Showing papers in "Psychosomatic Medicine in 2011"

Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research.

Abstract: Objectives To summarize quantitatively the literature comparing hypothalamic-pituitary-adrenal (HPA) axis function between depressed and nondepressed individuals and to describe the important sources of variability in this literature. These sources include methodological differences between studies, as well as demographic or clinical differences between depressed samples. Methods The current study used meta-analytic techniques to compare 671 effect sizes (cortisol, adrenocorticotropic hormone, or corticotropin-releasing hormone) across 361 studies, including 18,454 individuals. Results Although depressed individuals tended to display increased cortisol (d = 0.60; 95% confidence interval [CI], 0.54-0.66) and adrenocorticotropic hormone levels (d = 0.28; 95% CI, 0.16-0.41), they did not display elevations in corticotropin-releasing hormone (d = 0.02; 95% CI, -0.47-0.51). The magnitude of the cortisol effect was reduced by almost half (d = 0.33; 95% CI, 0.21-0.45) when analyses were limited to studies that met minimal methodological standards. Gender did not significantly modify any HPA outcome. Studies that included older hospitalized individuals reported significantly greater cortisol differences between depressed and nondepressed groups compared with studies with younger outpatient samples. Important cortisol differences also emerged for atypical, endogenous, melancholic, and psychotic forms of depression. Conclusions The current study suggests that the degree of HPA hyperactivity can vary considerably across patient groups. Results are consistent with HPA hyperactivity as a link between depression and increased risk for conditions, such as diabetes, dementia, coronary heart disease, and osteoporosis. Such a link is strongest among older inpatients who display melancholic or psychotic features of depression.

Childhood Adversity Heightens the Impact of Later-Life Caregiving Stress on Telomere Length and Inflammation

Abstract: Objective Previous research on the physical health consequences of childhood abuse and other adversities has been based on data from young or middle-aged adults. This study addressed the question of whether childhood abuse and other adversities have lasting, detectable consequences for inflammation and cell aging late in life, and whether the effects are large enough to be discernible beyond that of a major chronic stressor, dementia family caregiving.

The nocebo effect and its relevance for clinical practice.

Abstract: Negative expectations deriving from the clinical encounter can produce negative outcomes, known as nocebo effects. Specifically, research on the nocebo effect indicates that information disclosure about potential side effects can itself contribute to producing adverse effects. Neurobiological processes play a role in the nocebo effect and this paper provides a selective review of mechanistic research on the nocebo effect. Comparatively little attention has been directed to clinical studies and their implications for daily clinical practice. The nocebo response is influenced by the content and the way information is presented to patients in clinical trials in both the placebo as well as active treatment conditions. Nocebo effect adversely influences quality of life and therapy adherence, emphasizing the need for minimizing these responses to the extent possible. Evidence further indicates that the informed consent process in clinical trials may induce nocebo effects. This paper concludes with ethical directions for future patient-oriented research and routine practice.

Evaluation of enzyme immunoassay and radioimmunoassay methods for the measurement of plasma oxytocin

Abstract: Objective There is increased interest in measuring peripheral oxytocin levels to better understand the role of this peptide in mammalian behavior, physiology, and disease. The purpose of this study was to compare methods for plasma oxytocin measurement using a commercially available enzyme immunoassay (EIA) and radioimmunoassay (RIA), to evaluate the need for sample extraction, and to assess the immunospecificity of the assays.

Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions.

Abstract: Objective:To evaluate the use of existing practice control groups in randomized controlled trials of behavioral interventions and the role of extrinsic health care services in the design and conduct of behavioral trials.Method:Selective qualitative review.Results:Extrinsic health care services, also

The association between habitual diet quality and the common mental disorders in community-dwelling adults: the Hordaland Health study.

Abstract: Objective Recent evidence suggests a role for diet quality in the common mental disorders depression and anxiety. We aimed to investigate the association between diet quality, dietary patterns, and the common mental disorders in Norwegian adults. Methods This cross-sectional study included 5731 population-based men and women aged 46 to 49 and 70 to 74 years. Habitual diet was assessed using a validated food frequency questionnaire, and mental health was measured using the Hospital Anxiety and Depression Scale. Results After adjustments for variables including age, education, income, physical activity, smoking, and alcohol consumption, an a priori healthy diet quality score was inversely related to depression (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.59–0.84) and anxiety (OR = 0.77, 95% CI = 0.68–0.87) in women and to depression (OR = 0.83, 95% CI = 0.70–0.99) in men. Women scoring higher on a healthy dietary pattern were less likely to be depressed (OR = 0.68, 95% CI = 0.57–0.82) or anxious (OR = 0.87, 95% CI = 0.77–0.98), whereas men were more likely to be anxious (OR = 1.19, 95% CI = 1.03–1.38). A traditional Norwegian dietary pattern was also associated with reduced depression in women (OR = 0.77, 95% CI = 0.64–0.92) and anxiety in men (OR = 0.77, 95% CI = 0.61–0.96). A western-type diet was associated with increased anxiety in men (OR = 1.27, 95% CI = 1.14–1.42) and women (OR = 1.29, 95% CI = 1.17–1.43) before final adjustment for energy intake. Conclusions In this study, those with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety.

Sleep Misperception and Chronic Insomnia in the General Population: Role of Objective Sleep Duration and Psychological Profiles

Abstract: Objective:To examine the role of objective sleep duration, a novel marker in phenotyping insomnia, and psychological profiles on sleep misperception in a large, general population sample. Sleep misperception is considered by some investigators a common characteristic of chronic insomnia, whereas oth

Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study.

Abstract: Objective:To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with eating disorders (EDs) who were treated with individual cognitive behavior therapy. The diagnostic crossover, recovery, and relapses were assessed, applying both Diagnostic and Statistical Manual

Timing of prenatal maternal exposure to severe life events and adverse pregnancy outcomes: a population study of 2.6 million pregnancies.

Abstract: Objective:To identify the impact of timing of prenatal stress exposure on offspring risk for shortened gestational age, preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA), using a population-based sample.Methods:Swedish longitudinal population registries were linked to

Methylation at 5HTT mediates the impact of child sex abuse on women's antisocial behavior: an examination of the Iowa adoptee sample.

Abstract: Objective: To examine epigenetic processes linking childhood sex abuse to symptoms of antisocial personality disorder (ASPD) in adulthood and to investigate the possibility that the link between childhood sex abuse and deoxyribonucleic acid methylation at the 5HTT promoter might represent a pathway of long-term impact on symptoms of ASPD. Method: Deoxyribonucleic acid was prepared from lymphoblast cell lines derived from 155 female participants in the latest wave of the Iowa Adoptee Study. Methylation at 71 CpG residues was determined by quantitative mass spectroscopy, and the resulting values were averaged to produce an average CpG ratio for each participant. Simple associations and path analyses within an Mplus framework were examined to characterize the relationships among childhood sex abuse, overall level of methylation among women, and subsequent antisocial behavior in adulthood. Direct effects of biological parent psychopathology and 5HTT genotype were controlled. Results: Replicating prior work, we found that a significant effect of childhood sex abuse on methylation of the 5HTT promoter region emerged for women. In addition, a significant effect of methylation at 5HTT on symptoms of ASPD emerged. Conclusions: Child sex abuse may create long-lasting changes in methylation of the promoter region of 5HTT in women. Furthermore, hypermethylation may be one mechanism linking childhood sex abuse to changes in risk for adult antisocial behavior in women. Better understanding of the methylome may prove critical in understanding the role of childhood environments on long-term psychiatric sequelae.

Biobehavioral Factors and Cancer Progression: Physiological Pathways and Mechanisms

Abstract: Epidemiologic evidence increasingly has supported the role of biobehavioral risk factors such as social adversity, depression, and stress in cancer progression. This review describes in vitro, in vivo, and clinical studies demonstrating relationships between such processes and pathways involved in cancer progression. These include effects on the cellular immune response, angiogenesis, invasion, anoikis, and inflammation. Biobehavioral factors have been shown to contribute to the cross talk between tumor and host cells in the tumor microenvironment, and stress effects on host cells such as macrophages seem to be critical for many pathways involved in tumor progression. Some effects are bidirectional in that tumor-derived inflammation seems to affect central nervous system processes, giving rise to vegetative symptoms and contributing to dysregulation of the hypothalamic-pituitary-adrenal axis with downstream effects on inflammatory control. Findings to date are reviewed, and fruitful areas for future research are discussed.

Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study.

Abstract: OBJECTIVE To examine a 1-year follow-up of a 4-month, controlled clinical trial of exercise and antidepressant medication in patients with major depressive disorder (MDD). METHODS In the original study, 202 sedentary adults with MDD were randomized to: a) supervised exercise; b) home-based exercise; c) sertraline; or d) placebo pill. We examined two outcomes measured at 1-year follow-up (i.e., 16 months post randomization): 1) continuous Hamilton Depression Rating Scale score; and 2) MDD status (depressed; partial remission; full remission) in 172 available participants (85% of the original cohort). Regression analyses were performed to examine the effects of treatment group assignment, as well as follow-up antidepressant medication use and self-reported exercise (Godin Leisure-Time Exercise Questionnaire), on the two outcomes. RESULTS In the original study, patients receiving exercise achieved similar benefits compared with those receiving sertraline. At the time of the 1-year follow-up, rates of MDD remission increased from 46% at post treatment to 66% for participants available for follow-up. Neither initial treatment group assignment nor antidepressant medication use during the follow-up period were significant predictors of MDD remission at 1 year. However, regular exercise during the follow-up period predicted both Hamilton Depression Rating Scale scores and MDD diagnosis at 1 year. This relationship was curvilinear, with the association concentrated between 0 minute and 180 minutes of weekly exercise. CONCLUSION The effects of aerobic exercise on MDD remission seem to be similar to sertraline after 4 months of treatment; exercise during the follow-up period seems to extend the short-term benefits of exercise and may augment the benefits of antidepressant use. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00331305.

Psychosocial Factors and Sleep Efficiency: Discrepancies Between Subjective and Objective Evaluations of Sleep

Abstract: Self-reported sleep efficiency may not precisely reflect objective sleep patterns. We assessed whether psychosocial factors and affective responses are associated with discrepancies between subjective reports and objective measures of sleep efficiency.Participants were 199 working women aged 20 to 61 years. Standardized questionnaires were used to assess psychosocial characteristics and affect that included work stress, social support, happiness, and depressive symptoms. Objective measures of sleep were assessed on one week and one leisure night with an Actiheart monitor. Self-reported sleep efficiency was derived from the Jenkins Sleep Problems Scale. Discrepancies between self-reported and objective measures of sleep efficiency were computed by contrasting standardized measures of sleep problems with objectively measured sleep efficiency.Participants varied markedly in the discrepancies between self-reported and objective sleep measures. After adjustment for personal income, age, having children, marital status, body mass index, and negative affect, overcommitment (p = .002), low level of social support (p = .049), and poor self-rated heath (p = .02) were associated with overreporting of sleep difficulties and underestimation of sleep efficiency. Self-reported poor sleep efficiency was more prevalent among those more overcommitted at work (p = .009) and less happy (p = .02), as well as among those with lower level of social support (p = .03) and more depressive symptoms (p = .048), independently of covariates. Objective sleep efficiency was unrelated to psychosocial characteristics or affect.The extent to which self-reported evaluations of sleep efficiency reflect objective experience may be influenced by psychosocial characteristics and affect. Unless potential moderators of self-reported sleep efficiency are taken into account, associations between sleep and psychosocial factors relevant to health may be overestimated.

Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

Abstract: Posttraumatic stress disorder (PTSD) is associated with a broad range of medical conditions, including cardiovascular disease, arthritis, asthma, chronic pain, diabetes, bone or joint conditions, and gastrointestinal disorders (1-5), as well as reduced health-related quality of life (2, 4, 6-8), high rates of medical service utilization (9, 10), and excess mortality (11, 12). Evidence regarding associations of specific medical disorders with PTSD is derived largely from select populations, such as Veterans, so its generalizability to the general adult population remains to be determined. It is also unclear whether PTSD is independently associated with medical disorders after adjustment for sociodemographic characteristics and additional psychiatric comorbidities, including Axis II personality disorders (PDs). Because mood, anxiety, substance use, and personality disorders are independently related to medical comorbidities, these conditions may confound purported associations between PTSD and medical conditions, and studies that fail to adjust for them may overestimate these associations (2). While studies have found associations of PTSD with medical conditions independent of comorbid Axis I disorders (2, 3, 5, 8), some have not adjusted for all of these variables (4), and none have adjusted for PDs. To our knowledge, only one study has examined medical comorbidity of PTSD in a nationally representative sample of U.S. adults (3). This study, which used data from the National Comorbidity Survey-Replication (NCS-R), found a graded relationship between trauma exposure, PTSD, and lifetime medical comorbidities, with PTSD associated with elevated rates of medical conditions such as chronic pain, heart disease, and ulcer; and trauma exposure associated with intermediate rates of these conditions. This study also found that the number of lifetime traumas (cumulative trauma burden) may explain associations between PTSD and medical morbidities, although these associations were difficult to disentangle given greater cumulative trauma burden among respondents with PTSD. While this study provided the first characterization of medical comorbidity of PTSD in a national sample of U.S. adults, it was based on the Part II subsample of the NCS-R, which oversampled respondents with clinically significant psychopathology (3); only some of the medical conditions were queried as those diagnosed by a health professional; and analyses of associations between PTSD and medical conditions did not adjust for PDs, which are common in PTSD (13-15) and independently associated with medical morbidities and physical disability (16-18). Additional studies of large, representative samples that query healthcare professional-diagnosed medical conditions and adjust more comprehensively for psychiatric comorbidity, including PDs, are needed to evaluate independent associations of medical conditions with PTSD. Further, because the number of lifetime trauma exposures may be related to medical conditions independent of PTSD status (3, 5), more research is needed to evaluate the extent to which cumulative trauma burden and PTSD status are associated with specific medical conditions in population-based samples. Subthreshold or partial PTSD is also associated with functional impairment, though no study of which we are aware has examined specific medical disorders associated with this condition. Partial PTSD describes clinically significant PTSD symptoms among trauma-exposed individuals who do not meet full criteria for PTSD (7). It is typically identified when individuals meet Criterion B (re-experiencing) and either Criterion C (avoidance and numbing) or Criterion D (hyperarousal), or if they meet Criterion B and endorse at least one symptom each from Criteria C and D (6, 7). Studies of partial PTSD in Veterans (7) and civilian survivors of disasters and other traumas (6, 19) have found intermediate levels of psychiatric comorbidity and functional impairment relative to trauma-exposed individuals without PTSD and those with full PTSD. Because associations between partial PTSD and medical illnesses may have public health implications, evaluation of medical comorbidity among individuals with partial PTSD in a large, representative sample is indicated. The current study examined associations between lifetime PTSD and partial PTSD and past-year medical conditions; as well as the relation between lifetime traumatic exposures, PTSD status, and medical conditions using data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), one of the largest psychiatric epidemiology surveys ever conducted (Wave 1: N=43,093; Wave 2: N=34,653). Wave 2 of the NESARC included sections on PTSD and a broad range of respondent-reported, healthcare provider-diagnosed medical conditions. Thus, it provides a unique opportunity to examine specific medical conditions associated with PTSD and partial PTSD in a large, nationally representative sample of U.S. adults. In order to examine medical conditions associated with full and partial PTSD above and beyond traumatic exposure in general, and to permit comparison of odds ratios (ORs) of medical conditions associated with PTSD status to previous studies, the comparison group for this study consisted of respondents endorsing a lifetime Criterion A-qualifying traumatic event. Given the expansion of Criterion A-qualifying traumas in DSM-IV (20), this comparison group represents the vast majority of the population. We hypothesized that (a) rates of medical conditions in the comparison group would be comparable to those obtained in population-based studies of U.S. adults (21); (b) PTSD and partial PTSD would be associated with elevated rates of chronic medical conditions, especially stress-related ones such as cardiovascular, musculoskeletal, and gastrointestinal disorders, even after adjustment for psychiatric comorbidity; (c) partial PTSD would be associated with intermediate levels of these conditions compared to individuals with full PTSD and those exposed to trauma but with neither full nor partial PTSD; and (d) total number of lifetime traumatic event types would be associated with many of the medical conditions assessed and would consequently reduce the magnitudes of associations between PTSD status and medical conditions, rendering some of these associations non-significant.

Effects of mindfulness training on body awareness to sexual stimuli: implications for female sexual dysfunction.

Abstract: OBJECTIVES Treatments of female sexual dysfunction have been largely unsuccessful because they do not address the psychological factors that underlie female sexuality. Negative self-evaluative processes interfere with the ability to attend and register physiological changes (interoceptive awareness). This study explores the effect of mindfulness meditation training on interoceptive awareness and the three categories of known barriers to healthy sexual functioning: attention, self-judgment, and clinical symptoms. METHODS Forty-four college students (30 women) participated in either a 12-week course containing a "meditation laboratory" or an active control course with similar content or laboratory format. Interoceptive awareness was measured by reaction time in rating physiological response to sexual stimuli. Psychological barriers were assessed with self-reported measures of mindfulness and psychological well-being. RESULTS Women who participated in the meditation training became significantly faster at registering their physiological responses (interoceptive awareness) to sexual stimuli compared with active controls (F(1,28) = 5.45, p = .03, η(p)(2) = 0.15). Female meditators also improved their scores on attention (t = 4.42, df = 11, p = .001), self-judgment, (t = 3.1, df = 11, p = .01), and symptoms of anxiety (t = -3.17, df = 11, p = .009) and depression (t = -2.13, df = 11, p < .05). Improvements in interoceptive awareness were correlated with improvements in the psychological barriers to healthy sexual functioning (r = -0.44 for attention, r = -0.42 for self-judgment, and r = 0.49 for anxiety; all p < .05). CONCLUSIONS Mindfulness-based improvements in interoceptive awareness highlight the potential of mindfulness training as a treatment of female sexual dysfunction.

The association of traumatic experiences and posttraumatic stress disorder with physical morbidity in old age: a German population-based study.

Abstract: Objective To examine the relationship of traumatic experiences and posttraumatic stress disorder (PTSD) among a representative population sample of 1456 German elderly (60-85 years). Several studies have suggested that PTSD and traumatic experiences are related to adverse health outcomes. However, many past studies were based on special samples such as combat veterans or survivors of natural disasters. Methods Using self-report data and regression analyses, we investigated the association of traumatic experiences and PTSD with several medical conditions. Results Traumatized subjects had a significantly increased risk for all the medical conditions under study compared with those participants without a traumatic exposure, ranging from odds ratio of 1.37 (95% confidence interval [CI] = 1.07-1.75) for hypertension up to 5.12 (95% CI = 2.25-11.6) for cancer. There are significant associations of current PTSD with cardiovascular diseases (angina pectoris/coronary artery disease, congestive heart failure, and peripheral vascular disease) and cardiovascular risk factors (hypertension and elevated cholesterol level; odds ratio of 1.94 [95% CI = 1.14-3.31]) for peripheral vascular disease up to 3.76 [95% CI = 2.11-6.70] for elevated cholesterol level), as well as with asthma, cancer, back pain, hard of hearing, osteoporosis, stomach problems, and thyroid disorders. Conclusions These findings suggest an association between traumatic stress and PTSD with impaired physical health in a general population sample in the German elderly. It underscores the importance of traumatic experiences and PTSD not only for mental health but also for physical health as a long-term consequence. Language: en

Psychiatric symptoms and proinflammatory cytokines in pregnancy.

Abstract: Objective Clinical studies suggest that psychiatric symptoms, particularly depression, anxiety and trauma, may be associated with inflammation, as indexed by proinflammatory cytokines. Such a link may be especially significant in pregnancy, and may shed additional light on the etiology of perinatal mood disorders.

Depression and Leukocyte Telomere Length in Patients With Coronary Heart Disease: Data From The Heart and Soul Study

Abstract: Objective: Shortened telomere length has been associated with mortality in patients with coronary heart disease (CHD) and is considered as an emerging marker of biologic age. Whether depression is associated with telomere length or trajectory has not been evaluated in patients with CHD. Methods: In a prospective cohort study, we measured leukocyte telomere length in 952 participants with stable CHD at baseline and in 608 of these participants after 5 years of follow-up. The presence of major depressive disorder in the past month was assessed using the computerized diagnostic interview schedule at baseline. We used linear and logistic regression models to evaluate the association of depression with baseline and 5-year change in leukocyte telomere length. Results: Of the 952 participants, 206 (22%) had major depression at baseline. After the adjustment for age and sex, the patients with current major depressive disorder had shorter baseline telomere length than those without depression (mean [standard error] = 0.86 [0.02] versus 0.90 [0.01]; p = .02). This association was similar (but no longer statistically significant) after adjustment for body mass index, smoking, diabetes, left ventricular ejection fraction, statin use, antidepressant use, physical inactivity, and anxiety (0.85 [0.02] versus 0.89 [0.01], p = .06). Depression was not predictive of 5-year change in telomere length after adjustment for the mentioned covariates and baseline telomere length. Conclusions: Depression is associated with reduced leukocyte telomere length in patients with CHD but does not predict 5-year change in telomere length. Future research is necessary to elucidate the potential mechanisms underlying the association between depression and telomere length.

Gender differences in placebo analgesia: event-related potentials and emotional modulation.

Abstract: Objectives To examine whether there are gender differences in event-related potential (ERP) responses to painful stimulation after administration of placebo medication; and to investigate whether placebo medication reduces anticipatory stress and if this reduction can explain the placebo analgesic response. Several experimental and clinical studies have shown that males report lower pain compared with females. There are, however, few reports of gender differences in placebo analgesia. Methods All subjects (n = 33; 17 women) participated in both a natural history and a placebo condition. ERPs were evoked by heat pulses with a peak at 52 °C. Results The results showed that pain unpleasantness and the N2/P2 ERP components were reduced in the placebo condition compared with the natural history condition. Only men displayed placebo responses in pain report and in the P2 component. Anticipatory stress was reduced after placebo administration, and the reduction in anticipatory stress was significantly related to the placebo effect on pain. Regression analyses revealed that the interaction of gender by anticipatory stress was significantly related to the mean placebo response, with men responding with lower stress after placebo medication, and larger placebo responses. Conclusions A placebo response on pain unpleasantness was observed in men only, and reduced stress after placebo administration was observed in males only. Thus, reduced stress may be a mechanism for placebo responses in pain.

Lack of Prognostic Value of Type D Personality for Mortality in a Large Sample of Heart Failure Patients

Abstract: Background: Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. Methods: We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. Results: At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). Conclusions: In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.

Sleep variability, health-related practices, and inflammatory markers in a community dwelling sample of older adults.

Abstract: OBJECTIVE To explore relationships between wake- and sleep-related health behaviors and circulating concentrations of inflammatory markers (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) in a cohort of community dwelling older adults. Low-grade chronic inflammation is an important risk factor for age-related morbidity. Health behaviors, including average aggregate measures of sleep, have been linked to increased inflammation in older adults. Variability in sleep timing may also be associated with increased inflammation. METHOD Participants were community dwelling older adults ≥ 60 years (n = 222: 39 bereaved, 55 caregivers, 52 with insomnia, and 76 good sleepers). Mean values and intraindividual variability in sleep, as well as caffeine and alcohol use, exercise, and daytime napping, were assessed by sleep diaries. Blood samples were obtained in the morning. RESULTS Several interactions were noted between sleep behaviors, inflammatory markers, and participant group. Greater variability in wake time and time in bed was associated with higher IL-6 among good sleepers relative to caregivers and older adults with insomnia. Good sleepers who consumed moderate amounts of alcohol had the lowest concentrations of IL-6 compared with the other three groups who consumed alcohol. Insomnia subjects, but not good sleepers, showed increased concentrations of IL-6 associated with caffeine use. Caregivers showed increased concentrations of TNF-α with alcohol use relative to good sleepers. Greater variability in bedtime, later wake times, and longer time in bed was associated with higher TNF-α regardless of group. CONCLUSIONS Moderation and regularity in the practice of certain health behaviors, including sleep practices, were associated with lower plasma levels of inflammatory markers in older adults. Life circumstances and specific sleep disorders may modify these associations.

Modeling Social Influences on Human Health

Abstract: Social interactions have long-term physiological, psychological and behavioral consequences. Social isolation is a well recognized but little understood risk factor and prognostic marker of disease, and can have profoundly detrimental effects on both mental and physical well-being, particularly during states of compromised health. In contrast, the health benefits associated with social support (both reduced risk and improved recovery) are evident in a variety of illnesses and injury states; however, the mechanisms by which social interactions influence disease pathogenesis remain largely unidentified. The substantial health impact of the psychosocial environment can occur independently of traditional disease risk factors and is not accounted for solely by peer-encouraged development of health behaviors. Instead, social interactions are capable of altering shared pathophysiological mechanisms of multiple disease states in distinct measurable ways. Converging evidence from animal models of injury and disease recapitulates the physiological benefits of affiliative social interactions and establishes several endogenous mechanisms (inflammatory signals, glucocorticoids and oxytocin) by which social interactions influence health outcomes. Taken together, both clinical and animal research are undoubtedly necessary in order to develop a complete mechanistic understanding of social influences on health.

Depressed Mood and Flow-Mediated Dilation: A Systematic Review and Meta-Analysis

Abstract: Objective:This systematic and quantitative review evaluates the literature on associations between depressed mood and flow-mediated dilation (FMD), a measure of endothelial function, in adults.Methods:Published English-language articles (through December 2010) were identified from literature searche

Blood pressure reactions to acute mental stress and future blood pressure status: data from the 12-year follow-up of the West of Scotland Study.

Abstract: Objective: To test the reactivity hypothesis using blood pressure data collected 12 years after baseline. This study examined whether blood pressure reactions to acute mental stress predicted future blood pressure resting levels, as well as the temporal drift in resting blood pressure, and whether the prediction was affected by sex, age, and socioeconomic status. Methods: Resting blood pressure was recorded at an initial baseline and in response to a mental stress task. Twelve years later, resting blood pressure was again assessed. Data were available for 1196 participants (645 women, 551 men), comprising, at the time of stress testing, 439 whowere aged 24 years; 503, aged 44; and 254, aged 63. The participants included 531 who were from manual occupational households and 661 from nonmanual occupational households. Results: In multivariate linear regression models, adjusting for a number of potential confounders, systolic blood pressure (SBP) reactivity positively predicted future resting SBP, as well as the upward drift in SBP over the 12 years (A = 0.10, p < .001 in both cases). The effect sizes were smaller than those reported from an earlier 5-year follow-up. The analogous associations for diastolic blood pressure reactivity were not statistically significant. In multivariate logistic regression, high SBP reactivity was associated with an increased risk of being hypertensive 12 years later (odds ratio = 1.03, 95% confidence interval = 1.01Y1.04, p < .001). Conclusions: The present findings that greater reactivity is associated with higher future resting blood pressure, more upward drift in resting blood pressure, and future hypertension provide support for the reactivity hypothesis.

Ecological momentary assessment of maternal cortisol profiles over a multiple-day period predicts the length of human gestation.

Abstract: Objective Biobehavioral models of prenatal stress highlight the importance of the stress-related hormone cortisol. However, the association between maternal cortisol levels and the length of human gestation requires further investigation because most previous studies have relied on one-time cortisol measures assessed at varying gestational ages. This study assessed whether ecological momentary assessment (EMA) of cortisol sampling improves the ability to predict the length of human gestation. In addition, associations between EMA-based measures of psychological state (negative affect) with cortisol levels during pregnancy were assessed. Methods For a 4-day period, 25 healthy pregnant women (mean gestational age at assessment = 23.4 [standard deviation = 9.1] weeks) collected seven salivary samples per day for the assessment of cortisol and provided a rating of negative affect every waking hour using an electronic diary. Results Higher salivary cortisol concentrations at awakening and throughout the day (p = .001), as well as a flatter cortisol response to awakening (p = .005), were associated with shorter length of gestation. Women who delivered an infant at 36 weeks of gestations had 13% higher salivary cortisol levels at awakening than women who delivered an infant at 41 weeks of gestation. The EMA-based measure of negative affect was associated with higher cortisol throughout the day (p = .006) but not to gestational length (p = .641). The one-time measure of cortisol was not associated with length of gestation, and traditional retrospective recall measures of negative affect were not associated with cortisol. Conclusions Our findings support the ecological validity of repeated ambulatory assessments of cortisol in pregnancy and their ability to improve the prediction of adverse birth outcomes.

Type D Personality and All-Cause Mortality in Cardiac Patients-Data From a German Cohort Study

Abstract: Objective Type D personality has been established as a predictor of adverse clinical events in patients with cardiovascular diseases. To date, all studies except one have been conducted by a single research group. Thus, the aim of our study was to provide an independent replication of the results regarding the prognostic validity of Type D personality in a German sample of cardiac patients. Methods Cardiac patients (n = 1040) were recruited from cardiac rehabilitation centers (n = 484), an outpatient clinic (n = 249), and a university hospital (n = 307). Main analyses were based on the combined data from these three subsamples. Cardiac health status, medical risk factors, sociodemographic characteristics, psychological symptoms, and Type D personality were assessed at baseline. The primary end point was all-cause mortality. The Cox proportional hazards regression model was used to estimate the relative risk of death. Results Vital status was known for 977 patients (22.5% women; mean [standard deviation] = 63.3 [10.7] years). Within the follow-up time (mean [standard deviation] = 71.5 [3.6] months), 172 patients died. Type D personality was found in 25.2% of survivors and in 22.2% of nonsurvivors (χ²= 0.78, p = .38). Depressive symptoms (p = .13) and anxiety (p = .27) were also not predictive of mortality. In the multivariate analyses, neither Type D (p = .95) nor negative affectivity (p = .71) and social inhibition (p = .59), as well as their interaction (p = .88), were associated with all-cause mortality. Conclusions In the present study, Type D personality and its constituents are not associated with increased mortality in patients with heart disease. The discrepancies with previous results deserve further investigation.

Cardiovascular reactivity to acute psychological stress following sleep deprivation.

Abstract: Objective:Psychological stress and sleep disturbances are highly prevalent and are both implicated in the etiology of cardiovascular diseases. Given the common co-occurrence of psychological distress and sleep disturbances including short sleep duration, this study examined the combined effects of t

Can neuroimaging help us to understand and classify somatoform disorders? A systematic and critical review.

Abstract: Objective Debate about the nature of somatoform disorders and their current diagnostic classification has been stimulated by the anticipation of new editions of Diagnostic and Statistical Manual of Mental Disorders and International Statistical Classification of Diseases and Related Health Problems diagnostic classifications. In the current paper, we review systematically the literature on the neuroimaging of somatoform disorders and related conditions with the aim of addressing two specific questions: Is there evidence of altered neural function or structure that is specifically associated with somatoform disorders? What conclusions can we draw from these findings about the etiology of somatoform disorders? Methods Studies reporting neuroimaging findings in patients with a somatoform disorder or a functional somatic syndrome (such as fibromyalgia) were found using Pubmed, PsycINFO, and EMBASE database searches. Reported structural and functional neuroimaging findings were then extracted to form a narrative review. Results A relatively mature literature on symptoms of pain and less developed literatures on conversion and fatigue symptoms were identified. The available evidence indicates that, when compared with nonclinical groups, somatoform diagnoses are associated with increased activity of limbic regions in response to painful stimuli and a generalized decrease in gray matter density; however, methodological considerations restrict the interpretation of these findings. Conclusions Whereas the neuroimaging literature has provided evidence about the possible mechanisms underlying somatoform disorders, this is not yet sufficient to provide a basis for classification. By adopting a wider variety of experimental designs and a more dynamic approach to diagnosis, there is every reason to be hopeful that neuroimaging data will play a significant role in future taxonomies.

Optimism in relation to inflammation and endothelial dysfunction in older men: the VA Normative Aging Study.

Abstract: Background:Recent research suggests that optimism may reduce the risk of incident cardiovascular disease, but the mechanisms have not been determined. This study examines the association of optimism with change in inflammation and endothelial function over time in men.Methods:Longitudinal data were

Does disturbed sleeping precede symptoms of anxiety or depression in toddlers? The generation R study.

Abstract: Objective:To examine whether sleep problems in infancy and early toddlerhood precede symptoms of anxiety or depression at 3 years.Methods:Data on specific sleep problems at 2 months and 24 months were available for 4,782 children participating in a population-based cohort in The Netherlands. The Chi