Showing papers in "Psychosomatic Medicine in 2009"

Associations of Depression With C-Reactive Protein, IL-1, and IL-6 : A Meta-Analysis

Abstract: Objective:To assess the magnitude and direction of associations of depression with C-reactive protein (CRP), interleukin (IL)-1, and IL-6 in community and clinical samples.Methods:Systematic review of articles published between January 1967 and January 2008 in the PubMed and PsycINFO electronic data

Cumulative childhood stress and autoimmune diseases in adults.

Abstract: Objective: To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult. Methods: Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005. ACEs included childhood physical, emotional, or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or an incarcerated household member. The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress. The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings: T- helper 1 (Th1) (e.g., idiopathic myocarditis); T-helper 2 (Th2) (e.g., myasthenia gravis); Th2 rheumatic (e.g., rheumatoid arthritis); and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia). Results: Sixty-four percent reported at least one ACE. The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men. First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p /=2 ACEs were at a 70% increased risk for hospitalizations with Th1, 80% increased risk for Th2, and 100% increased risk for rheumatic diseases (p Language: en

A meta-analytic review of the effects of childhood abuse on medical outcomes in adulthood.

Abstract: Objective: To summarize the relationship between abuse during childhood and physical health outcomes in adulthood and to examine the role of potential moderators, such as the type of health outcome assessed, gender, age, and the type of abuse. Studies using self-report assessment methods were compared with studies using objective or independently verifiable methods. Method: The current study is a quantitative meta-analysis comparing results from 78 effect sizes across 24 studies including 48,801 individuals. Results: Experiencing child abuse was associated with an increased risk of negative physical health outcomes in adulthood (effect size d = 0.42, 95% Confidence Interval = 0.39-0.45). Neurological and musculoskeletal problems yielded the largest effect sizes, followed by respiratory problems, cardiovascular disease, gastrointestinal and metabolic disorders. Effect sizes were larger when the sample was exclusively female and when the abuse was assessed via self-report rather than objective, independently verifiable methods. Conclusions: Child abuse is associated with an increased risk of poor physical health in adulthood. The magnitude of the risk is comparable to the association between child abuse and poor psychological outcomes. However, studies often fail to include a diverse group of participants, resulting in a limited ability to draw conclusions about the population of child abuse survivors as a whole. Important methodological improvements are also needed to better understand potential moderators. Language: en

Purpose in Life Is Associated With Mortality Among Community-Dwelling Older Persons

Abstract: Objective:To assess the association between purpose in life and all-cause mortality in community-dwelling elderly persons.Methods:We used data from 1238 older persons without dementia from two longitudinal cohort studies (Rush Memory and Aging Project and Minority Aging Research Study) with baseline

Embodiment of sadness and depression--gait patterns associated with dysphoric mood.

Abstract: Objective: To analyze gait patterns associated with sadness and depression. Embodiment theories suggest a reciprocal relationship between bodily expression and the way in which emotions are processed. Methods: In Study 1, the gait patterns of 14 inpatients suffering from major depression were compared with those of matched never-depressed participants. In Study 2, we employed musical mood induction to induce sad and positive mood in a sample of 23 undergraduates. A Fourier-based description of walking data served as the basis for the computation of linear classifiers and for the analysis of gait parameters. Results: Gait patterns associated with sadness and depression are characterized by reduced walking speed, arm swing, and vertical head movements. Moreover, depressed and sad walkers displayed larger lateral swaying movements of the upper body and a more slumped posture. Conclusion: The results of the present study indicate that a specific gait pattern characterizes individuals in dysphoric mood. Key words: embodiment, gait, sadness, emotions, major depression, psychopathology.

Association of enjoyable leisure activities with psychological and physical well-being.

Abstract: Objective:To examine whether engaging in multiple enjoyable activities was associated with better psychological and physiological functioning. Few studies have examined the health benefits of the enjoyable activities that individuals participate in voluntarily in their free time.Method:Participants

Trauma, posttraumatic stress disorder, and physical illness: findings from the general population

Abstract: Objective To determine in a general population sample the differential impact on physical health of exposure to traumatic experiences and posttraumatic stress disorder (PTSD). Trauma exposure and PTSD have been associated with physical illness in specific populations, such as veterans. Methods Medical histories including cardiovascular, endocrine, pulmonary, and other chronic diseases were obtained from 3171 adults living in the community. They were administered the PTSD module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and were assigned to three groups: no trauma (n = 1440); trauma, but no PTSD (n = 1669); and trauma with subsequent PTSD (n = 62). Results After adjustments for sociodemographic factors, smoking, body mass index, blood pressure, depression, and alcohol use disorders, subjects with trauma history had higher odds ratios (ORs) for angina pectoris and heart failure (OR = 1.2; 95% Confidence Interval [CI] = 1.1-1.3), stroke (OR = 1.2; 95 CI = 1.0-1.5), bronchitis, asthma, renal disease, and polyarthritis (ORs between 1.1 and 1.3) compared with nontraumatized participants. The PTSD positive subsample had increased ORs for angina (OR = 2.4; 95% CI = 1.3-4.5), heart failure (OR = 3.4; 95% CI = 1.9-6.0), bronchitis, asthma, liver, and peripheral arterial disease (ORs, range = 2.5-3.1). Conclusions Our findings suggest a strong association between PTSD and cardiovascular and pulmonary diseases. Particular diagnostic and treatment attention should be paid to physical illness in PTSD positive patients in primary care, medical, and mental health settings.

Women, loneliness, and incident coronary heart disease.

Abstract: Objective:To examine associations between loneliness and risk of incident coronary heart disease (CHD) over a 19-year follow-up period in a community sample of men and women. Loneliness, the perceived discrepancy between actual and desired social relationships, has been linked to several adverse hea

Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia.

Abstract: Objective:Studies in fibromyalgia syndrome with functional neuroimaging support the hypothesis of central pain augmentation. To determine whether structural changes in areas of the pain system are additional preconditions for the central sensitization in fibromyalgia we performed voxel based morphom

Association between anxiety disorders and heart rate variability in The Netherlands Study of Depression and Anxiety (NESDA)

Abstract: Objective: To determine whether patients with different types of anxiety disorder (panic disorder, social phobia, generalized anxiety disorder) have higher heart rate and lower heart rate variability compared with healthy controls in a sample that was sufficiently powered to examine the confounding effects of lifestyle and antidepressants. Methods: The standard deviation of the normal-to-normal intervals (SDNN), heart rate (HR), and respiratory sinus arrhythmia (RSA) were measured in 2059 subjects (mean age = 41.7 years, 66.8% female) participating in The Netherlands Study of Depression and Anxiety (NESDA). Based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Composite International Diagnostic Interview (CIDI), NESDA participants were classified as healthy controls (n = 616), subjects with an anxiety diagnosis earlier in life (n = 420), and subjects with current anxiety diagnosis (n = 1059). Results: Current anxious subjects had a significantly lower SDNN and RSA compared with controls. RSA was also significantly lower in remitted anxious subjects compared with controls. These associations were similar across the three different types of anxiety disorders. Adjustment for lifestyle had little impact. However, additional adjustment for antidepressant use reduced all significant associations between anxiety and HRV to nonsignificant. Anxious subjects who used a tricyclic antidepressant, a selective serotonin reuptake inhibitor, or another antidepressant showed significantly lower mean SDNN and RSA compared with controls (effect sizes = 0.20-0.80 for SDNN and 0.42-0.79 for RSA). Nonmedicated anxious subjects did not differ from controls in mean SDNN and RSA. Conclusion: This study shows that anxiety disorders are associated with significantly lower HR variability, but the association seems to be driven by the effects of antidepressants Copyright © 2009 by the American Psychosomatic Society.

Facets of personality linked to underweight and overweight.

Abstract: Objective—Personality traits underlie maladaptive behaviors, and cognitive and emotional disturbances that contribute to major preventable causes of global disease burden. This study examines detailed personality profiles of underweight, normal, and overweight individuals to provide insights into the causes and treatments of abnormal weight. Methods—More than half of the population from four towns in Sardinia, Italy (N=5,693; aged 14-94; M=43; SD=17), were assessed on multiple anthropometric measures and 30 facets that comprehensively cover the five major dimensions of personality, using the Revised NEO Personality Inventory. Results—High Neuroticism and low Conscientiousness were associated with being underweight and obese, respectively. High Impulsiveness (specifically eating-behavior items) and low Order were associated with BMI categories of overweight and obese, and with measures of abdominal adiposity (waist and hip circumference). Those scoring in the top 10% of Impulsiveness were about 4 Kg heavier than those in the bottom 10%, an effect independent and larger than the FTO genetic variant. Prospective analyses confirmed that Impulsiveness and Order were significant predictors of general and central measures of adiposity assessed 3 years later. Conclusions—Overweight and obese individuals have difficulty resisting cravings and lack methodical and organized behaviors that might influence diet and weight control. While individuals’ traits have limited impact on the current obesogenic epidemic, personality traits can improve clinical assessment, suggest points of intervention, and help tailor prevention and treatment approaches.

Patient and practitioner influences on the placebo effect in irritable bowel syndrome.

Abstract: Objective:To determine whether placebo responses can be explained by characteristics of the patient, the practitioner, or their interpersonal interaction.Methods:We performed an analysis of videotape and psychometric data from a clinical trial of patients with irritable bowel syndrome who were treat

Chronic interpersonal stress predicts activation of pro- and anti-inflammatory signaling pathways 6 months later.

Abstract: Considerable research indicates that socially integrated persons enjoy better mental and physical health than their more isolated peers 1,2. However, in a series of recent studies it has become evident that social ties can also have detrimental influences on health, especially when they are marked by conflict, mistrust, and instability 3–5. Among patients recovering from a mood disorder, for example, family tensions double the odds of a relapse occurring, and similar patterns are seen in patients with eating disorders and schizophrenia 6. Interpersonal difficulties are also associated with heightened susceptibility to respiratory infections, delayed healing of wounds, accelerated emergence of the metabolic syndrome, and increased morbidity and mortality from cardiovascular disease 7–11. These effects have been well-substantiated in a series of tightly controlled studies with rodents and non-human primates 12–14. Despite this robust pattern of findings, little is known about the responsible underlying mechanism(s). One candidate hypothesis is that chronically abrasive relationships foster low-grade systemic inflammation, which then contributes to the evolution and/or expression of psychiatric, infectious, metabolic, and coronary diseases 15–17. This view received initial support in a study of married couples who had conflictual interactions in the laboratory; those who expressed greater hostility showed higher levels of the inflammatory cytokines interleukin-6 and tumor necrosis factor-α the next morning 8. In this article we examine a broader spectrum of interpersonal relationships, including romantic relationships, friendships, and familial relationships, and consider whether their quality relates to two major biomarkers of systemic inflammation, C-reactive protein (CRP) and interleukin-6 (IL-6). To identify the molecular signaling pathways involved in these dynamics, we also assess the expression of mRNA for the chief pro-inflammatory transcription factor, nuclear factor-kappa B (NF-κB), and for the α and β isoforms of the glucorticoid receptor (GR). When it is ligated by cortisol, GR-α has potent anti-inflammatory properties, mediated by its inhibition of NF-κB signaling 18. This inhibition occurs through direct protein-protein interactions, as well as GR-mediated induction of inhibitor of kappa-b (IκB), a molecule that sequesters NF-κB in the cytosol and thereby prevents it from switching on pro-inflammatory genes. The functions of GR-β are not fully defined, but it is thought to inhibit the activity of GR-α and may, thus, facilitate pro-inflammatory signaling 19. Finally, to model the dynamics of these signaling pathways under conditions of immune challenge, we quantified expression of IL-6 by leukocytes that had been stimulated with bacterial product ex vivo. These analyses were carried out within the context of a short-term prospective study, in which interpersonal difficulties were assessed at baseline, and inflammatory processes were measured at that time and again six months later. This design has a number of strengths compared to the cross-sectional analyses that are more common in psychoneuroimmunology. First, it allows changes over time in the outcomes of interest to be modeled, which is presumably more relevant to disease pathogenesis than one-time assessments. Second, it minimizes the likelihood that erroneous conclusions about directionality will be made, which is an important consideration here because inflammatory cytokines can have profound influences on social behavior 20. Finally, a design like this is able to capture stress-related changes that take time to evolve, such as those that result from gradual “wear and tear” on bodily systems. Based upon these considerations we hypothesized a prospective association between interpersonal difficulties and inflammatory processes. Specifically, to the extent that subjects were high in chronic interpersonal stress at study entry, we expected them to display greater activation of pro-inflammatory signaling pathways and higher levels of inflammatory biomarkers six months later.

Pain Sensitivity and Analgesic Effects of Mindful States in Zen Meditators : A Cross-Sectional Study

Abstract: OBJECTIVE To investigate pain perception and the potential analgesic effects of mindful states in experienced Zen meditators. METHODS Highly trained Zen meditators (n = 13; >1000 hours of practice) and age/gender-matched control volunteers (n = 13) received individually adjusted thermal stimuli to elicit moderate pain on the calf. Conditions included: a) baseline-1: no task; b) concentration: attend exclusively to the calf; c) mindfulness: attend to the calf and observe, moment to moment, in a nonjudgmental manner; and d) baseline-2: no task. RESULTS Meditators required significantly higher temperatures to elicit moderate pain (meditators: 49.9 degrees C; controls: 48.2 degrees C; p = .01). While attending "mindfully," meditators reported decreases in pain intensity whereas control subjects showed no change from baseline. The concentration condition resulted in increased pain intensity for controls but not for meditators. Changes in pain unpleasantness generally paralleled those found in pain intensity. In meditators, pain modulation correlated with slowing of the respiratory rate and with greater meditation experience. Covariance analyses indicated that mindfulness-related changes could be partially explained by changes in respiratory rates. Finally, the meditators reported higher tendencies to observe and be nonreactive of their own experience as measured on the Five Factor Mindfulness Questionnaire; these factors correlated with individual differences in respiration. CONCLUSIONS These results indicated that Zen meditators have lower pain sensitivity and experience analgesic effects during mindful states. Results may reflect cognitive/self-regulatory skills related to the concept of mindfulness and/or altered respiratory patterns. Prospective studies investigating the effects of meditative training and respiration on pain regulation are warranted.

Autonomy of autonomic dysfunction in major depression.

Abstract: Objective:To investigate cardiac autonomic dysfunction in patients with major depressive disorder (MDD). Research in this area has faced several limitations because of the heterogeneity of the disease, the influence of medication, and methodological shortcomings.Methods:Participants were 75 patients

Rumination predicts longer sleep onset latency after an acute psychosocial stressor

Abstract: Objectives:Rumination has been linked to self-reported sleep quality. However, whether rumination is related to an objective sleep parameter has not been tested. This study examined whether rumination predicts sleep onset latency (SOL) on the night after an acute psychosocial stressor. We hypothesiz

ECT in pregnancy: a review of the literature from 1941 to 2007.

Abstract: Objective To review the literature on the use of electroconvulsive therapy (ECT) during pregnancy and to discuss its risks and benefits for treating severe mental illness during pregnancy. Method PubMed and PsycINFO databases were searched for English or English-translated articles, case reports, letters, chapters, and Web sites providing original contributions and/or summarizing prior data on ECT administration during pregnancy. Results A total of 339 cases were found. The majority of patients were treated for depression and at least partial remission was reported in 78% of all cases where efficacy data were available. Among the 339 cases reviewed, there were 25 fetal or neonatal complications, but only 11 of these, which included two deaths, were likely related to ECT. There were 20 maternal complications reported and 18 were likely related to ECT. Conclusions Although there are limited available data in the literature, it seems that ECT is an effective treatment for severe mental illness during pregnancy and that the risks to fetus and mother are low.

Generalized Anxiety Disorder, Major Depressive Disorder, and Their Comorbidity as Predictors of All-Cause and Cardiovascular Mortality: The Vietnam Experience Study

Abstract: Objective: To examine whether the 1-year prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and their comorbidity were associated with subsequent all-cause and cardiovascular disease (CVD) mortality during 15 years in Vietnam veterans. Methods: Participants (N = 4256) were from the Vietnam Experience Study. Service, sociodemographic, and health data were collected from service files, telephone interviews, and a medical examination. One-year prevalence of MDD and GAD was determined through a diagnostic interview schedule based on the Diagnostic and Statistical Manual of Mental Disorders (version IV) criteria. Mortality over the subsequent 15 years was gathered from US army records. Results: MDD and GAD were positively and significantly associated with all-cause and CVD mortality. The relationships between MDD and GAD and CVD mortality were no longer significant after adjustment for sociodemograhics, health status at entry, health behaviors, and other risk markers. Income was the covariate with the strongest impact on this association. In analyses comparing comorbidity and GAD and MDD alone, with neither diagnosis, comorbidity proved to be the strongest predictor of both all-cause and CVD mortality. Conclusion: GAD and MDD predict all-cause mortality in a veteran population after adjusting for a range of covariates. However, those with both GAD and MDD were at greatest risk of subsequent death, and it would seem that these disorders may interact synergistically to affect mortality. Future research on mental disorders and health outcomes, as well as future clinical interventions, should pay more attention to comorbidity.

A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems.

Abstract: Objective To evaluate the efficacy of Familias Unidas, a Hispanic-specific, parent-centered intervention, in preventing/reducing adolescent substance use, unsafe sexual behavior, and externalizing disorders. Methods A total of 213 8th grade Hispanic adolescents with behavior problems and their primary caregivers were assigned randomly to one of two conditions: Familias Unidas or Community Control. Participants were assessed at baseline and at 6, 18, and 30 months post baseline. Results Results showed that, relative to a Community Control condition, Familias Unidas was efficacious in preventing or reducing externalizing disorders, preventing and reducing substance use, and in reducing unsafe sexual behavior. The effects of Familias Unidas on these outcomes were partially mediated by improvements in family functioning. Conclusions These findings suggest that parent-centered intervention is an efficacious strategy for preventing/reducing specific health risk behaviors in Hispanic adolescents with behavior problems.

A preliminary study of daily interpersonal stress and C-reactive protein levels among adolescents from Latin American and European backgrounds.

Abstract: Objective To examine the association between the experience of daily interpersonal stress and levels of C-reactive protein (CRP), an inflammatory marker that is a key indicator of cardiovascular risk, during the teenage years. Methods A total of 69 adolescents (Mage= 17.78 years) completed daily diary checklists each night for 14 days in which they reported their experience of negative interpersonal interactions in the domains of family, peers, and school (e.g., conflict with family and friends, peer harassment, punishment by parents and teachers). Blood samples were obtained an average of 8.63 months later and assayed for circulating levels of CRP, using enzyme-linked immunosorbent assay. Measures of body mass index (BMI), socioeconomic status (SES), substance use, stressful life events, rejection sensitivity, and psychological distress were obtained. Results A greater frequency of daily interpersonal stress was associated with higher levels of CRP, even after controlling for BMI, SES, substance use, life events, rejection sensitivity, psychological distress, and frequency of daily interpersonal stress 2 years earlier. Conclusions Experiencing a high frequency of interpersonal stressors that are typical of adolescent life is associated with higher levels of inflammation even among a normative, healthy sample of adolescents. Additional work should focus on other daily experiences during the adolescent period and their implications for elevated risk for later cardiovascular disease.

A general enhancement of autonomic and cortisol responses during social evaluative threat.

Abstract: Objective:To examine the Social Self Preservation Theory, which predicts that stressors involving social evaluative threat (SET) characteristically activate the hypothalamic-pituitary-adrenal (HPA) axis. The idea that distinct psychosocial factors may underlie specific patterns of neuroendocrine str

Lifetime history of major depression predicts the development of the metabolic syndrome in middle-aged women.

Abstract: Objective: To prospectively examine the association of major depression with incidence of the metabolic syndrome in women. Methods: Data were drawn from one of seven sites of the Study of Women’s Health Across the Nation (SWAN), a prospective cohort study of the menopausal transition. Participants were 429 (34.5% African-American) women. Major depression and comorbid diagnoses were assessed via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders at baseline and seven annual follow-up evaluations. The metabolic syndrome was measured at baseline and each follow-up evaluation (except the second) based on National Cholesterol Education Program (NCEP) criteria. Results: Longitudinal generalized estimating equations (GEE) models indicated that, in women who were free of the metabolic syndrome at baseline, a lifetime major depression history or current major depressive episode at baseline was significantly associated with the onset and presence of the metabolic syndrome during the follow-up (odds ratio = 1.82; 95% Confidence Interval (CI) = 1.06–3.14). Survival analyses showed that, in women who were free of the metabolic syndrome at baseline, a lifetime major depression history or current major depressive episode at baseline predicted increased risk of developing the metabolic syndrome during the follow-up (hazard ratio = 1.66; 95% CI = 0.99-3.75). Lifetime history of alcohol abuse or dependence predicted incident metabolic syndrome and attenuated the association between depression and the metabolic syndrome in both models. Conclusions: This study documents that major depression is a significant predictor of the onset of the metabolic syndrome. Intervention studies targeting depression may prevent the development of the metabolic syndrome in women.

Double-exposure to acute stress and chronic family stress is associated with immune changes in children with asthma

Abstract: Objective: To understand how psychological stress heightens risk for asthma flare-ups, we examined the relationship between acute stress, chronic family stress, and the production of asthma-related cytokines. Methods: Seventy-one children with asthma and 76 medically healthy children completed interviews regarding life stress, and peripheral blood samples were collected. After mononuclear cells had been mitogenically stimulated, production of the cytokines interleukin (IL)-4, IL-5, IL-13, and IFN- was measured. All measurements were repeated every 6 months for 2 years. Children reported on their asthma symptoms for 14 days after each study visit. Results: Children with asthma who had higher levels of chronic family stress showed increased production of IL-4, IL-5, and IFN- at times when they had experienced an acute event compared with times when they had not. These stress-related changes did not occur in asthmatic children with lower levels of chronic family stress, or in healthy controls. The combination of acute and chronic stress was also associated with increased asthma symptoms. Conclusion: These findings suggest that acute negative life events have a particularly strong impact among a subgroup of children with asthma who are under high chronic family stress. The heightened inflammatory profile in this group suggests an explanation for why children experiencing life stressors are at greater risk for asthma exacerbations. Key words: asthma, chronic stress, acute stress, cytokines, children.

Patients with pain disorder show gray-matter loss in pain-processing structures: a voxel-based morphometric study.

Abstract: disorder assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) criteria is characterized by persistent and distressing chronic pain at one or more body sites which cannot be fully explained by a physiological process or somatic disorder. Psychological factors are thought to play a major role. Recent neuroimaging studies evidenced altered pain processing in patients suffering from this disorder. Methods: Fourteen right-handed women fulfilling the DSM-IV criteria for pain disorder and 25 healthy age-matched women were investigated with magnetic resonance imaging. In the voxel-based morphometry analysis, we compared both groups for changes of gray-matter density. We included age and Beck Depression Inventory scores as nuisance variables to minimize possible confounding effects of age or depressive comorbidity. Results: In the patient group, we found significant gray-matter decreases in the prefrontal, cingulate, and insular cortex. These regions are known to be critically involved in the modulation of subjective pain experiences. Conclusions: In the context of similar results in patients with other functional pain syndromes, such as fibromyalgia and chronic back pain, we suggest that structural changes in fronto-limbic brain circuits represent not only an objective marker of these pain syndromes but also constitute a critical pathophysiological element. These findings represent a further proof of the important role of central changes in pain disorder. Key words: pain disorder, idiopathic chronic pain, voxel-based morphometry, orbitofrontal cortex, ventromedial prefrontal cortex, classification. DSM-IV Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision; VBM voxel-based morphometry; fMRI functional magnetic resonance imaging; GM gray matter; WM white matter; CSF cerebrospinal fluid; BDI Beck Depression Inventory; MNI standardized reference space defined by the Montreal Neurological Institute; SOMS screening for somatoform symptoms; PPS Pain Perception Scale; SCID Structured Clinical Interview for DSM-IV disorders.

A taxometric analysis of type-D personality.

Abstract: Objective: To test the dimensionality of Type-D personality, using taxometric procedures, to assess if Type-D personality is taxonic or dimensional. Type-D personality is treated as a categorical variable and caseness has been shown to be a risk factor for poor prognosis in coronary heart disease. However, at present, there is no direct evidence to support the assumption that Type D is categorical and able to differentiate true cases from noncases. Methods: In total, 1012 healthy young adults from across the United Kingdom and Ireland completed the DS14, the standard index of Type D, and scores were submitted to two taxometric procedures MAMBAC and MAXCOV. Results: Graphical representations (comparing actual with simulated data) and fit indices indicated that Type D is more accurately represented as a dimensional rather than categorical construct. Conclusion: Type D is better represented as a dimensional construct. Implications for theory development and clinical practice with respect to Type D are examined as well as the wider use of taxometrics within psychosomatic medicine (e.g., to investigate if there are medically unexplained syndrome taxons, such as a Gulf War Syndrome taxon).

Diabetes and poor disease control: is comorbid depression associated with poor medication adherence or lack of treatment intensification?

Abstract: Background Many patients with diabetes fail to achieve American Diabetes Association Guidelines for glycemic, blood pressure and lipid control. Depression is a common comorbidity and may affect disease control through adverse effects on adherence and physician intensification of treatment.

Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study.

Abstract: Objective:To determine whether major depression (MD) leads to an increased risk of new-onset high blood pressure diagnoses.Methods:The data source was the Canadian National Population Health Survey (NPHS). The NPHS included a short-form version of the Composite International Diagnostic Interview (CI

Depression and C-reactive protein: population-based Health 2000 Study

Abstract: Objective:To test whether depression is independently associated with elevated levels of C-reactive protein (CRP) in a large nationwide population-based sample.Methods:Depression and CRP were assessed in 6005 Finns aged >30 years, as part of the ongoing population-based Health 2000 Study. Depression

Comorbid depression and anxiety symptoms as predictors of cardiovascular events: results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) study.

Abstract: Among psychiatric symptoms linked to cardiovascular disease (CVD), anxiety and depression are perhaps the most common. Both conditions are widespread among cardiac patients (1-3), each is associated with behavioral and pathophysiological markers of CVD risk (4-7), and the independence of anxiety and depression as predictors of CVD outcomes is supported by multiple studies (8-15). Anxiety and depressive disorders also share treatment approaches, with serotonin reuptake inhibitor medications, cognitive behavioral therapy, and their combination recognized as effective interventions for both conditions (16). The high degree of overlap between anxiety and depression symptoms with regard to their co-morbidity in clinical populations, effective methods of treatment, and specific symptoms may represent more than coincidence. Some have suggested that anxiety and depression may be characteristics of a broader negative affect dimension (17-18). Others have argued that they are produced by the same dysfunctional biology or that they may originate from parallel genetic dispositions (19-21). Despite the strong convergence between these two psychiatric conditions and evidence of their independent value in predicting CVD risk, few studies have investigated the combined or interactive contribution of anxiety and depression in the prediction of CVD events (22-23). If anxiety and depression are indeed variations of a similar biopsychosocial origin, then either of two outcomes could follow: 1) These conditions could interchangeably predict CVD events, and the presence of both would not be more predictive than either alone; or 2) The co-occurrence of anxiety and depression could predict CVD risk above and beyond their independent predictions. The literature provides differing views regarding these hypotheses. For one, depression is a more established predictor of cardiovascular outcomes than anxiety (13-14), the latter boasting a smaller and less consistent empirical literature to date (17). This observation appears to argue against treating the conditions interchangeably in regards to CVD risk, but comes with the limitation that much of the previous anxiety-CVD research has focused on men (e.g., 24). In contrast, recent findings drawn from large female cohorts such as the Nurse's Health Study (25) and Women's Health Initiative (26) have supported relationships between anxiety symptom severity and/or anxiety disorders with adverse cardiac events. Two prospective studies to date have directly compared anxiety and depression alone versus jointly in predicting CVD outcomes (22-23). These studies produced evidence of independent statistical relationships between anxiety and depressive disorders with adverse cardiac events (22), and between questionnaire measures of phobic anxiety and depression and ventricular arrhythmias (23), respectively. Whereas Frasure-Smith (22) reported no added predictive effects of combining anxiety and depression status, Watkins and colleagues (23) also described the largest associations with ventricular arrhythmias as resulting from a composite of anxiety and depression scores. The fact that women comprised less than 30% of the sample in both studies could be important given the higher rates of anxiety and depressive disorders diagnosed in women relative to men (27). This study describes relationships among anxiety, depression, and CVD mortality and events in a sample of women undergoing coronary angiography as part of an evaluation for suspected myocardial ischemia. We were able to expand upon previous research in this area using a large female cohort, followed for a median of nearly 6-years, in which we were able to directly control for CAD severity with the use of quantitative angiograms. Using questionnaire-measured severity of trait anxiety and depression symptoms, we specifically compared independent versus interactive prediction models.

Manic/hypomanic symptom burden and cardiovascular mortality in bipolar disorder.

Abstract: Objectives—Bipolar disorder conveys an increased risk of cardiovascular mortality. We compared the risk for cardiovascular mortality between bipolar I and bipolar II subtypes and determined correlates of cardiovascular mortality. Methods—Participants with major affective disorders were recruited for the National Institute of Mental Health Collaborative Depression Study and followed prospectively for up to twenty-five years. A total of 435 participants met diagnostic criteria for bipolar I (N=288) or bipolar II (N=147) disorder based on Research Diagnostic Criteria at intake and measures of psychiatric symptoms during follow-up. Diagnostic subtypes were contrasted by cardiovascular mortality risk using Cox proportional-hazards regression. Affective symptom burden (the proportion of time with clinically significant manic/hypomanic or depressive symptoms) and treatment exposure were additionally included in the models. Results—Thirty-three participants died from cardiovascular causes. Participants with bipolar I disorder had more than double the cardiovascular mortality risk of those with bipolar II disorder, after controlling for age and gender (HR=2.35, 95% C.I. 1.04–5.33, p=0.04). The observed difference in cardiovascular mortality between these subtypes was at least partially confounded by the burden of clinically significant manic/hypomanic symptoms which predicted cardiovascular mortality independent of diagnosis, treatment exposure, age, gender, and cardiovascular risk factors at intake. Selective serotonin uptake inhibitors appeared protective though were introduced late in follow-up. Depressive symptom burden was not related to cardiovascular mortality. Conclusions—Participants with bipolar I disorder may face greater risk of cardiovascular mortality than those with bipolar II disorder. This difference in cardiovascular mortality risk may reflect manic/ hypomanic symptom burden.