Negative affect and self-report of physical symptoms: Two longitudinal studies of older adults.

The ability of negative affect (NA) to predict somatic complaints 6 months later was examined. State NA, including anxious affect (AA) and depressive affect (DA), was measured in 2 separate samples of older adults averaging 62 and 73 years of age. In the first study, DA reliably predicted later complaints, and a corresponding trend was noted for NA. The second study showed that state NA and its 2 constituent variables predicted somatic complaints associated with acute illness (e.g., colds) 6 months later. The second study also examined trait measures of the 3 predictor variables and found that NA and AA, but not DA, were associated with subsequent somatic complaints. However, these trait effects were less robust than those attributable to their state counterparts. The authors conclude that negative mood states are the more consistent predictors of later physical symptom reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of state and trait affect on HIV risk behaviors: A daily diary study of MSM.

Objective: To characterize the influence of state and trait affect on HIV risk behaviors. Design: Men who have sex with men (N = 155) completed reports of trait affect and daily reports of affect and sexual behaviors each night for up to 30 days. Main Outcome Measures: Analyses focused on the role of state and trait positive activation (PA), negative activation (NA), anxious arousal (AA), and sexual activation (SA) on sexual risk taking, operationalized as having a sex partner, a partner-related risk composite, and an HIV risk behavior composite. Results: State SA was positively associated with having a sex partner and HIV risk behaviors; trait SA was positively associated with partner-related risk. State AA was negatively associated with having a sex partner and positively associated with HIV risk behaviors. Trait AA had a negative association with partner-related risk and moderated the effects of state AA. State PA was negatively associated with HIV risk behaviors, and trait PA had a main effect on having a sex partner. NA had no significant trait or state effects. Conclusion: These data suggest a role for multiple affective states in sexual risk taking. Models of HIV risk-taking behaviors should be extended to include affective processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anhedonia, positive and negative affect, and social functioning in schizophrenia

This study examines the relationship between anhedonia and the trait dimensions of positive affect (PA) and negative affect (NA) in schizophrenia. The relationship between poor social functioning in schizophrenia and these individual differences in affectivity is also examined. Schizophrenia outpatients (n = 37) and normal controls (n = 15) were assessed at a baseline evaluation and again approximately 90 days later. Consistent with the hypothesized decrease in hedonic capacity in schizophrenia, patients reported significantly greater physical and social anhedonia and less PA than controls. However, the schizophrenia group also reported significantly greater NA and social anxiety than did controls. In support of the dispositional view of these individual differences in affectivity, trait measures demonstrated test-retest reliability, and group differences between the schizophrenia group and controls were stable over the 90-day followup period. Within the schizophrenia group, physical and social anhedonia were comparably negatively correlated with trait PA; however, social but not physical anhedonia was significantly positively correlated with NA and social anxiety. Poor social functioning in the schizophrenia group was associated with greater physical and social anhedonia and greater NA and social anxiety. Alternatively, greater trait PA was related to better social functioning. These findings indicate that schizophrenia is characterized by both low PA and elevated NA and that these affective characteristics are a stable feature of the illness. The results also suggest important links between affect and social functioning in schizophrenia.     

Objective and subjective socioeconomic status and susceptibility to the common cold.

Objective: We ask whether subjective socioeconomic status (SES) predicts who develops a common cold when exposed to a cold virus. Design: 193 healthy men and women ages 21-55 years were assessed for subjective (perceived rank) and objective SES, cognitive, affective and social dispositions, and health practices. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms. Main Outcome Measures: Infection, signs and symptoms of the common cold, and clinical illness (infection and significant objective signs of illness). Results: Increased subjective SES was associated with decreased risk for developing a cold for both viruses. This association was independent of objective SES and of cognitive, affective and social disposition that might provide alternative spurious (third factor) explanations for the association. Poorer sleep among those with lesser subjective SES may partly mediate the association between subjective SES and colds. Conclusions: Increased Subjective SES is associated with less susceptibility to upper respiratory infection, and this association is independent of objective SES, suggesting the importance of perceived relative rank to health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status

BACKGROUND: The etiology of inflammatory bowel disease is unclear, and the role played by anxiety and depression is highly controversial. Anxiety and depression in patients with inflammatory bowel disease could be secondary to disabling symptoms, but the interaction between physical morbidity and psychologic illness in these subjects has not been sufficiently investigated. Patients with inflammatory bowel disease are nevertheless frequently undernourished, but there are no studies on the association between anxiety and depression and malnutrition. This study was designed to characterize anxiety and depression in subjects affected by inflammatory bowel disease and to establish the influence of physical morbidity and/or nutritional status on psychologic disorders. METHODS: Seventy-nine consecutive patients, 43 with Crohn's disease (CD) and 36 with ulcerative colitis (UC), were enrolled in the study. An index of the disease activity and physical morbidity was obtained by the simplified Crohn's Disease Activity Index and Truelove-Witts criteria and using the Clinical Rating Scale. Thirty-six healthy volunteers were studied as controls. All the subjects were given the State and Trait Anxiety Inventory (STAI) test and the Zung self-rating Depression Scale. RESULTS: The percentage of subjects with state anxiety was significantly higher in the CD (P < 0.001) and UC (P < 0.001) groups than in control subjects. There was no significant difference in trait anxiety among groups. The percentage of subjects with depression was significantly higher in the CD (P < 0.05) and UC (P < 0.05) groups than in control subjects. State anxiety and depression were significantly associated with physical morbidity and correlated with malnutrition in CD and UC patients. CONCLUSION: Anxiety and depression in patients with inflammatory bowel disease could be reactive to the disabling symptoms and to malnutrition. As measured with the STAI, personality trait of anxiety does not seem to play an important role in inflammatory bowel disease.     

Does Positive Affect Influence Health?

This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does unhappiness make you sick? The role of affect and neuroticism in the experience of common physical symptoms.

The relative strength of both affective state and the personality trait neuroticism in predicting common physical symptoms was tested among 19–63 yr-olds. The authors used an event-sampling design to overcome methodological limitations of past research in the area. Contrary to much previous research, neuroticism was found to be unrelated to reports of physical symptoms, although it was found to be related to unpleasant affective state. Unpleasant affect bore a strong concurrent relation to the frequency of reported symptoms. Temporal relations between experiences of unpleasant affect and subsequent symptoms were found for some individuals, but wide individual variability was seen in both the strength and direction of this linkage. The findings suggest that when individuals are asked to report their subjective experiences of physical illness without the necessity to retrospect over significant periods of time, unpleasant affective state is more strongly related to experiences of symptoms than is the trait neuroticism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of stressful daily events on mood states: relationship to global perceived stress

This study used experience sampling methodology to examine the relationship between stressful daily events and mood. Eighty-five male white-collar workers completed self-reports 10 times a day for 5 days. Controlling for individual differences in mood levels, multilevel regression analyses showed that events were followed by increases in negative affect (NA) and agitation (Ag) and by decreases in positive affect (PA). More unpleasant events were associated with greater changes in all three mood dimensions; controllability mitigated the effects of events on NA and PA. Prior events had persistent effects on current mood. High perceived stress (PS) was associated with greater reactivity of NA and PA to current events, whereas trait anxiety moderated reactivity of Ag. Results indicate that PS is related not only to a higher frequency of reported events but also to more intense and prolonged mood responses to daily stress.     

Chicken microchromosomes are hyperacetylated, early replicating, and gene rich

Persons with chronic pain often report a range of physical symptoms beyond their primary pain complaint itself. We predicted that non-specific physical symptom complaints would correlate more strongly with pain-related distress than with general measures of distress, and that they would contribute directly to disability. Results from 210 adults with chronic pain showed that collateral physical complaints are common in persons with chronic pain. Correlational analyses showed that greater reporting of physical complaints was associated with reports of higher pain severity, higher levels of depression, more cognitive, escape/avoidance, fearful appraisal, and physiological symptoms of pain-related anxiety and more physical and psychosocial disability. Regression analyses showed that, with pain-related anxiety variables entered either before or after depression, physiological symptoms of pain-related anxiety significantly predicted physical complaints. In comparison with cognitive and somatic depression symptoms physiological symptoms of pain-related anxiety were the stronger predictor.     

Appraisals of control and predictability in adapting to a chronic disease.

In a sample of 92 patients with rheumatoid arthritis, we examined interrelations among various control appraisals, illness predictability, psychosocial adjustment, mood, and illness status. Perceiving greater personal control over the disease and symptoms and perceiving greater health-care-provider control over symptoms were associated with greater illness predictability. Patients reported more personal control over their symptoms than over the course of the disease and thought that their health care providers had more control over disease course than they did themselves. Multiple regression analyses showed that perceiving greater personal control over one's medical care and treatment was associated with positive mood and psychosocial adjustment. Negative mood was also associated with the belief that providers have greater control over the patient's daily symptoms. Patients who had a more severe disease and expressed greater personal control over its course reported greater mood disturbance and were rated as exhibiting less positive adjustment, but those who had more severe daily symptoms and expressed greater personal control over their symptoms reported less mood disturbance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why do people with an anxiety disorder utilize more nonmental health care than those without?

Objective: It is unclear why nonmental healthcare utilization is greater among those with psychological problems. The authors examined healthcare utilization in HMO patients to determine whether greater utilization in anxiety disorder (AD) patients was explained by anxiety symptoms (increasing sensitivity to physical symptoms) or comorbid illness (causing greater need for services). Design: Patients were randomly selected from the database of a multi-specialty practice and 1,041 completed a survey assessing psychological symptoms, health behaviors, and demographics. Anxiety symptoms were assessed by questionnaire and the presence of an AD was determined from the medical chart. Healthcare encounters and medication use were abstracted from medical charts and HMO claims data. Main Outcome Measures: Healthcare utilization. Results: Both AD and anxiety symptoms predicted utilization, but symptoms were not associated with utilization in a model that also included AD. Comorbid illness was significantly associated with utilization independent of AD and somewhat reduced the strength of the AD-utilization association. The results were replicated in comparison of those with any psychiatric disorder to those without. Conclusion: Among those with AD, greater utilization is not explained by anxiety symptoms but is partly explained by greater comorbid illness. Further study is needed to understand excess healthcare utilization among AD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative affect and the reporting of physical symptoms among college students.

This study examined relations between negative affect and the reporting of physical symptoms for a group of college students by empirically deriving, through cluster analyses, two profiles that differed in their levels of trait anxiety, trait anger, and depressive symptoms, and then evaluating differences in symptom reporting between these two profiles. Analyses revealed that persons with an elevated profile of negative affect reported being bothered by physical complaints statistically more often than those persons with the converse profile. Additional analyses indicated that the relation between levels of negative affect and physical complaints was mediated by trait anxiety. Physical symptom reporting is discussed in the context of its being a possible correlate of neuroticism. The mediating role of anxiety and implications for counseling are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of current psychiatric disorder to functional disability and distress in patients with inflammatory bowel disease

Although prior theories about psychiatric disorders causing inflammatory bowel disease (IBD) have largely been discredited, these same disorders have at times been associated with functional gastrointestinal symptoms such as those found in irritable bowel syndrome. Since functional gastrointestinal symptoms can also occur in patients with organic pathology, we hypothesized that a current psychiatric disorder might amplify or produce additional gastrointestinal symptoms in patients with organic gastrointestinal diseases such as IBD, leading to additive functional disability and decreased quality of life. This pilot study evaluated a sequential sample of 40 IBD patients using the NIMH Diagnostic Interview Schedule, structured interviews for functional gastrointestinal symptoms, and prior episodes of emotional, physical, and sexual abuse as well as self-report measures of personality and disability. We compared IBD patients with and without a current psychiatric disorder while controlling for disease severity. Eight patients with major depression were treated with antidepressants. Patients with a current psychiatric disorder had significantly higher 1) mean number of lifetime psychiatric diagnoses, 2) prevalence rates of prior sexual and physical victimization, and, 3) mean numbers of both gastrointestinal and other medically unexplained symptoms despite no differences in severity of IBD. Significant and trend level differences were apparent on several measures of functional disability. A regression analysis showed that number of psychiatric diagnoses, number of functional gastrointestinal symptoms, and dissociation scale scores significantly discriminated the groups. Treatment of current major depression decreased functional disability despite no objective changes in gastrointestinal disease severity. It was concluded that the presence of a current psychiatric disorder appears to alter the perception of disease severity in patients with IBD. Nonrecognition of the psychiatric disorder may lead to unnecessary and aggressive interventions for IBD patients such as medication changes, invasive testing, or surgery. The presence of a current psychiatric illness also appears to be associated with increased functional disability. Psychiatric evaluation and treatment, therefore, have an important role in the ongoing management of IBD patients with distressing gastrointestinal symptoms not directly attributable to their IBD.     

Number of symptoms, quantification, and qualification of depression

Current classification systems (ICD-10 and DSM-IV) require a quantitative criterion for differentiating depressive states, suggesting a correlation between the number of symptoms, i.e., the pervasiveness of the syndrome, and the subtype of the illness. All the symptoms (within those contained in the diagnostic lists) are assumed to have comparable value. To investigate the relevance of the number and the type of symptoms reported by 196 patients suffering from depression, we compared the symptoms using independent indicators of severity such as the Clinical Global Index (CGI) and the social functioning subscale of the Global Assessment of Functioning (GAF). A second comparison using the same indicators was made between qualitatively distinct categories of DSM-IV and ICD-10 (i.e., melancholic v nonmelancholic, somatic v nonsomatic, and psychotic v nonpsychotic). There was evidence that increasing numbers of symptoms actually reflect higher levels of severity, but the categorizations that were mainly based on qualitative criteria (e.g., melancholia, somatic syndrome, etc.) usually attained better discrimination compared with those based on the number of symptoms. Moreover, certain symptoms (usually those indicated as endogenous) were more likely to be associated with greater severity and pervasiveness. Finally, the results clearly showed that different symptoms had different weight in establishing the gradient of severity.     

Negative life events, perceived stress, negative affect, and susceptibility to the common cold.

After completing questionnaires assessing stressful life events, perceived stress, and negative affect, 394 healthy Ss were intentionally exposed to a common cold virus, quarantined, and monitored for the development of biologically verified clinical illness. Consistent with the hypothesis that psychological stress increases susceptibility to infectious agents, higher scores on each of the 3 stress scales were associated with greater risk of developing a cold. However, the relation between stressful life events and illness was mediated by a different biologic process than were relations between perceived stress and illness and negative affect and illness. That these scales have independent relations with illness and that these relations are mediated by different processes challenges the assumption that perceptions of stress and negative affect are necessary for stressful life events to influence disease risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Curiosity and mortality in aging adults: A 5-year follow-up of the Western Collaborative Group Study.

Research suggests that curiosity in older people is associated with maintaining the health of the aging central nervous system. We examined prospectively the relationship of curiosity in 1,118 community dwelling older men to subsequent survival over a 5-year period. Curiosity was measured when the participants were a mean age of 70.6 years. Initial levels of trait and state curiosity were higher in survivors than in those who subsequently died. After adjustment for other risk factors, the state curiosity-mortality association remained significant in the Cox regression model. Ancillary analyses in 1,035 older women (M age at initial examination?=?68.6 years) confirmed the pattern found in the men. State curiosity in these women was significantly associated with survival after adjustment for other risk factors. This is the first study to identify a predictive role for curiosity in the longevity of older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations of positive and negative affectivity to anxiety and depression in children: Evidence from a latent variable longitudinal study.

The tripartite model of anxiety and depression has been studied with adults; however, support is still emerging with children concerning measurement and relations between positive (PA) and negative (NA) affect and psychopathology. In this longitudinal study of 270 4th- to 11th-grade children (mean age=12.9 years, SD=2.23), confirmatory factor analysis supported a 2-factor orthogonal model of children's self-reported affect and revealed that the concurrent relations of NA and PA to anxiety and depression symptoms were consistent with the tripartite model. Structural equation modeling demonstrated moderate cross-time stability of trait PA and NA, consistent with a temperament view of these factors, as well as partial support for the role of NA and PA in the development of anxiety and depression symptoms in children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal analysis of specific domains of internal control and depressive symptoms in patients with recurrent cancer.

The relation between perceptions of control and depressive symptoms was examined in a longitudinal study of patients with recurrent cancer. Five domains of control (self-blame, control over cancer onset, control over symptoms, control over the course of the illness, and overall control over life events) were found to be independent of one another. In cross-sectional analyses, depression symptomatology was negatively correlated with illness course control, symptom control, and overall control. Cross-lagged longitudinal analyses using structural equation modeling suggested only onset control and overall control were significantly associated with depressive symptomatology over the 8-month interval. Greater baseline onset control predicted greater follow-up depression, whereas higher baseline depression predicted lower follow-up overall control. The importance of developing and using domain-specific measures of control and investigating the association of control and adjustment in longitudinal analysis are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diurnal cortisol secretion and 2-year changes in older adults' physical symptoms: The moderating roles of negative affect and sleep.

Objective: This study examined whether the association between cortisol secretion and changes in physical health symptoms would depend on other factors in a person's life. The authors expected that physical health effects would emerge particularly when cortisol disturbances co-occur in the context of high levels of trait negative affect or poor sleep. Design: Physical symptoms, diurnal cortisol secretion, affective tendencies, and sleep efficiency were assessed in a 2-yr longitudinal study of 184 older adults. Main Outcome Measure: Two-year changes in physical symptoms. Results: High cortisol levels were associated with increases in physical symptoms, but only among participants who experienced high negative affect and poor sleep. Conclusion: Elevated levels of cortisol secretion contribute to older adults' physical symptoms if they co-occur in the context of other emotional and behavioral problems. By contrast, cortisol disturbances may not influence physical symptoms among people who are emotionally well or engage in efficient sleep behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The symptom perception hypothesis revised: Depression and anxiety play different roles in concurrent and retrospective physical symptom reporting.

According to the classic symptom perception hypothesis (Costa & McCrae, 1987; Watson & Pennebaker, 1989), the global predisposition to frequently experience a variety of negative emotions—that is, neuroticism (N) or trait negative affectivity (NA)—is associated with inflated physical symptom reporting. We tested a revision of this hypothesis, which posits distinctive roles for depression and anxiety in the physical symptom experience. Three studies tested predictions from the revised symptom perception hypothesis: (a) that depressive affect should be related to inflated retrospective physical symptom reports and (b) that anxious affect should be related to inflated concurrent, or momentary, physical symptom reports. Study 1 assessed the relations among N/NA, depressive affect, and recall of physical symptoms experienced in the previous 3 weeks. Depressive affect was uniquely and positively associated with recalling more symptoms. When entered with depressive affect in multiple regression analyses, neuroticism was not associated with level of symptoms recalled. In Study 2, participants were randomly assigned to anxious, depressed, angry, happy, or neutral mood inductions and then reported about concurrent symptom experience. Participants in the anxious mood condition reported significantly more concurrent physical symptoms than did those in the other 4 conditions. In Study 3, anxious, depressed, or neutral mood was induced, followed by assessment of both concurrent and retrospective physical symptoms. Those assigned to the anxious mood induction reported more concurrent symptoms, while those in the depressed mood condition reported having experienced more symptoms in the past. These findings are consistent with the idea that encoding and retrieval processes, which are differentially associated with anxious versus depressed affect, influence different aspects of physical symptom reporting. The results have implications for self-diagnosis, medical treatment-seeking, and care, and potential insights about other complex social and interpersonal behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)