摘要:

ObjectiveThe objective of this meta-analytic study was to determine whether individuals with posttraumatic stress disorder (PTSD) have higher levels of basal cardiovascular activity relative to comparable groups of individuals without PTSD.MethodsMeta-analytic data methods were applied to 34 studies that gathered indicators of basal cardiovascular activity including: heart rate (HR), systolic blood pressure, and diastolic blood pressure on subjects diagnosed with PTSD and two types of comparison groups. In total, cardiovascular measures were analyzed for 2670 subjects across all studies.ResultsResults indicate that individuals with a current PTSD diagnosis have higher resting HR relative to both trauma-exposed individuals without a PTSD diagnosis and non–trauma-exposed individuals. The results also suggest that PTSD is associated with elevations in blood pressure; however, the effect sizes were smaller in magnitude than those obtained for heart rate. A subset analysis revealed that the effect sizes for comparisons on basal HR were greatest in studies with the most chronic PTSD samples.ConclusionThe meta-analysis supports previous qualitative reviews, finding a positive association between PTSD and basal cardiovascular activity. The discussion addresses possible mechanisms of action and the health-related implications of these findings.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population.MethodsA representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index.ResultsThe most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes.ConclusionWe present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivePrevious studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy.DesignCross-sectional survey.SettingCommunity sample.MethodsData are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999.MeasuresDepression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women’s reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause.ResultsThere were 168 women (28.9%) who reported a high level (≥10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms.ConclusionsIn this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThese cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and women, such that the higher the hostility, the worse the health behavior profile. The current study investigated whether high social support was associated with better health behavior than low social support in individuals with high hostility scores.MethodsThe subjects were 5115 healthy black and white men and women ranging in age from 18 to 30 years. The hypothesis was that the association between hostility and certain adverse health behaviors would be diminished in the presence of high social support. Race-gender specific median cutpoints of the Cook-Medley Hostility scale and an index of social support defined levels of high and low hostility and social support.ResultsAfter controlling for age and body mass index (BMI), support was positively associated with more exercise in all groups except black women, but when coupled with high hostility, this positive association between support and exercise remained only in men. White women with high support were less often smokers but this association did not hold when examined only in the high-hostile group. Black men and white women with high support in the presence of high hostility consumed more alcohol, but the amount was moderate.ConclusionsWe conclude that social support in the presence of high hostility only sometimes reduces the association of hostility to adverse health behaviors and that these effects are complex. Additional research investigating types of social support on health behavior in different race-gender groups is advocated.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to examine the strength and consistency of the relationship between depression and diabetes complications in studies of type 1 and type 2 adult patients with diabetes.MethodMEDLINE and PsycINFO databases were searched for articles examining depression and diabetes complications in type 1 and type 2 diabetes samples published between 1975 and 1999. Meta-analytic procedures were used. Studies were reviewed for diabetes type, sample size, statistical tests, and measures of diabetes complications and depression. Significance values, weighted effect sizesr, 95% confidence intervals (CI), and tests of homogeneity of variance were calculated for the overall sample (k = 27) and for subsets of interest.ResultsA total of 27 studies (total combinedN= 5374) met the inclusion criteria. A significant association was found between depression and complications of diabetes (p< .00001,z= 5.94). A moderate and significant weighted effect size (r= 0.25; 95% CI: 0.22–0.28) was calculated for all studies reporting sufficient data (k = 22). Depression was significantly associated with a variety of diabetes complications (diabetic retinopathy, nephropathy, neuropathy, macrovascular complications, and sexual dysfunction). Effect sizes were in the small to moderate range (r= 0.17 to 0.32).ConclusionsThese findings demonstrate a significant and consistent association of diabetes complications and depressive symptoms. Prospective, longitudinal studies are needed to identify the pathways that mediate this association.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to assess and quantify bone marrow changes in patients with anorexia nervosa using1H magnetic resonance spectroscopy and relaxometry.MethodsThe bone marrow fat fraction and the longitudinal and transverse relaxation times (T1 and T2, respectively) of water were measured in the lumbar and femoral marrow of 20 patients with anorexia nervosa and 19 healthy control subjects.ResultsPatients with anorexia nervosa showed significant hyperhydration and reduction of the fat fraction in their bone marrow, predominantly in the proximal femur. These changes were associated with hematological abnormalities. In a retest of seven patients after psychotherapy and gain of weight, the pathological changes in marrow proved to be largely reversible in correlation with the increase in body mass index.ConclusionsFat depletion and excess of tissue water in the bone marrow in anorexia nervosa can be quantified by1H magnetic resonance spectroscopy and relaxometry. The distribution of the pathological changes in the lumbar and femoral marrow follows the pattern of normal bone marrow conversion from hematopoietic to cellular during childhood.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveBecause hyperventilation has figured prominently in theories of panic disorder (PD) but not of social phobia (SP), we compared predictions regarding diagnosis-specific differences in psychological and physiological measures before, during, and after voluntary hyperventilation.MethodPhysiological responses were recorded in 14 patients with PD, 24 patients with SP, and 24 controls during six cycles of 1-minute of fast breathing alternating with 1 minute of recovery, followed by 3 minutes of fast breathing and 10 minutes of recovery. Speed of fast breathing was paced by a tone modulated at 18 cycles/minute, and depth by feedback aimed at achieving an end-tidal pCO2of 20 mm Hg. These values were reached equally by all groups.ResultsDuring fast breathing, PD and SP patients reported more anxiety than controls, and their feelings of dyspnea and suffocation increased more from baseline. Skin conductance declined more slowly in PD over the six 1-minute fast breathing periods. At the end of the final 10-minute recovery, PD patients reported more awareness of breathing, dyspnea, and fear of being short of breath, and their pCO2s, heart rates, and skin conductance levels had returned less toward normal levels than in other groups. Their lower pCO2s were associated with a higher frequency of sigh breaths.ConclusionsPD and SP patients report more distress than controls to equal amounts of hypocapnia, but PD differ from SP patients and controls in having slower symptomatic and physiological recovery. This finding was not specifically predicted by hyperventilation, cognitive-behavioral, or suffocation alarm theories of PD.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo characterize cardiovascular recovery and examine the possible relationship of vagal activity and reflexes to risk for heart disease.MethodsSubjects performed cold pressor and mental arithmetic tasks. Heart rate, heart period variability, and pre-ejection period were obtained for 1 minute before, during, and after each task (Experiment 1). In the second experiment, subjects performed a Stroop color-word task and a mental arithmetic task. Heart rate, heart period variability, blood pressure, and baroreflex sensitivity were obtained during the 5-minute baseline, task, and recovery periods (Experiment 2).ResultsIn Experiment 1, heart rate during recovery was lower than baseline despite continued pre-ejection period shortening, whereas recovery heart period variability was higher than baseline. In Experiment 2, blood pressure increased throughout the session. However, recovery heart rate after mental arithmetic was lower than baseline heart rate, and heart period variability was higher during both recovery periods than during baseline. Vagal rebound, a sharp increase in variability in the first minute of recovery, was reduced in men in Experiment 1 and in individuals with a family history of cardiovascular disease in Experiment 2 and was associated with degree of change in baroreflex sensitivity between task and rest.ConclusionsCardiovascular recovery from stress is associated with increased vagal modulation despite residual sympathetic activation. Vagal rebound may be involved in mechanisms resetting the baroreflex sensitivity at the onset and offset of stress. Diminished vagal rebound during recovery from stress is associated with standard risk factors for cardiovascular disease. The results support an association between attenuated vagal reflexes and risk for cardiovascular disease.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe goal of the study was to examine the utility of Creamer’s cognitive processing theory of trauma in a sample of individuals undergoing treatment for cancer. This theory proposes that avoidance is a maladaptive strategy of dealing with intrusive thoughts about a traumatic experience and suggests that avoidance mediates the relation between intrusive thoughts and later psychological distress. The role of disease-related factors, specifically changes in physical impairment and disease stage, was also examined.MethodsPatients (N= 189) undergoing treatment for cancer completed questionnaires at three time points, spaced 3 months apart. Intrusive thoughts, functional impairment, and psychological distress were assessed at Time 1, avoidance and functional impairment at Time 2, and psychological distress was assessed again at Time 3. The fit of the model was tested separately for patients with early-stage (stages 1 and 2) and late-stage (stages 3 and 4) disease.ResultsThe mediational role for avoidance was supported among patients with advanced stages of cancer but not for patients with early-stage disease. Results were inconsistent with predictions about the role of physical impairment. Among individuals with late-stage cancer, changes in functional impairment were not predictive of greater avoidance, and impairment had a significant but weak effect on the change in distress. Among patients with early-stage cancer, a deterioration in physical impairment was associated with increases in avoidance, and deterioration in physical impairment increased distress.ConclusionsThe results of this study were partially consistent with Creamer’s cognitive processing theory. A moderating effect was found for disease stage on associations between intrusions, avoidance, physical impairment, and distress.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to develop the Stress Response Inventory (SRI), which includes emotional, somatic, cognitive, and behavioral stress responses, and then to use the scale in clinical practice.MethodsFirst, a preliminary survey was conducted using 109 healthy adults to obtain 75 response items. Second, the preliminary questionnaire was completed by 215 healthy subjects. Third, stress responses were compared among 242 patients (71 with anxiety disorder, 73 with depressive disorder, 47 with somatoform disorder, and 51 with psychosomatic disorder) and the 215 healthy subjects.ResultsFactor analysis yielded seven subscales: tension, aggression, somatization, anger, depression, fatigue, and frustration. Reliability was computed by administering the SRI to 62 healthy subjects during a two-week interval. Test-retest reliability for the seven subscale scores and the total score was high, ranging between 0.69 and 0.96. Internal consistency was computed, and Cronbach’s &agr; for the seven subscales ranged between 0.76–0.91 and 0.97 for the total score. Convergent validity was computed by correlating the seven subscales and the total score of the SRI with the total score of the Global Assessment of Recent Stress (GARS) scale, the Perceived Stress Questionnaire (PSQ), and the subscale scores of the Symptom Checklist-90-Revised (SCL-90-R). The correlations were all at significant levels. The sensitivity of the SRI was 0.57, specificity 0.74, and the predictive value positive (PVP) was 0.71. The patient group also scored significantly higher on the six subscale scores and the total score than the control group, with the exception being the aggression subscale. The depressive disorder group was highest in total scores on the SRI among the four patient groups, and showed significantly higher total scores than the anxiety disorder and psychosomatic disorder groups. In total scores on the SRI, female subjects scored significantly higher than males.ConclusionsThese results indicate that the SRI is highly reliable and valid, and that it can be utilized as an effective measure of stress for research in stress-related fields. The depressive disorder group showed more prominent stress responses than the anxiety and psychosomatic disorder groups.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID