A prospective study of positive psychological well-being and coronary heart disease.

Objective: Research suggests that positive psychological well-being is associated with cardiovascular health. However, much of this research uses elderly samples and has not determined the pathways by which psychological well-being influences cardiovascular disease or whether effects are similar for men and women. This study investigates the association between two aspects of well-being (emotional vitality and optimism) and coronary heart disease (CHD) in a sample of middle-aged men and women, and considers potential mediating factors. Method: Between 1991 and 1994, well-being and coronary risk factors were assessed among 7,942 individuals without a prior cardiovascular event from the Whitehall II cohort. Incident CHD (fatal CHD, first nonfatal myocardial infarction, or first definite angina) was tracked during 5 person-years of follow-up. Results: Positive psychological well-being was associated with reduced risk of CHD with an apparent threshold effect. Relative to people with the lowest levels of well-being, those with the highest levels had minimally adjusted hazard ratios of 0.74, 95% confidence interval [0.55, 0.98] for emotional vitality and 0.73, 95% confidence interval [0.54, 0.99] for optimism. Moreover, the association was strong for both genders and was only weakly attenuated when accounting for ill-being. Neither health-related behaviors nor biological factors explained these associations. Conclusions: Positive psychological well-being was associated with a modest, but consistent reduced risk of incident CHD. The relationship was comparable for men and women, and was maintained after controlling for cardiovascular risk factors and ill-being. Additional research is needed to identify underlying mechanisms and investigate whether interventions to increase well-being may enhance cardiovascular health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A prospective study of posttraumatic stress disorder symptoms and coronary heart disease in women.

Objective: Posttraumatic stress disorder (PTSD) reflects a prolonged stress reaction and dysregulation of the stress response system and is hypothesized to increase risk of developing coronary heart disease (CHD). No study has tested this hypothesis in women even though PTSD is more prevalent among women than men. This study aims to examine whether higher levels of PTSD symptoms are associated with increased risk of incident CHD among women. Design: A prospective study using data from women participating in the Baltimore cohort of the Epidemiologic Catchment Area study (n = 1059). Past year trauma and associated PTSD symptoms were assessed using the NIMH Diagnostic Interview Schedule. Main Outcome Measures: Incident CHD occurring during the 14-year follow-up through 1996. Results: Women with five or more symptoms were at over three times the risk of incident CHD compared with those with no symptoms (age-adjusted OR = 3.21, 95% CI: 1.29-7.98). Findings were maintained after controlling for standard coronary risk factors as well as depression or trait anxiety. Conclusion: PTSD symptoms may have damaging effects on physical health for civilian community-dwelling women, with high levels of PTSD symptoms associated with increased risk of CHD-related morbidity and mortality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hostility, the metabolic syndrome, and incident coronary heart disease.

This investigation examined the impact of hostility and the metabolic syndrome on coronary heart disease (CHD) using prospective data from the Normative Aging Study. Seven hundred seventy-four older, unmedicated men free of cardiovascular disease were included in the study. The total Cook-Medley Hostility (Ho) Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption, and total dietary calories were used to predict incident CHD during a 3-year follow-up interval. Multivariate analysis indicated that only Ho positively predicted and high-density lipoprotein cholesterol level negatively predicted incident CHD. Ho's effects on CHD may be mediated through mechanisms other than factors that constitute the metabolic syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The composition and structure of depressive symptomatology in renal disease.

Renal disease is an increasingly common illness among middle-aged and older adults, and is often associated with depression. The Center for Epidemiologic Studies Depression Scale (CES–D) is a widely used self-report screening measure on which responses generally conform to a 4-factor structure, with each factor loading onto a higher-order Depression factor. The current study examines whether this structure is supported among individuals with renal disease (both predialysis and posttransplant kidney disease patients). Persons with renal disease (n = 225) and healthy control participants (n = 230) were recruited from Vancouver General Hospital and the community. Participants completed the CES–D as part of an extended assessment. Confirmatory factor analytic models were computed for the renal disease and healthy control groups. Results support a 4-factor structure for CES–D responses in persons with renal disease and healthy controls. The hierarchical structure of CES–D responses also appears invariant between groups. Factor structure was similar between groups; only for Depressive Affect was the strength of association with the second-order factor greater among the renal disease than healthy control participants. Findings support similarity of CES–D factor structures between patients with renal disease and healthy individuals. Results suggest that the CES–D's 4 factors contribute to measurement of a higher-order Depression factor in both groups; furthermore, 3 of 4 factors appear invariant between groups. As such, this measure can be used confidently to quantify depressive symptoms in individuals with renal disease. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and the metabolic syndrome in childhood and adulthood: A prospective cohort study.

Objective: To examine the reciprocal associations between depressive symptoms and clinical definitions of the metabolic syndrome in childhood and adulthood. Design: Population-based prospective cohort study of 921 participants (538 women and 383 men) in Finland. The components of the metabolic syndrome were measured in childhood (mean age 12 years) and again in adulthood (mean age 33 years). A revised version of the Beck Depression Inventory was used to assess depressive symptoms at the mean ages of 24 and 33. Main Outcome Measures: Metabolic syndrome defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP), the European Group for the Study of Insulin Resistance, and the International Diabetes Federation criteria. Results: In women, depressive symptoms were associated with increased risk of the metabolic syndrome in adulthood (odds ratio for NCEP metabolic syndrome per 1 SD increase in depressive symptoms 1.40, 95% confidence interval 1.05-1.85). The metabolic syndrome in childhood, in turn, predicted higher levels of depressive symptoms in adulthood (p = .03). In men, no associations were found between depressive symptoms and the clinical definitions of the metabolic syndrome. Conclusion: The process linking depressive symptoms with the metabolic syndrome may go into both directions and may begin early in life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospitalization cost offset of a hostility intervention for coronary heart disease patients.

The authors evaluated hospitalization cost offset of hostility management group therapy for patients with coronary heart disease (CHD) from a previously published randomized controlled trial (Y. Gidron, K. Davidson, & I. Bata, 1999). Twenty-six male patients with myocardial infarction or unstable angina were randomized to either 2 months of cognitive-behavioral group therapy or an information (control) session. Therapy patients had a shorter average length of hospital stay (n = 13, M = 0.38 days, SD = 0.96) than did control patients (n = 13, M = 2.15 days, SD = 2.6), t(15.2) = -2.29, p = .04, over 6 months following therapy. The average hospitalization costs were significantly lower for therapy patients (M = $245, SD = $627) than for control patients (M = $1,333, SD = $1,609), t(15.6) = -2.27, p = .04. The cost-offset ratio is calculated by dividing the $1,088 of hospitalization savings by the $560 of therapy expense ($1.00:$1.94), indicating that for every $1.00 spent on therapy, there is an approximate savings of $2.00 in hospitalization costs in the following 6 months. These findings support the hospitalization cost offset of hostility-reduction in CHD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model psychosocial screening program for children and youth with newly diagnosed Type 1 diabetes: Implications for psychologists across contexts of care.

Psychosocial factors are strongly associated with long-term medical and mental health outcomes for children with Type 1 diabetes. As a result, current national and international guidelines now call for psychosocial screening at or near the time of diabetes diagnosis. Despite this recommendation, there are no published protocols to provide guidance to psychologists attempting to screen and identify at-risk patients and their families and prevent the emergence of secondary psychological and medical complications. In this article, the authors describe a model psychosocial screening program that was designed to minimize barriers to implementation and that can potentially be adapted for use by psychologists in different settings. Preliminary findings from the pilot phase of program development suggest that the screening is effective at identifying patients at risk for subsequent problems with diabetes management. The screening was able to identify specific, modifiable risk factors that provide targets for efforts at preventive intervention using treatment approaches familiar to most psychologists. The authors conclude with a discussion of the importance of screening and knowledge of diabetes risk factors for psychologists working in different treatment settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors.

One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual differences in trajectories of emotion regulation processes: The effects of maternal depressive symptomatology and children's physiological regulation.

Trajectories of emotion regulation processes were examined in a community sample of 269 children across the ages of 4 to 7 using hierarchical linear modeling. Maternal depressive symptomatology (Symptom Checklist-90) and children's physiological reactivity (respiratory sinus arrhythmia [RSA]) and vagal regulation (ΔRSA) were explored as predictors of individual differences in trajectories of emotion regulation and negativity (mother-reported Emotion Regulation Checklist; A. M. Shields & D. Cicchetti, 1997). In addition, the authors explored whether children's physiological regulation would moderate the effect of maternal depressive symptomatology on children's emotion regulation trajectories. Results indicated that over time, emotion regulation increased whereas negativity decreased, though considerable individual variability in the pattern of change was observed. Greater maternal depressive symptomatology was associated with less steep emotion regulation trajectories. There was a significant Maternal Depressive Symptomatology × Baseline RSA × Age interaction predicting emotion regulation trajectories. Overall, it appears that the development of emotion regulation over time is compromised when mothers report greater depressive symptomatology. There is also evidence that children's capacity for physiological regulation can buffer some of the adverse consequences associated with maternal depressive symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Contributions toward evidence-based psychocardiology: A systematic review of the literature.

Reviews the book, Contributions toward evidence-based psychocardiology: A systematic review of the literature by Jochen Jordan, Benjamin Bardé, and Andreas-Michael Zeiher (see record 2006-13513-000). Reflecting a strong trend in the field towards evidence-based behavioural medicine, 10 systematic reviews of broad areas in psychocardiology are presented. Unfortunately, although the copyright date is 2007, the reviews focus largely on research published more than five years earlier, ignoring what are arguably the largest and most influential clinical trials and observational studies in behavioural medicine to date. The first chapter provides a comprehensive overview of the sociological aspects of the development and course of coronary heart disease (CHD). The final chapter is an examination of cardiac rehabilitation from a health systems analysis perspective. In between, the authors cover various psychological, psychosocial and medical aspects of CHD. The reviewers commend the editors for compiling an ambitious book on an important topic, but lament that its inconsistent approach is unlikely to completely satisfy physicians, behavioral medicine researchers or graduate students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and marital satisfaction in the context of chronic disease: A longitudinal dyadic analysis.

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Longitudinal Analysis of the Course of Depressive Symptomatology in Geriatric Patients With Cancer of the Breast, Colon, Lung, or Prostate.

This study mapped the trajectory of depression and its components (depressive mood, somatic expression of depression, and lack of positive affect) for 1 year after an initial cancer diagnosis, revealing the complex nature of the psychological response to the cancer experience. The analysis was based on 4 waves of panel data from 860 older patients with incident breast, colon, lung, or prostate cancer. Predictors of depressive symptoms included cancer site; stage; comorbidities; sociodemographic characteristics; and indicators of physical functioning, symptom severity, and treatment. Patients' overall depressive symptoms declined, especially depressive mood and somatic indicators. By contrast, the sense of well-being did not recover; in fact, it would have deteriorated without improvements in physical functioning and physical symptoms. The present findings show the importance of psychological assessments and symptom management during cancer treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of rumination and distraction in formerly depressed inpatients and community controls.

The response styles theory (S. Nolen-Hoeksema, B. E. Wisco, & S. Lyubomirsky, 2008) supposes that ruminative coping is a cognitive risk factor for the course of depression, whereas distractive coping has protective effects. The authors present a longitudinal study on reciprocal relations between coping styles and depressive symptoms. They investigated 82 formerly depressed inpatients 4 weeks, 6 months, and 3.5 years after hospital discharge together with 76 age- and gender-matched community controls. Depressive symptoms predicted future symptom-focused rumination over the initial short-term interval in both samples. In former inpatients, this predictive effect was also significant over the subsequent long-term interval. Symptom-focused rumination and distraction were significant predictors of future depressive symptoms across both intervals, with sample-specific effects. In the community sample, symptom-focused rumination predicted more depressive symptoms, whereas in former inpatients, distractive coping predicted fewer depressive symptoms over time. The authors conclude that interventions aimed at reducing rumination should preferably be applied in preventive and early intervention settings, although in individuals with a history of more severe and long-standing depression rumination might gradually lose its capacity to predict the further illness course. In these persons, interventions should particularly strengthen distractive coping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions.

Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, resulting from prolonged exposure to work-related stress. The authors review the accumulated evidence suggesting that burnout and the related concept of vital exhaustion are associated with increased risk of cardiovascular disease and cardiovascular-related events. The authors present evidence supporting several potential mechanisms linking burnout with ill health, including the metabolic syndrome, dysregulation of the hypothalamic-pituitary-adrenal axis along with sympathetic nervous system activation, sleep disturbances, systemic inflammation, impaired immunity functions, blood coagulation and fibrinolysis, and poor health behaviors. The association of burnout and vital exhaustion with these disease mediators suggests that their impact on health may be more extensive than currently indicated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linkages between facial expressions of anger and transient myocardial ischemia in men with coronary artery disease.

The authors examined whether facial expressions of emotion would predict changes in heart function. One hundred fifteen male patients with coronary artery disease underwent the Type A Structured Interview, during which time measures of transient myocardial ischemia (wall motion abnormality and left ventricular ejection fraction) were obtained. Facial behavior exhibited during the ischemia measurement period was videotaped and later coded by using the Facial Action Coding System (P. Ekman & W. V. Friesen, 1978). Those participants who exhibited ischemia showed significantly more anger expressions and nonenjoyment smiles than nonischemics. Cook–Medley Hostility scores did not vary with ischemic status. The findings have implications for understanding how anger and hostility differentially influence coronary heart disease risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial Factors in Outcomes of Heart Surgery: The Impact of Religious Involvement and Depressive Symptoms.

This article reports a prospective study of religiousness and recovery from heart surgery. Religiousness and other psychosocial factors were assessed in 142 patients about a week prior to surgery. Those with stronger religious beliefs subsequently had fewer complications and shorter hospital stays, the former effect mediating the latter. Attendance at religious services was unrelated to complications but predicted longer hospitalizations. Prayer was not related to recovery. Depressive symptoms were associated with longer hospital stays. Dispositional optimism, trait hostility, and social support were unrelated to outcomes. Effects of religious beliefs and attendance were stronger among women than men and were independent of biomedical and other psychosocial predictors. These findings encourage further examination of differential health effects of the various elements of religiousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Course of Depressive Symptoms in Men From Early Adolescence to Young Adulthood: Identifying Latent Trajectories and Early Predictors.

Heterogeneity in the longitudinal course of depressive symptoms was studied through the use of general growth mixture modeling for young men in the Oregon Youth Study (N=206), who ranged in age from 15 to 24 years. Four trajectory classes were identified: the very-low, the moderate-decreasing, the high-decreasing, and the high-persistent classes. The 3 lowest classes differed primarily quantitatively with the initial level or mean level across time being the major determinant of class differences, whereas the high-persistent class appeared qualitatively different in terms of long-term developmental trends and variation. Findings from univariate and multivariate analyses revealed specific effects of childhood, parental, contextual, and individual risk factors on the class membership as well as on the growth within each trajectory class. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking behavior in offspring of heart disease patients: A response to cognitive dissonance.

Offspring of heart disease patients, with their variety of health concerns, were compared to a control group with respect to cigarette smoking behavior. Contrary to common-sense expectations, a significantly greater proportion of both male and female offspring were current smokers, and smoked to a greater degree (heavy) than control Ss. The MMPI, however, did not discriminate between Ss on the basis of smoking behavior. In accordance with previous research, it was theorized that the differences observed could be attributed to the higher state of cognitive dissonance associated with cigarette smoking in the offspring group. The fact that a relationship existed between quitting and age, for male and female offspring, suggests that more research is required to study the effects of extreme states of cognitive dissonance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality, Type A behavior, and coronary heart disease: The role of emotional expression.

The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern—Structured Interview (SI) versus Jenkins Activity Survey (JAS)—and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)