Journal of Psychosomatic Research - Articles in Press

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

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 diurnal salivary cortisol pattern of adolescents from families with single, ill and healthy parents - Corrected Proof

Dominik S. Sieh, Johanna M.A. Visser-Meily, Frans J. Oort, Anne Marie Meijer — 2012-02-01

Abstract: Objective: Adolescents of single and/or chronically ill parents (target groups) reportedly have elevated psychological stress. However, their salivary cortisol pattern as part of the physiological stress system has not been compared to controls. The aim of this study is to examine differential outcomes in the diurnal cortisol pattern of the target groups.Methods: In total, 100 adolescents of three groups with either single, chronically ill or two healthy parents were compared on cortisol. Three salivary cortisol samples were taken after awakening, one sample at noon and one sample at 20:00p.m. during a non-school day. Group differences and interaction effects between measurement (5 times), group membership and covariates were tested through linear mixed modeling, repeated measures. Covariates were children's sex and age, socioeconomic status (SES) and parental depression as measured with the Beck Depression Inventory.Results: The three groups did not differ significantly concerning the amount of salivary cortisol, even after controlling for the covariates. The target groups had a lower SES than adolescents with two healthy parents. In addition, chronically ill parents were more depressed than single and healthy parents. Male sex and older age of the child, and lower parental depression were associated with increased cortisol values throughout the day.Conclusion: Research on cortisol in children should control for children's sex and age, and parental depression. Adolescents with single and/or chronically ill parents displayed a healthy pattern of diurnal salivary cortisol.

Body image, emotions and thought control strategies in body dysmorphic disorder compared to eating disorders and healthy controls - Corrected Proof

2012-01-30

Abstract: Objective: A disordered body image, emotions such as shame and disgust, and intrusive thoughts are described as important and interdependent features of body dysmorphic disorder (BDD). However, research in this field is scarce and knowledge is often based on clinical observation.Methods: The present study examined body image dimensions, emotions, and thought control strategies in individuals with: BDD (n=31), anorexia nervosa (n=32), bulimia nervosa (n=34), and healthy controls (n=33). Assessment was based on structured diagnostic interviews and self-report questionnaires.Results: Individuals with BDD scored higher on psychosocial and appearance manipulation dimensions of body image compared to healthy controls. Furthermore, they reported higher psychosocial impairment due to appearance than both eating disorder groups. In terms of emotions, BDD subjects reported a higher degree of negative emotions compared to healthy controls, whereas no differences were found in comparison to eating-disordered patients. Individuals with BDD reported using maladaptive strategies such as worrying and confrontation more often than healthy controls, when encountering intrusive and unwanted thoughts.Conclusion: The results indicate that individuals with BDD experience substantial psychosocial impairment due to appearance, high levels of various negative emotions and frequently use maladaptive thought control strategies.

Posttraumatic growth in coronary artery disease outpatients: Relationship to degree of trauma and health service use - Corrected Proof

2012-01-30

Abstract: Objectives: Posttraumatic growth (PTG) is frequently reported after the strike of a serious medical illness. The current study sought to: 1) assess the relationship between degree of cardiac “threat” and PTG one-year post-hospitalization; and 2) to explore the association between PTG and healthcare utilization.Methods: In a cohort study, 2636 cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey; clinical data were extracted from charts. One year later, 1717 of these outpatients completed a postal survey, which assessed PTG and healthcare utilization. Morbidity data were obtained retrospectively through probabilistic linkage to administrative data. The predicted risk of recurrent events for each participant was calculated using a logistic regression model, based on participants' sociodemographic and clinical characteristics. The relationship among PTG, trauma and health service use was examined with multiple regression models.Results: Greater PTG was significantly related to greater predicted risk of recurrent events (p<0.001), but not the actual rate of recurrent events (p=0.117). Moreover, greater PTG was significantly related to more physician visits (p=0.006), and cardiac rehabilitation program enrolment (p=0.001) after accounting for predicted risk and sociodemographic variables. PTG was not related to urgent healthcare use.Conclusions: Greater PTG was related to greater objective risk of morbidity but not actual morbidity, suggesting that contemplation about the risk of future health problems may spur PTG. Moreover, greater PTG was associated with seeking non-urgent healthcare. Whether this translates to improved health outcomes warrants future study.

Effect of obstructive sleep apnea on response to cognitive behavior therapy for depression after an acute myocardial infarction - Corrected Proof

2012-01-30

Abstract: Objective: To determine whether obstructive sleep apnea (OSA) interferes with cognitive behavior therapy (CBT) for depression in patients with coronary heart disease.Methods: Patients who were depressed within 28days after an acute myocardial infarction (MI) were enrolled in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial; 289 (12%) of the 2481 participants in ENRICHD met the criteria for inclusion in this ancillary study.Results: A validated ambulatory ECG algorithm was used to detect OSA. Of the 289 participants, 64 (22%) met the criteria for OSA. CBT was efficacious relative to usual care (UC) for depression (p=.004). OSA had no effect on 6-month Beck Depression Inventory (BDI) scores (p=.11), and there was no interaction between OSA and treatment (p=.42). However, the adjusted mean (s.e.) 6-month BDI scores among patients without OSA were 12.2 (0.8) vs. 9.0 (0.8) in the UC and CBT groups (Cohen's d=.40); among those with OSA, they were 9.5 (1.4) and 8.1 (1.5) in the UC and CBT groups (d=.17). There were no significant OSA×Treatment interactions in the major depression (n=131) or minor depression (n=158) subgroups, but in those with major depression, there was a larger treatment effect in those without (d=.44) than with (d=.09) OSA. In those with minor depression, the treatment effects were d=.37 and d=.25 for the non-OSA and OSA subgroups.Conclusion: CBT is efficacious for depression after an acute myocardial infarction in patients without obstructive sleep apnea, but it may be less efficacious for post-MI patients with OSA.

Type D (distressed) personality in primary care patients with type 2 diabetes: Validation and clinical correlates of the DS14 assessment - Corrected Proof

Giesje Nefs, François Pouwer, Victor Pop, Johan Denollet — 2012-01-30

Abstract: Objective: In cardiovascular research, Type D personality (high negative affectivity and social inhibition) has been associated with a more than 3-fold increased risk of adverse health outcomes. This study examined the validity and clinical correlates of the Type D construct as assessed by the Type D Scale-14 (DS14) in type 2 diabetes patients.Methods: 1553 primary care patients with type 2 diabetes were assessed for demographic, clinical, lifestyle and psychological characteristics in 2007. A subgroup (n=1012) completed the DS14 again 1year later.Results: The two-factor model of the Type D construct was confirmed in exploratory and confirmatory factor analyses; results were stable across gender. The Negative Affectivity (NA) and Social Inhibition (SI) subscales had adequate reliability in both men and women, as measured by Cronbach's alpha (NA=0.87, SI=0.83), lambda2 (NA=0.87/0.88, SI=0.84), corrected item-total correlations (NA 0.47–0.77, SI 0.34–0.72) and mean inter-item correlations (NA=0.50/0.51, SI=0.42). One year test–retest reliability using intraclass correlation coefficients was 0.64/0.63 for NA and 0.73/0.65 for SI. Type D and non-Type D patients did not differ in vascular history or physiological risk factors, but Type D women had a more sedentary lifestyle (p=.003). Type D patients experienced less social support and more stressful life events, loneliness, and more depressed mood, anhedonia and anxiety (p 0.60 for most variables).Conclusion: Type D personality can be reliably assessed in primary care patients with type 2 diabetes, and is associated with increased loneliness, stress and emotional distress in these patients.

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

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.

Psychological stress as a risk factor for postoperative keloid recurrence - Corrected Proof

2012-01-27

Abstract: Objective: To investigate psychological stress on the prognosis of the postoperative recurrence of keloids.Methods: Patients with keloids (n=25), candidates for surgical resection and postoperative radiotherapy, had their psychological stress evaluated on the day before the surgical procedure. The parameters evaluated were pain and itching (Visual Numerical Scale), quality of life (Questionnaire QualiFibro/Cirurgia Plástica-UNIFESP), perceived stress (Perceived Stress Scale), depression and anxiety (Hospital Depression and Anxiety Scale), salivary cortisol and minimum and maximum galvanic skin responses (GSR) at rest and under stress (i.e., while the questionnaires were being filled out). Patients were evaluated during the 3rd, 6th, 9th and 12th months of postoperative care. During each return visit, two experts classified the lesions as non-recurrent and recurrent.Results: The recurrence group presented the greatest values in GSR during a stressful situation. The chance of recurrence increased by 34% at each increase of 1000 arbitrary units in maximum GSR during stress.Conclusion: Psychological stress influenced the recurrence of keloids.

The relationship of modern health worries to depression, symptom reporting and quality of life in a general population survey - Corrected Proof

2012-01-20

Abstract: Objective: Worries about the risk to personal health from new technology and features of modern life have been shown to be associated with the use of health care services, health behaviours, mood and reporting of physical symptoms. We examined the frequency and nature of these concerns in a large national sample and the relationship of modern health worries to demographic factors, depression, symptom reporting and health-related quality of life.Methods: A representative sample of the German population (n=2485) completed a face-to-face survey which included demographic information, the Modern Health Worries Scale, as well as measures of depression, symptom reporting, and health-related quality of life.Results: The majority of the population reports high or extremely high concerns about aspects of modernity affecting their personal health, while only six percent reported no concerns at all. Higher levels of modern health worries were found in females but were not associated with income or age. Higher levels of modern health worries were significantly associated with depression, symptom reporting and lower health-related quality of life. We found the relationship between modern health worries and both symptom reporting and health-related quality of life was only partially explained by depression for most outcome variables, while the association between MHW and physical component (SF-12) was fully mediated by depression.Conclusions: Concerns about aspects of modernity affecting health are common in a general population sample and associated with depression, symptom reporting and quality of life.

Alexithymia in children with cancer and their siblings - Corrected Proof

2012-01-20

Abstract: Objective: The purpose of this study was to examine the levels of alexithymia in children with cancer, in siblings of children with cancer, and in healthy controls.Method: In order to compare the groups the Alexithymia Questionnaire for Children was used. The study group consisted of 97 children with cancer, 95 siblings, and 151 healthy controls.Results: The highest level of alexithymia was reported by children diagnosed with cancer, followed by their siblings. Healthy controls reported the lowest level of alexithymia. No gender differences were observed. The intensity of cancer was a significant predictor of the alexithymia score, with patients with the most severe cancers reporting the highest levels of alexithymia. No differences were found between the patients with moderately severe and least severe cancers.Conclusions: Not only children with cancer, but also their siblings show significantly more alexithymia than their healthy counterparts. Professionals should aim at preventing or reducing the psychological problems in both patients and their siblings.

Fatigue after subarachnoid haemorrhage: A systematic review - Corrected Proof

Mansur A. Kutlubaev, Amanda J. Barugh, Gillian E. Mead — 2012-01-20

Abstract: Background: Fatigue is common and debilitating symptom in many neurological disorders and it has been reported in patients after non-traumatic subarachnoid haemorrhage (SAH).Objectives: We undertook a systematic review to identify and critically appraise all published studies that have reported frequency, severity and time course of fatigue after SAH, the factors associated with its development and the impact of fatigue on patients' life after SAH.Methods: We searched Medline, EMBASE, CINAHL, PsycINFO, AMED, PubMed and included in the review all studies published in English, recruiting at least 10 patients (>18years old) after SAH, which reported fatigue.Results: We identified 13 studies (total number of subjects 737) meeting our inclusion criteria. The frequency of fatigue ranged from 31 to 90%. Fatigue remained common even several years after the ictus. According to some studies fatigue after SAH was associated with sleep disturbances, anxiety, depression, posttraumatic stress disorder, cognitive and physical impairment, but these could not explain all cases of fatigue. Fatigue reduces quality of life and life satisfaction in patients after SAH.Conclusions: Fatigue is common after SAH and seems to persist. Further research is needed to clarify its time course and identify factors associated with its development.

Nurse-led liaison mental health service for older adults: Service development using lean thinking methodology - Corrected Proof

Paula Atkinson, Elizabeta B. Mukaetova-Ladinska — 2012-01-20

Abstract: Objectives: Liaison Psychiatric Services for Older Adults in the UK have been established over the last decade, with rather divergent team composition and involvement. The latest documents (National Dementia Strategy, Who Cares Wins) set the gold standard for liaison services for older adults in England, requiring a proactive approach to services and integrating assessment and treatment of mental disorder into routine general hospital practice. This requires a physical presence of liaison services in the hospital, with collaboration with medical colleagues.Methods: We have adopted the above strategy in a nurse-led liaison service working in a General District Hospital, and used the Toyota Production System.Results: In the current study we reflect on the 5day rapid progress improvement workshops event for the liaison branch of the project, and describe the process of identifying real situation problems for the care of the medically ill, the involvement of the liaison team in their clinical care, and a feedback on the change in practice.Conclusion: The novel approach of identifying areas for change in an ongoing nurse-led Liaison service for Older Adults resulted in improving access to mental health services for elderly medically ill inpatients and improved quality of their overall care.

Disease-related and psychosocial factors associated with depressive symptoms in patients with systemic sclerosis, including fear of progression and appearance self-esteem - Corrected Proof

2012-01-18

Abstract: Objective: The prevalence of depressive symptoms is high in patients with systemic sclerosis (SSc, scleroderma). This study was conducted to determine which disease-related and psychosocial factors are associated with depressive symptoms, independent of sociodemographic factors.Methods: In total, 215 patients with SSc completed questionnaires on sociodemographics, physical functioning (HAQ-DI), pain (VAS), fatigue (CIS), psychosocial characteristics (CISS, ICQ, PRQ, ASE, FoP-Q-SF) and depressive symptoms (CES-D). Disease characteristics (disease duration, disease subtype, modified Rodnan Skin Score) were collected. Hierarchical linear regression analyses were conducted to assess associations with depressive symptoms.Results: The mean CES-D score was 12.9 (SD=9.7) and the prevalence of patients scoring>= 16 and>=19 were 32.1% and 25.1%, respectively. The variance explained by sociodemographics and disease characteristics was negligible (R2≤.09). Fatigue and pain were independently associated with depressive symptoms (R2 change=.35). After adding psychological factors (R2 change=.21), satisfaction with social support, emotion-focused coping and helplessness were also significantly associated with depressive symptoms. Higher fear of progression was associated with more depressive symptoms (P≤.01), and appearance self-esteem showed a marginally significant association (P=.08).Conclusion: Depressive symptoms were common in the present sample of patients with SSc and were independently associated with pain, fatigue, social support, emotion-focused coping, helplessness and fear of progression. Results suggest that, in addition to assessment of disease characteristics, attention should be given also to psychosocial factors found to be associated with depressive symptoms. For the development and trialling of psychological interventions, fear of progression could be an important target.

Healthcare costs incurred by patients repeatedly referred to secondary medical care with medically unexplained symptoms: A cost of illness study - Corrected Proof

Christopher Burton, Kelly McGorm, Gerry Richardson, David Weller, Michael Sharpe — 2012-01-18

Abstract: Background: Some patients are repeatedly referred from primary to secondary care with medically unexplained symptoms (MUS). We aimed to estimate the healthcare costs incurred by such referrals and to compare them with those incurred by other referred patients from the same defined primary care sample.Methods: Using a referral database and case note review, all adult patients aged less than 65years, who had been referred to specialist medical services from one of five UK National Health Service primary care practices in a five-year period, were identified. They were placed in one of three groups: (i) repeatedly referred with MUS (N=276); (ii) infrequently referred (IRS, N=221), (iii) repeatedly referred with medically explained symptoms (N=230). Secondary care activities for each group (inpatient days, outpatient appointments, emergency department attendances and investigations) were identified from primary care records. The associated costs were allocated using summary data and the costs for each group compared.Results: Patients who had been repeatedly referred with MUS had higher mean inpatient, outpatient and emergency department costs than those infrequently referred (£3,539, 95% CI 1458 to 5621, £778 CI 705 to 852 and £99, CI 74 to 123 respectively. The mean overall costs were similar to those of patients who had been repeatedly referred with medically explained symptoms.Conclusions: The repeated referral of patients with MUS to secondary medical care incurs substantial healthcare costs. An alternative form of management that reduces such referrals offers potential cost savings.

The course of depression and anxiety in patients undergoing disc surgery: A longitudinal observational study - Corrected Proof

2012-01-16

Abstract: Objective: This study examines longitudinal depression and anxiety rates in disc surgery patients in comparison to the general population, the change and associated determinants of depression and anxiety over time.Methods: The longitudinal observational study refers to 305 consecutive disc surgery patients (age range: 18–55years). Depression and anxiety was assessed with the Hospital Anxiety and Depression Scale. Random effects regression models for unbalanced panel data were used.Results: Depression and anxiety decreases significantly during nine months after surgery. Depression rates vary between 23.6% (T0), 9.6% (T1) and 13.1% (T2). Only at T0 the depression rate differs significantly from the general population. Anxiety rates range between 23.7% (T0), 10.9% (T1) and 11.1% (T2). Compared to the general population anxiety rates are significantly higher at all three assessment points. Risk factors for anxiety or depression at the time of the surgery are psychiatric comorbidity before surgery, higher age, female gender, lower educational level, lower physical health status and higher pain intensity. Regarding depression and anxiety in the course of time significant time interactions were found for the existence of other chronic diseases, higher pain intensity and vocational dissatisfaction.Conclusions: Compared to the general population patients undergoing herniated disc surgery are often affected by depression and anxiety during hospital treatment and also in the course of time. Multimodal diagnostics regarding psychological well-being, pain and physical health status may help to identify this risk group. The assistance by mental health professionals during hospital and rehabilitation treatment may reduce poor postoperative outcome.

No further research needed: Abandoning the Hospital and Anxiety Depression Scale (HADS) - Corrected Proof

James C. Coyne, Eric van Sonderen — 2012-01-16

Cosco and colleagues [this issue] provide a well done and transparently reported systematic review of the Hospital and Anxiety Depression Scale (HADS) literature of the past decade. They conclude that the underlying structure of the HADS is inconsistent across samples and highly dependent on the statistical methods used to establish that structure. The implication is that the HADS is not a dependable means of differentiating anxiety and depression for the purposes of assessing the absolute or relative levels of these variables. These results can also go far in explaining the confusing difficulties that have arisen in research concerning use of the HADS as the first stage of two-stage screening procedures for depression and anxiety disorders or case identification purposes.

Comparison of two depression measures for predicting stroke outcomes - Corrected Proof

2012-01-16

Abstract: Objectives: Little is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ability to predict quality of life and functioning at 3 and 12months after stroke.Methods: A cohort of 460 ischemic stroke patients from the 2005 Greater Cincinnati/North Kentucky Stroke Study was assessed within 2weeks of the stroke, including the 10-item Center for Epidemiological Studies Depression Scale (CESD) for current symptoms of depression. Lifetime history of depression was also assessed by a 2-question measure at 3 and 12months after stroke. Two outcome measures, Stroke Specific Quality of Life (SSQOL) and the modified Rankin Scale (mRS) to assess functional status, were also collected at 3 and 12months.Results: Of the 322 survivors included in the analysis, 52.2% reported depression on at least one measure. Both current symptoms and lifetime history of depression predicted poor functional outcomes and poor quality of life at 3 and 12months, after adjustment for age, race, sex, prior stroke, baseline functional status, and stroke severity. The combination of depression measures was a better predictor of poor outcomes than either measure alone.Conclusion: Depression by either measure was a frequent, substantial, and independent predictor of poor outcomes at 3 and 12months after stroke. Stroke outcomes studies should further examine the predictive value of assessing both depressive symptoms at the time of the stroke and lifetime history of depression.

The impact of the voice in relation to psychosomatic well-being after education in female student teachers: A longitudinal, descriptive study - Corrected Proof

2012-01-16

Abstract: Objective: Voice handicap in relation to psychosomatic well-being after education in female student teachers.Methods: A longitudinal survey among 90 female students using Voice Handicap Index and Symptom Check List-90 at the start and end of education.Results: Student teachers in fourth grade showed lower VHI Total and lower SCL-90 Total scores compared to first grade. Students with higher VHI scores in fourth grade had higher risk on “Anxiety” (OR=1.8 to 4.8), “Agoraphobia” (OR=1.9 to 3.9) and “Insufficiency in thinking and acting” (OR=1.6 to 3.2). Students with respectively higher VHI-Total and VHI-Emotional subscale scores had higher risk on “Depression” (OR=1.7, resp. 3.9), “Interpersonal sensitivity and mistrust” (OR=1.6, resp. 3.2), “Hostility” (OR=1.7, resp. 2.1) and SCL-Total (OR=3.1 resp. 4.0).Conclusions: Student teachers at the end of education showed more well-being and were less vocally handicapped. A tendency for a positive relation between higher emotional voice handicap and more psychosomatic complaints was found.Suggestions: The VHI has proven to be useful and special attention to VHI Emotional scale is advised in screening. This study might have implications for the preventive care and a multi-dimensional approach with attention to physical, mental and social voice care in future teachers is suggested. In contrast to the group score comparisons a closer look at individual reports on specific VHI items in relation to SCL-90 may be fruitful to detect tendencies. Student teachers can benefit from interdisciplinary collaboration between a psychologist and voice therapist in reducing psychosocial risk factors.

Salivary testosterone: Associations with depression, anxiety disorders, and antidepressant use in a large cohort study - Corrected Proof

2012-01-13

Abstract: Objective: Low circulating levels of testosterone have been associated with major depression, but there is more limited evidence for differences in patients with anxiety disorders. The use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants is associated with sexual side effects, warranting testing for interactions with testosterone.Methods: Data are from 722 male and 1380 female participants of The Netherlands Study of Depression and Anxiety (NESDA), who were recruited from the community, general practice care, and specialized mental health care. Depressive and anxiety diagnoses were assessed using the DSM-IV Composite International Diagnostic Interview. To smooth the episodic secretion, the four morning saliva samples per participant and the two evening samples were pooled before testosterone analysis.Results: Morning median testosterone levels were 25.2pg/ml in men and 16.2pg/ml in women, with lower evening levels of 18.2 and 14.1pg/ml, respectively. Significant determinants of testosterone levels were sex, age, time of the day, use of contraceptives, and smoking status. Female patients with a current (1-month) depressive disorder (effect size 0.29; P=0.002), generalized anxiety disorder (0.25; P=0.01), social phobia (0.30; P<0.001), and agoraphobia without panic disorder (0.30; P=0.02) had lower salivary testosterone levels than female controls. Higher testosterone levels were found in male and female participants using SSRIs than in non-users (effect size 0.26; P<0.001).Conclusion: Salivary testosterone levels are lower in female patients with a depressive disorder, generalized anxiety disorder, social phobia, and agoraphobia as compared to female controls. SSRIs may increase salivary testosterone in men and women.

Vascular function is not impaired early in the course of bipolar disorder - Corrected Proof

Dylan P. Murray, Nora S. Metz, William G. Haynes, Jess G. Fiedorowicz — 2012-01-13

Abstract: Objective: Individuals with bipolar disorder face a nearly two-fold increased risk of cardiovascular mortality relative to the general population. Endothelial dysfunction precedes cardiovascular disease and serves as a quantifiable phenotype for vasculopathy. We investigated whether individuals with bipolar disorder had poorer vascular function than controls using a case–control design.Methods: The sample of 54 participants included 27 individuals with bipolar disorder and 27 age- and gender-matched controls. Participants underwent an assessment of metabolic (weight, lipids, and insulin resistance) and vascular parameters (endothelial function using flow-mediated dilation; arterial stiffness using pulse wave velocity and estimated aortic pressure).Results: Participants had a mean age of 32years and 41% were female. No significant differences were found between groups in endothelial function or arterial stiffness. Individuals with bipolar disorder demonstrated 100% greater insulin resistance.Conclusion: The lack of clinically significant differences in vascular function in this young sample suggests any increased risk either occurs later in the course of illness or is largely due to behavioral risk factors, such as smoking, which was balanced between groups. Substantial insulin resistance is identifiable early in course of illness, perhaps secondary to treatment.

The relation of early experienced negative life events and current itch. A longitudinal study among adolescents in Oslo, Norway - Corrected Proof

Lars Lien, Jon Anders Halvorsen, Ole Rikard Haavet, Florence Dalgard — 2012-01-12

Abstract: Objective: Negative life events have impact on mental health and skin diseases among adults. Itch is a common, disabling skin symptom. The aim was to describe negative life events associated with current itch and to analyze the impact of number of negative life events on symptoms of itch, controlling for possible confounders.Method: This school-based longitudinal survey was conducted among 15 and 18years old high-school students in Oslo, Norway. From a baseline cohort of 3811 students, 2489 (65%) participants were followed-up after three years later. They completed questionnaires at baseline and follow-up. Current itch was measured with a validated instrument asking for symptoms on a four point Likert scale at follow-up.Results: More girls than boys reported itch. There were no gender differences in number of negative life events. Death among close relative/friend was the most common negative life event among boys and girls. All negative life experiences before 15years of age were statistically significantly associated with itch, but after 15years only half of the negative life events were associated with itch. The bivariate association between number of negative life events and itch was statistically significant, and only when adjusting for mental distress at baseline there was a considerable drop in the Odds Ratio.Conclusion: There is a clear association between number of negative life events at baseline and itch at follow-up three years later among adolescents. It is therefore important to discuss possible adverse experiences with adolescents presenting with severe symptoms of itch.

The association between discrepancy in illness representations on distress in stroke patients and carers - Corrected Proof

Maureen Twiddy, Allan House, Fiona Jones — 2012-01-12

Abstract: Background: To investigate the association between the illness representations of recently diagnosed stroke patients and their carers and distress in the months after stroke.Method: Forty-two stroke survivors and their carers were assessed at 3months and 32 couples returned data at 6months after stroke. Patients and carers completed the Illness Perceptions Questionnaire-Revised, Barthel Index, Significant Others Scale and General Health Questionnaire. Analyses were conducted using the Actor–Partner Interdependence Model.Results: Carers were more pessimistic than patients about the symptoms, timeline and consequences of the stroke. Patient distress was associated with both patient and carer illness representations at Time 1, and their own illness representations and discrepancy in the illness representations of patients and carers at Time 2. Carer distress was associated with their own illness representations at Time 1, but not the patient's illness representations. Discrepant illness representations were associated with higher carer distress at Time 1 but not Time 2.Conclusion: Illness representations of stroke patients and carers have implications for adjustment for both partners. It is important to understand couples' views of stroke, as discrepancy was as strongly associated with patient and carer distress as was physical disability.

A longitudinal study of motor subtypes in delirium: Frequency and stability during episodes - Corrected Proof

2012-01-09

Abstract: Objective: Motor-defined subtypes are a promising means of identifying clinically relevant patient subgroups but little is known about their course and stability during a delirium episode.Methods: We assessed 100 consecutive adult palliative care patients with DSM-IV delirium twice weekly during their episodes using the Delirium Motor Subtype Scale (DMSS), Delirium Rating Scale-Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). DMSS subtypes were assigned for each assessment and analysed for stability within patients during episodes.Results: Across all assessments (n=303; mean 3 per patient, range 2–9), subtype occurrence was hypoactive (35%), mixed (26%), hyperactive (15%) and no subtype (24%). “No subtype” was associated with significantly lower DRS-R98 severity scores, of which 80% were subsyndromal, whereas mixed subtype assessments were the most impaired on the DRS-R98 and CTD. Subtypes were stable within delirium episodes in 62% of patients: 29% hypoactive, 18% mixed, 10% hyperactive and 6% no-subtype. The DRS-R98 noncognitive subscale scores differed across groups whereas cognitive subscale scores did not (p<0.001).Conclusions: We conclude that motor subtypes occur in nearly all patients with full syndromal delirium and are often stable during an episode. Subtypes exhibited comparable levels of cognitive impairment but differed in non-cognitive symptoms, supporting the importance of cognitive testing to detect delirium in less overt cases.

Predicting intentions and adherence behavior in the context of organ transplantation: Gender differences of provided social support - Corrected Proof

2012-01-09

Abstract: Objectives: Medication non-adherence is a common problem in organ transplantation patients with severe consequences for the patients' health. This study aimed at examining the determinants of intention formation and adherence behavior based on the Theory of Planned Behavior (TPB). Moreover, to account for the role of patients' partners, provided social support by partners was included. Here, support provided by female partners was hypothesized to be more effective than support provided by male partners.Method: This cross-sectional study comprised 121 heart, liver, lung, and kidney transplant recipients (n=81 men; mean age=54.32, SD=13.32) and their partners (mean age=51.99, SD=13.67). Patients completed a questionnaire with TPB variables and a validated measure of self-reported adherence. Partners reported their provided social support with regard to medication adherence of the patients.Results: For the prediction of intention to adhere to medication, the non-significant main effect of provided social support was qualified by partners' gender: Support provided by women was positively related to patients' intention to adhere, whereas support provided by men was slightly negatively related to the intention to adhere in their female spouses. Intentions in turn emerged together with relationship quality as the most important predictor of adherence behavior.Conclusion: The beneficial effects of support provided by women could be replicated within the framework of the TPB in the context of organ transplantation. Interventions should focus on increasing the effectiveness of support provision of male partners and on promoting relationship quality.

Latent structure of the Hospital Anxiety And Depression Scale: A 10-year systematic review - Corrected Proof

Theodore D. Cosco, Frank Doyle, Mark Ward, Hannah McGee — 2011-09-19

Abstract: Objective: To systematically review the latent structure of the Hospital Anxiety and Depression Scale (HADS).Methods: A systematic review of the literature was conducted across Medline, ISI Web of Knowledge, CINAHL, PsycInfo and EmBase databases spanning articles published between May 2000 and May 2010. Studies conducting latent variable analysis of the HADS were included.Results: Twenty-five of the 50 reviewed studies revealed a two-factor structure, the most commonly found HADS structure. Additionally, five studies revealed unidimensional, 17 studies revealed three-factor, and two studies revealed four-factor structures. One study provided equal support for two- and three-factor structures. Different latent variable analysis methods revealed correspondingly different structures: exploratory factor analysis studies revealed primarily two-factor structures, confirmatory factor analysis studies revealed primarily three-factor structures, and item response theory studies revealed primarily unidimensional structures.Conclusion: The heterogeneous results of the current review suggest that the latent structure of the HADS is unclear, and dependent on statistical methods invoked. While the HADS has been shown to be an effective measure of emotional distress, its inability to consistently differentiate between the constructs of anxiety and depression means that its use needs to be targeted to more general measurement of distress.