ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivePsychological factors have been suspected of contributing to the development of cardiovascular disease. This study examined the relationship between a self-reported history of treatment for depression and subsequent myocardial infarction among treated hypertensive patients.MethodsParticipants (5564) in a union-sponsored, hypertension control program in New York City, who entered the program during 1981–1994 without a history of cardiovascular disease and who were asked whether they had been treated for depression, were followed in a prospective cohort study. The primary outcome of interest was hospitalization or death due to myocardial infarction.ResultsAt entry, 3.5% of men and 6.4% of women reported a history of treatment for depression. During 4.9 years (average) of follow-up, 112 fatal and nonfatal myocardial infarctions were recorded. The sex-adjusted relative risk of myocardial infarction was 2.24 (confidence interval = 1.13–4.45). Controlling for known cardiovascular risk factors with multivariate proportional hazards models, history of treatment for depression was significantly associated with subsequent myocardial infarction (hazard ratio = 2.10, confidence interval = 1.04–4.23).ConclusionsA self-reported history of treatment for depression is independently associated with subsequent myocardial infarction in treated hypertensive patients without prior cardiovascular disease. Whether additional or different treatment for depression will be cardioprotective is unknown and merits further study.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveIndividuals with high levels of depressive symptoms have an increased risk of many illnesses, including stroke. Measures of depressive symptoms include questions about the presence of negative affect, such as sadness, as well as the absence of positive affect, such as happiness and optimism. We assessed whether positive or negative affect, or both, predicted risk of stroke.MethodsData were from a 6-year prospective cohort study of a population-based sample of 2478 older whites and blacks from five counties in North Carolina who reported no history of stroke at the baseline interview. Baseline, in-person interviews were conducted to gather information on sociodemographic, psychosocial, and health-related characteristics of subjects. Thereafter interviews were conducted annually for 6 years.ResultsIncreasing scores on the modified version of the Center for Epidemiological Studies Depression Scale (CES-D) were significantly associated with stroke incidence for the overall sample (relative risk [RR] = 1.04 for each one-point increase, 95% confidence interval [CI] = 1.01–1.09) over the 6-year follow-up period after adjusting for sociodemographic characteristics, blood pressure, body mass index, smoking status, and selected chronic diseases. Positive affect score demonstrated a strong inverse association with stroke incidence (RR = 0.74, 95% CI = 0.62–0.88).ConclusionsIncreasing scores on the modified CES-D are related to an increased risk of stroke, whereas high levels of positive affect seem to protect against stroke in older adults.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveStudies have shown that stress can delay the healing of experimental punch biopsy wounds. This study examined the relationship between the healing of natural wounds and anxiety and depression.MethodsFifty-three subjects (31 women and 22 men) were studied. Wound healing was rated using a five-point Likert scale. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HAD), a well-validated psychometric questionnaire. Psychological and clinical wound assessments were each conducted with raters and subjects blinded to the results of the other assessment.ResultsDelayed healing was associated with a higher mean HAD score (p= .0348). Higher HAD anxiety and depression scores (indicating “caseness”) were also associated with delayed healing (p= .0476 andp= .0311, respectively). Patients scoring in the top 50% of total HAD scores were four times more likely to have delayed healing than those scoring in the bottom 50% (confidence interval = 1.06–15.08).ConclusionsThe relationship between healing of chronic wounds and anxiety and depression as measured by the HAD was statistically significant. Further research in the form of a longitudinal study and/or an interventional study is proposed.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality and quality of life in patients hospitalized for acute myocardial infarction (MI).MethodsThe Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by 288 patients hospitalized for MI. Twelve-month survival status was ascertained, and quality of life among survivors was assessed at 12 months using the Dartmouth COOP charts.ResultsThirty-one (10.8%) patients died, 27 of cardiac causes, during the 12-month follow-up. Symptoms of depression and anxiety predicted neither cardiac nor all-cause mortality. Severity of infarction and evidence of heart failure predicted both cardiac and all-cause mortality. The same findings emerged from supplementary analyses of data from patients who died after discharge from the hospital. Symptoms of depression and anxiety, measured at entry, predicted 12-month quality of life among survivors, as did gender, partner status, employment status, living alone, previous frequency of exercise, and indices of disease severity (Killip class and Peel Index). In a multiple regression model in which all of these variables were entered, initial depression scores provided the best independent prediction of quality of life, although living alone, severity of infarction, and state anxiety also entered the model.ConclusionsSymptoms of depression and anxiety did not predict either cardiac or all-cause mortality after MI, but they did predict quality of life among those who lived to 12 months.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveA model for the development of anxiety disorders (panic disorder with or without agoraphobia) is needed. Patients with an implantable cardioverter/defibrillator (ICD) are exposed to repeated electric shocks. If the theory of anxiety development by aversive classic conditioning processes is valid, these repeated shocks should lead to an increased risk of anxiety disorders. To study this hypothesis, we retrospectively studied 72 patients after implantation of an automatic ICD.MethodsPatients were assessed with the semistructured Diagnostic Interview of Psychiatric Disease 1 to 6 years after implantation of an automatic ICD. Panic disorder and/or agoraphobia was diagnosed in patients who fulfilled all DSM-III-R criteria for those conditions.ResultsAnxiety disorder developed in 15.9% of patients after ICD implantation. This was significantly related to the frequency of repeated defibrillation (shocks) to stop malignant ventricular arrhythmias. Dysfunctional cognitions are an additional vulnerability factor.ConclusionsThe data support both the conditioning hypothesis and the cognitive model of anxiety development. These findings suggest that ICD patients are an appropriate risk population for a prospective study of the development of anxiety disorders.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivePsychiatric and somatic disorders frequently co-occur in the same individuals. We examined whether this happens because these types of morbidity share risk factors or because they are risk factors for each other.MethodsNegative binomial regression was used to examine, in a random sample of Dutch adults (N= 7076), cross-sectional associations of sociodemographic and personality variables like income and neuroticism with the presence, over 1 year, of 30 somatic and 13 psychiatric disorders, with the latter diagnosed by structured interview. We examined to what extent the links of these variables with these two morbidity types were independent of each other.ResultsThis population experienced 5050 somatic and 2438 psychiatric disorders during the preceding year. Subjects reporting more somatic disorders had more psychiatric disorders. Neuroticism, followed closely by low educational attainment, was the strongest correlate of both morbidity types. After adjustment for all other covariates including somatic morbidity, the number of psychiatric diagnoses rose 1.84-fold (95% confidence interval = 1.74–1.94) per standard deviation increase in neuroticism. Likewise, adjusted for all other covariates including psychiatric diagnoses, 1.42 (95% confidence interval = 1.35–1.50) times more somatic disorders were reported per standard deviation increase in neuroticism.ConclusionsPersonal features like neuroticism and low educational attainment are linked with psychiatric and with somatic morbidity. These links are largely independent. Although this study was cross-sectional, the results suggest that these different types of morbidity may have overlapping etiologies.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesThe purpose of this study was to define how the relation between depression and self-reported physical health in patients with coronary disease is modified by other patient-centered factors.MethodsWe conducted a prospective cohort study of 111 patients (members of a health maintenance organization) with angiographically documented coronary disease, examining factors (physical symptoms, psychological states and traits, and spousal support) modifying the relation between depression and patient-reported physical health 5 years later using multiple hierarchical regression models.ResultsFive regression models (all including demographic and disease severity covariates) were constructed to predict physical health from depression only (R2= 0.22); depression plus angina and fatigue (R2= 0.53); depression plus positive affect and novelty seeking and their interaction (R2= 0.48); depression plus spousal support (R2= 0.27); and depression, angina, fatigue, positive affect, and novelty seeking (overall model) (R2= 0.65). Depression remained significant in each model, but the proportion of variance it predicted was diminished in the presence of the other variables (bivariater= 0.39, partialr= 0.37–0.13).ConclusionsThe effect of depression on self-reported physical health is significantly mediated by physical symptoms (angina and fatigue), personality states and traits (positive affect and novelty seeking), and spousal support. Positive affect and novelty seeking had more marked effects on physical health in the presence of more depression. Thus, a broad range of factors beyond the severity of coronary disease itself affect the perceived physical health of patients with coronary heart disease.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of this secondary analysis was to examine the relationships between a reduction in psychological distress and long-term cardiac and psychological outcomes in post–myocardial infarction patients who participated in a randomized trial of home-based psychosocial nursing interventions (the Montreal Heart Attack Readjustment Trial [M-HART]). Gender differences were considered.MethodsWe studied 433 patients (36.0% women) from the M-HART treatment group who received two home visits after achieving a high psychological distress score (ie, ≥5) on the General Health Questionnaire (GHQ). Short-term GHQ success was determined by a return to a normal GHQ score (<5) or a reduction of ≥50% after the two visits. Patients with short-term successful and unsuccessful GHQ outcomes were compared for mid-term maintenance of success, 1-year death and readmission rates, and 1-year depression and anxiety symptoms.ResultsPatients with short-term GHQ success were more likely to show mid-term GHQ success (p< .001), marginally less likely to die of any causes (p= .087), less likely to die of cardiac causes (p= .043), less likely to be readmitted for any reason (p< .001) and for cardiac reasons (p< .001), and less likely to have high depression (p< .001) and anxiety (p< .001) at 1-year than patients with short-term unsuccessful GHQ outcomes. Results held for men and women and were not altered by controlling for potential confounders. However, the number of deaths prevented analysis with statistical controls.ConclusionsPost–myocardial infarction interventions that reduce psychological distress have the potential to improve long-term prognosis and psychological status for both men and women.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesSocial isolation has been linked to poor survival in patients with coronary artery disease (CAD). Few studies have closely examined the psychosocial characteristics of CAD patients who lack social contact.MethodsSocial isolation was examined as a predictor of mortality in 430 patients with significant CAD. More isolated patients were compared with their less isolated counterparts on factors that might help explain the association between isolation and survival.ResultsThe mortality rate was higher among isolated individuals. Those with three or fewer people in their social support network had a relative risk of 2.43 (p= .001) for cardiac mortality and 2.11 (p= .001) for all-cause mortality, controlling for age and disease severity. Adjustments for income, hostility, and smoking status did not alter the risk due to social isolation. With the exception of lower income, higher hostility ratings, and higher smoking rates, isolated patients did not differ from nonisolated patients on demographic indicators, disease severity, physical functioning, or psychological distress. Isolated patients reported less social support and were less pleased with the way they got along with network members, but they did not report less satisfaction with the amount of social contact received.ConclusionsPatients with small social networks had an elevated risk of mortality, but this greater risk was not attributable to confounding with disease severity, demographics, or psychological distress. These findings have implications for mechanisms linking social isolation to mortality and for the application of psychosocial interventions.

ISSN:0033-3174    

出版商:OVID    

年代:2001

数据来源: OVID