.

Depressive symptoms and unprotected sex in St. Petersburg, Russia

2012-02-20

Abstract: Objective: Growing evidence indicates that emotional distress such as depression may have the potential to increase the risk for HIV and other sexually transmitted infections (STIs). This study investigated the association between depressive symptoms and unprotected sex among STI clinic patients in Russia.Methods: We used pre-intervention data collected between 2009 and 2010 among 307 participants who were enrolled in a randomized intervention trial conducted in an STI clinic in St. Petersburg, Russia. The 10-item Center for Epidemiological Studies Depression Scale was used to identify depressive symptoms and two indicators were used to measure unprotected sex. Logistic regression models were applied for the analysis and controlled for the following potential confounders: demographic characteristics, being a commercial sex worker, history of drug injection and alcohol misuse.Results: Of the participants, 20.2% were classified as having depressive symptoms. About 59.6% of the participants did not use a condom during the last sexual intercourse and 24.4% never used condoms in the past 3months. Depressive symptoms were significantly associated with both indicators of unprotected sex in two different models: odds ratio (OR)=2.36, 95% confidence interval (CI), 1.24–4.48 for unprotected sex in the last sexual intercourse; and OR=2.71, 95% CI, 1.43–5.11 for unprotected sex in the past 3months.Conclusion: Depressive symptoms were common and were strongly associated with unprotected sex among study participants in St. Petersburg, Russia. Efforts to promote condom use should address lack of condom use due to depressive symptoms.

Gender specific temporal and cross-sectional associations between BMI-class and symptoms of depression in the elderly

2012-03-19

Abstract: Objective: The aim of the study was the gender specific analysis of cross-sectional and longitudinal associations between body mass index class (BMI-class) and symptoms of depression in a representative sample of elderly German people.Methods: At the baseline of the ESTHER study (2000–2002), 9953 participants completed a comprehensive questionnaire including items regarding weight, height, and depression history. After five years, 7808 participants again completed the questionnaire and the 15-item geriatric depression scale (GDS-15). BMI was classified into five classes: normal weight, 18.5≤BMI<25; overweight, 25≤BMI<30; obesity class I, 30≤BMI<35; obesity class II, 35≤BMI<40; obesity class III, BMI≥40.Results: Logistic regression analysis for the cross-sectional data at five-year follow-up, adjusted for age, education, marital status, smoking, multimorbidity, physical activity, self-perceived cognitive impairment, and use of antidepressants, showed that the odds for depression were significantly elevated for women in obesity class II and significantly decreased for overweight men. The longitudinal analysis showed a similar pattern: Women in obesity classes II and III at baseline had significantly higher odds for being depressive five years later than women with normal weight at baseline (class II: OR=1.67; 95%CI=[1.06; 2.64]; class III: OR=2.93; 95%CI=[1.37; 6.26]; overweight men had lower odds than normal-weight men (OR=0.69; 95%CI=[0.51;0.92]).Conclusion: The relationship between obesity and symptoms of depression appears to be heterogeneous across BMI-classes. Women are more affected than men by obesity class II and III; overweight appears to be associated with reduced risk of depression in elderly men.

Biogenetic temperament and character in insomnia and depression

Sojin Lee, Seog Ju Kim, Jong Eun Park, Seong-Jin Cho, In Hee Cho, Yu Jin Lee — 2012-03-14

Abstract: Objective: We compared the biogenetic temperaments and characters of primary insomnia patients, major depressive disorder (MDD) patients with insomnia, MDD patients without insomnia, and normal controls.Methods: A total of 417 participants were recruited from a community and a psychiatric clinic in South Korea. Subjects were divided into 4 groups based on the Structured Clinical Interview for DSM-IV axis I disorder (SCID-IV) and sleep questionnaire: 1) normal controls (n=314), 2) primary insomnia (n=33), 3) MDD without insomnia (n=30), and 4) MDD with insomnia (n=40). All participants were requested to complete the Temperament and Character Inventory.Results: There were significant between-group differences in harm avoidance (HA)(F=32.96, p<0.001), reward dependence (RD)(F=5.21, p<0.01), self-directedness (SD)(F=24.72, p<0.001) and cooperativeness (CO)(F=15.75, p<0.001), after controlling for age and gender. Subjects with primary insomnia showed higher HA and lower SD than normal control, but lower HA and higher SD than MDD patients with insomnia. CO was lower in MDD patients, but not in subjects with primary insomnia. Lower RD was found only in MDD patients with insomnia.Conclusion: The current study suggests that high HA and low SD were related to primary insomnia, although these patterns were more prominent in patients with MDD.

Catastrophic interpretations and anxiety sensitivity as predictors of panic-spectrum psychopathology in chronic obstructive pulmonary disease

Nicole Livermore, Louise Sharpe, David McKenzie — 2012-02-27

Abstract: Objective: Panic-spectrum psychopathology (denoting panic attacks and panic disorder) is highly prevalent in chronic obstructive pulmonary disease (COPD), and the cognitive model of panic has been proposed as an explanation of this high prevalence. In the current cross-sectional study we investigated factors predicting panic-spectrum psychopathology in COPD, and hypothesized that, consistent with the cognitive model, both the catastrophic interpretation of shortness of breath and elevated anxiety sensitivity would be significant predictors when variance shared with confounding variables was controlled.Methods: Sixty-two participants with COPD were interviewed with the Anxiety Disorders Interview Schedule for DSM-IV, Panic Disorder section, and completed measures of interpretation of breathing difficulty, anxiety sensitivity, anxiety, depression, disease-specific quality of life, and stressful life events. Objective disease severity was measured using forced expiratory volume in the first second.Results: Direct logistic regression was performed, and worse depressive symptoms, more catastrophic interpretations of shortness of breath, higher anxiety sensitivity, higher magnitude of recent stressful life events, and worse disease severity were each found to be significant unique predictors of panic-spectrum psychopathology in COPD after shared variance was controlled.Conclusions: The results of the study provide support for the cognitive model of panic, and also suggest a diathesis-stress explanation of the development of panic-spectrum psychopathology in COPD. The findings have implications for future preventative psychological interventions.

Body mass index and mental health problems in general adults: Disparity in gender and socioeconomic status

Hsiao-Yun Hu, Chen-Yi Wu, Yiing-Jenq Chou, Nicole Huang — 2012-01-30

Abstract: Objective: This nationwide population-based study aims to evaluate the association between Body Mass Index (BMI) and mental health problems, and to investigate the effects of gender and socioeconomic status (SES) on this association.Methods: This study was a longitudinal study. 12,862 adults (aged 18years or older), who responded to the 2001 National Health Interview Survey (NHIS) and gave consent to the linking of the survey data to their National Health Insurance (NHI) claims records, were included. The 2002–2004 NHI claims records of the sample were analyzed. Logistic regression was used to evaluate the odds ratios. Those with middle and high income (per capita annual household income ≧US$9375) in the sample were referred to as the better-offs.Results: After adjustment, increased BMI was significantly associated with a higher risk of schizophrenia (OR: 1.14, 95% CI: 1.07–1.22) and a lower risk of mood disorder (OR: 0.95, 95% CI: 0.91–0.99) in women. In addition, a higher BMI was significantly associated with a lower risk of mood disorders (risk reduction: 6%) and a lower risk of any major mental health problem (risk reduction: 3%) among the better-offs.Conclusions: In contrast to other (cross-sectional) studies in other countries, our longitudinal results suggest that in a general Taiwanese population, the association between BMI and mental health may vary by type of mental health problems. Gender and SES may have influenced this relationship. Further studies are required to elucidate the biological or social factors underlying these empirical observations.

Towards an evidence-based treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome

Jan F. Wiborg, Hans Knoop, Laurence E. Frank, Gijs Bleijenberg — 2012-02-23

Abstract: Objective: The purpose of the present study was to develop a treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome (CFS) based on the model of perpetuating factors introduced by Vercoulen et al. [Journal of Psychosomatic Research 1998;45:507–17].Methods: For this purpose, we reanalyzed the data of a previously conducted randomized controlled trial in which a low intensity cognitive behavioral intervention was compared to a waiting list control group. Structural equation modeling was used to test a treatment model in which changes in focusing on symptoms, perceived problems with activity, and sense of control over fatigue were hypothesized to mediate the effect of our intervention on fatigue severity and disability.Results: In the final model, which had a good fit to the data, the effect of treatment was mediated by a decrease in perceived problems with activity and an increase in sense of control over fatigue.Conclusion: Our findings suggest that cognitive behavioral interventions for CFS need to change the illness perception and beliefs of their patients in order to be effective.

Diagnosis and assessment of apathy in Chinese patients with Alzheimer's disease

Hongyi Zhao, Zhongxin Zhao, Liuqing Huang, Maurice Preter — 2012-02-03

Abstract: Background: Apathy is a major component of the behavioral and psychological symptoms of Alzheimer's Disease (AD) and other types of dementia. Most researchers have reached a consensus on a new set of diagnostic criteria for apathy (DCA) recently. However, no relevant reports on apathy exist for AD patients in Asian countries yet.Objectives: To estimate the prevalence of apathy in Chinese AD patients.Methods: 83 AD patients were recruited for a cross-sectional observational study. Following the new diagnostic criteria for apathy (DCA) and DSM-IV criteria for Major Depressive Disorder (MDD), each patient was assessed successively by Mini Mental State Examination (MMSE), the Neuropsychiatric Inventory-apathy subscale (NPI-apathy), the Geriatric Depression Screening scale (GDS), and the Caregiver Burden Scale (CBS).Results: According to the DCA, we found that the frequency of apathy in Chinese AD patients reached 61.4%. The DCA had very good standard validity and internal consistency. The frequency of apathy was not significantly associated with that of depression, whereas there was a significant association between apathy and more severe cognitive deficits. Caregiver burden was significantly associated with severity of apathy.Conclusions: From the symptoms of a group of Chinese AD patients, we summarized a set of effective methods for the diagnosis and assessment of apathy.

The effect of priming illness memory on pain tolerance: A failed replication

Esther E. Meerman, Jos F. Brosschot, Bart Verkuil — 2012-03-19

It has been hypothesized that complaints without any medical origin are the result of illness-related memory networks, which cause increased selective attention towards innocuous bodily signals, and in turn cause increased detection, interpretation and reporting of these signals as complaints .

Outcomes of autogenic training for patients with chronic subjective dizziness

F. Goto, T. Tsutsumi, M. Kabeya, K. Ogawa — 2012-02-20

CSD was described by Staab and Ruckenstein , who defined it as a syndrome of chronic nonvertiginous dizziness or subjective imbalance accompanied by hypersensitivity to motion stimuli and poor tolerance for complex visual stimuli, occurring in the absence of active vestibular deficits. There is no universally effective treatment for patients with CSD. The use of psychotherapy for the treatment of dizziness was recently reviewed . However, only studies related to cognitive behavioral therapy were included . The present study aimed to investigate the efficacy of AT, which is a type of psychotherapy. We previously reported the benefits of AT in patients with intractable Meniere's disease . AT was developed by the German psychiatrist Johannes Schultz, . AT influences the autonomic nervous system and can be used to alleviate many stress-induced psychosomatic disorders. It is likely that stress and illness create a vicious cycle. Because AT is an effective self-control method, patients using AT may learn to control their symptoms, including anxiety. The first line of treatment for CSD patients may be selective serotonin reuptake inhibitors (SSRIs) . However, not all patients experience symptom improvement with SSRIs. It has been suggested that AT reduces depression by reducing anxiety and tension. It is expected that not only psychiatric patients, but also patients in general, including those experiencing otorhinolaryngological disorders, may benefit from psychological therapy, including AT. In the present study, we attempted to assess the efficacy of AT as a cotherapy for CSD.

Contents of this issue

2012-05-01

Title Page

2012-05-01

Copyright Page

2012-05-01