摘要:

The prevalence and prognostic impact of previous depression, depression in the hospital, and depression after discharge were studied in 222 patients admitted for acute myocardial infarction (MI).Patients were interviewed 1 week, 6 months, and 12 months after the index MI using a modified version of the Diagnostic Interview Schedule (DIS); patients also completed the Beck Depression Inventory (BDI). Patients or family members were recontacted at 18 months to determine survival. Some 27.5% of patients had at least one episode of major depression before their MI, but only 7.7% were depressed at some point during the year preceding the infarct. Overall, 31.5% of patients experienced depression in the hospital or during the year postdischarge. Some 35 patients were depressed in the hospital, 30 became depressed between discharge and 6 months, and five more between 6 and 12 months after the MI. History of depression increased the risk of depression in the hospital and after discharge. Depression in the hospital was associated with an increased risk of mortality over 18 months. Patients who experienced a recurrent depression in the hospital were at particularly high risk. Although patients who became depressed after discharge differed from those who remained depression-free in terms of age, history of depression, BDI scores, and the number of depression symptoms on the DIS in the hospital, a model including these variables identified only 14.7% of the patients who became depressed after returning home. Post-MI depression is common and largely unrelated to medical and psychosocial factors.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We examined the relationship among low, moderate, and high levels of hopelessness, all-cause and cause-specific mortality, and incidence of myocardial infarction (MI) and cancer in a population-based sample of middle-aged men. Participants were 2428 men, ages 42 to 60, from the Kuopio Ischemic Heart Disease study, an ongoing longitudinal study of unestablished psychosocial risk factors for ischemic heart disease and other outcomes. In 6 years of follow-up, 174 deaths (87 cardiovascular and 87 noncardiovascular, including 40 cancer deaths and 29 deaths due to violence or injury), 73 incident cancer cases, and 95 incident MI had occurred. Men were rated low, moderate, or high in hopelessness if they scored in the lower, middle or upper one-third of scores on a 2-item hopelessness scale. Age-adjusted Cox proportional hazards models identified a dose-response relationship such that moderately and highly hopeless men were at significantly increased risk of all-cause and cause-specific mortality relative to men with low hopelessness scores. Indeed, highly hopeless men were at more than three-fold increased risk of death from violence or injury compared with the reference group. These relationships were maintained after adjusting for biological, socioeconomic, or behavioral risk factors, perceived health, depression, prevalent disease, or social support. High hopelessness also predicted incident MI, and moderate hopelessness was associated with incident cancer. Our findings indicate that hopelessness is a strong predictor of adverse health outcomes, independent of depression and traditional risk factors. Additional research is needed to examine phenomena that lead to hopelessness.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo examine the influence of patient ethnicity on receipt of postoperative analgesia. Method: Chart review of 250 consecutive patients hospitalized for open reduction and internal fixation of a limb fracture. Analgesics consumption in the postoperative period was measured in terms of morphine equivalents. Results: There were significant differences (p<.005) in analgesics administered to black, Hispanic, and white patients. Whites received 22 mg/day, blacks 16 mg/day, and Hispanics 13 mg/day. These ethnic differences persisted after controlling for possible confounding variables. Conclusion: Ethnicity exerts a powerful impact on medical care. We cannot determine from our data whether these differences stem from differences in pain behavior of the patients or differences in medical staff's perception and treatment of such patients.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveThe effects of lifestyle incongruity on blood pressure were tested in a cross-sectional study of 711 modernizing adult men and women, ages 25 to 64 years, residing in nine villages throughout Western Samoa. Methods: Lifestyle incongruity (LI) was conceptualized as the mismatch between a 21-item material possessions and lifestyle scale and an eight-part occupational rank score. LI was measured by the arithmetic difference between the standardized distributions of lifestyle and occupation. Blood pressure (BP) was measured three times in the seated position, averaged and adjusted for body mass. Sex-stratified analyses were performed and adjusted BP was regressed on LI, age, and socioeconomic rank. Results: In men systolic BP was associated (p <.01) with incongruity between material way of life and occupation. Men with higher occupation scores than lifestyle scores had significantly higher systolic BP. This association was stronger and significant for both systolic and diastolic BP among young (<40 years) men and all men from the more economically developed island. On the other hand, among older women diastolic BP was significantly (p <.01) higher among those whose material lifestyles exceeded their occupational class. Conclusions: The results in men, especially the young group, suggest two explanations: 1) financial demands from the extended family on young men with better paying jobs may reduce material consumption and produce psychosocial stress; 2) upward socioeconomic mobility marked by good jobs but a lag in material lifestyle may represent work stress. The results in older women support the suggestion of earlier studies that excess material consumption for enhancement of social prestige (living beyond ones' means) leads to stress and elevations in BP.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Previous work from our group has examined the relationship between stress and immunodepression in medical students taking National Boards, Part I, and has described a relationship between stress intrusion scores (SIS) and immunodepression.We have also shown that a high proportion of individuals with generalized anxiety disorders (GAD) and panic disorders (PD) exhibit enhanced stress intrusion (SI) and are more prone to upper respiratory infections (URI). In the present preliminary study, we sought to establish a model to evaluate further the role of SI level on the extent of immunodepression. This would serve to assess in further studies the mechanism(s) of stress-induced immunodepression, its relationship to morbidity, and the role of therapeutic interventions. In 14 GAD patients and 14 controls, we correlated the expression of interleukin-2 receptors (CD25) on T lymphocytes stimulated with anti-CD3 in short term cultures and the frequency of URI and the SIS to assess the relationships among these parameters. A decreased expression of CD25 correlates linearly with increasing SIS and with a higher number of sick days with URI. These results support our previous observations that GAD patients are more susceptible to URI. Moreover, they suggest that there may be a direct relationship between immunodepression and morbidity and between SIS and immunodepression.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Previous studies have demonstrated a potential relationship between psychological stress and platelet activation, which may serve as a link between stress and myocardial infarction (MI).However, the possibility that personality traits associated with coronary heart disease may affect platelet activation has not been adequately investigated. The effect of a laboratory stressor (Type A Structured Interview (SI) and speech task) on platelet activation was assessed in 14 stable post-MI patients and 15 age-matched healthy men, using a standardized method of measuring plasma beta-thromboglobulin (BTG) levels. BTG levels were increased after the stressor (average change = 2.0 ng/ml, p =.005). Increases in BTG with stress were related to higher SI ratings of Potential for Hostility (r =.53, p =.004) and Type A behavior (r =.43, p =.02) but not to Cook-Medley-rated hostility scores. Increases in norepinephrine levels and in diastolic blood pressure were nonsignificantly related to increases in BTG levels (ps <.10), whereas increases in epinephrine levels were unrelated. Despite ceasing aspirin and other platelet inhibitors for 10 days before testing, individuals taking platelet inhibitors before the study had less change in BTG with stress (p =.05). However, after statistical adjustment for this factor, SI ratings of Potential for Hostility were still strongly related to increases in BTG with stress (adjusted r =.56, p =.002). Contrary to expectations, healthy men tended to have greater change in BTG with stress than post-MI patients (p =.06). These results indicate that acute stress increases BTG levels and that hostility is related to greater platelet reactivity, independent of any long term effects of platelet inhibition.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

One objective of the present research was to examine the immunological effects of self-disclosing personal information regarding a traumatic or stressful experience. A second objective was to examine the hypothesis that the effect of self-disclosure on immune function is moderated by individual differences in cynical hostility. Forty-three male college undergraduates, classified as high or low on the Cook-Medley Hostility scale were randomly assigned to either a verbal self-disclosure or a nondisclosure discussion condition. Task-induced change in natural killer (NK) cell activity (i.e., cytotoxicity) served as the dependent variable. As predicted, a significant interaction between discussion condition and hostility was obtained. Among subjects in the self-disclosure condition, high hostility subjects exhibited a significantly greater increase in NK cell cytotoxicity than low hostility subjects. The effect of self-disclosure on NK cell activity is moderated by an individual's level of cynical hostility. The greater short term enhancement in NK cell activity observed for hostile persons is a likely correlate of a more pronounced acute arousal response elicited by the self-disclosure task.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Oral malodor (halitosis) is a common concern in Western society.As with other human perceptions, emotional as well as cognitive variables play a major role in one's sensation and complaint. To study factors potentially associated with the complaint of oral malodor, periodontal and psychological evaluations were carried out on 38 subjects (66% female, mean age 43 years) with a complaint of oral malodor. Subjects underwent evaluation of their periodontal status, odor evaluation by an odor judge, and psychopathological symptom survey by means of the SCL-90 questionnaire. The patient's self-rating of oral odor was significantly higher than the evaluation of an objective odor judge and was not associated with their periodontal status. The SCL-90 profile of subjects was relatively higher than that of an age- and gender-matched reference group of dental patients. The results suggest that the complaint of oral malodor may be related to psychopathological symptoms as recorded by the SCL-90 questionnaire.

ISSN:0033-3174    

出版商:OVID    

年代:1996

数据来源: OVID