ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveAlthough the association between depression and the incidence of coronary heart disease has been established in many studies, the impact of depression on the incidence of heart failure has not been previously investigated.MethodsWe examined the effect of depression (assessed by means of the Center for Epidemiological Studies Depression Scale (CES-D) with a cutoff point of ≥21) on the incidence of heart failure in a community sample of persons aged ≥65 years who were participants in the New Haven cohort of the Established Populations for Epidemiological Studies in the Elderly.ResultsAt baseline 2501 individuals were free of heart failure. Of these, 188 (132 women and 56 men) scored as depressed. Depressed participants were significantly more likely to have hypertension, diabetes, and mobility-related functional limitations and were less likely to be male or married. During the 14-year follow-up period, 313 participants (146 men and 167 women) developed heart failure, defined as hospital admission for heart failure or mortality with heart failure as the underlying cause of death. After adjusting for baseline differences in demographic and comorbidity factors and functional status using Cox regression, depression tended to be associated with a greater risk of heart failure (hazard ratio (HR) = 1.52, 95% confidence interval (CI) = 0.94–2.43,p= .09). This effect was significant in women (HR = 1.96, 95% CI = 1.11–3.46,p= .02) but not in men (HR = 0.62, 95% CI = 0.23–1.71,p= .05 for the interaction term between sex and depression).ConclusionsDepression is an independent risk factor for heart failure among elderly women but not elderly men.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveAlthough psychological modulation of immune function is now a well-established phenomenon, much of the relevant literature has been published within the last decade. This article speculates on future directions for psychoneuroimmunology research, after reviewing the history of the field.MethodsThis review focuses on human psychoneuroimmunology studies published since 1939, particularly those that have appeared inPsychosomatic Medicine. Studies were clustered according to key themes, including stressor duration and characteristics (laboratory stressors, time-limited naturalistic stressors, or chronic stress), as well as the influences of psychopathology, personality, and interpersonal relationships; the responsiveness of the immune system to behavioral interventions is also addressed. Additionally, we describe trends in populations studied and the changing nature of immunological assessments. The final section focuses on health outcomes and future directions for the field.ResultsThere are now sufficient data to conclude that immune modulation by psychosocial stressors or interventions can lead to actual health changes, with the strongest direct evidence to date in infectious disease and wound healing. Furthermore, recent medical literature has highlighted a spectrum of diseases whose onset and course may be influenced by proinflammatory cytokines, from cardiovascular disease to frailty and functional decline; proinflammatory cytokine production can be directly stimulated by negative emotions and stressful experiences and indirectly stimulated by chronic or recurring infections. Accordingly, distress-related immune dysregulation may be one core mechanism behind a diverse set of health risks associated with negative emotions.ConclusionsWe suggest that psychoneuroimmunology may have broad implications for the basic biological sciences and medicine.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe objective of this article is to examine the relationship between exposures to the dead and the development of somatic symptoms.MethodsWe studied the pre-post responses of 352 military men and women who worked in the mortuary that received the dead from the Persian Gulf War (Operation Desert Storm) in 1990 to 1991. Symptoms of somatization were measured before and after exposure to the dead. The respondents were volunteers and nonvolunteers for assignment to the mortuary; some had prior experience in handling the dead and some did not. Four groups of participants were examined based on the degree of exposure to remains. Age, sex, volunteer status, prior experience handling remains, and preexposure measures of depression and mutilation fear were statistically controlled.ResultsPostexposure somatic symptoms increased significantly over preexposure levels for the two groups with the most exposure to the dead.ConclusionsThese results provide additional evidence that exposure to the dead is related to somatic distress.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe primary objectives of this study were 1) To assess whether previously reported findings of high levels of repressive adaptation in children with cancer are unique to the cancer population or are generally characteristic of children with serious chronic illness and 2) to assess the utility of including a new measure of anger expression in the adaptive style measurement paradigm.MethodsMeasures of defensiveness, trait anxiety, and anger expression were obtained from three groups of children: those with cancer (N= 130), those with chronic illnesses (diabetes, cystic fibrosis, and juvenile rheumatoid disorders;N= 121), and healthy control participants (N= 368). Based on their self-reports, participants were categorized according to the adaptive style paradigm as either high anxious, low anxious, defensive high anxious, or repressor. The prevalence of these categories was compared across groups.ResultsChildren in the cancer and chronic illness groups both reported significantly higher levels of defensiveness and lower levels of anxiety than did the healthy control participants. Application of the adaptive style paradigm produced a significantly higher percentage of children identified as repressors in the both cancer and chronic illness groups relative to healthy children. Children classified as repressors also reported significantly less expression of anger than did nonrepressors.ConclusionsAn increased prevalence of repressive adaptation is not unique to children with cancer, but may be generally characteristic of children with serious chronic illness. Use of anger in place of anxiety as the repressed affect produced a similar distribution of adaptive styles in the study populations.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThe present study examined self-efficacy and self-esteem as basic aspects of the self that influence self-care and physiological outcomes among young adults with Type I diabetes. The two aims of this study were 1) to examine the cross-sectional and longitudinal role of the self-variables as they predict self-care and HbA1c and 2) to test whether self-care mediates the association between the self variables and HbA1c using cross-sectional and longitudinal data.MethodsOne hundred ten participants were recruited from a regional diabetes outpatient clinic. Inclusion criteria were age (18–35 years) and duration of diabetes (>1 year before recruitment). Participants were 61% female and 88% white. In addition, the sample had an average annual income between $24,999 and $34,999, and 85% had completed some or all of college. The average duration of diabetes was 15 years.ResultsUsing multiple regression analyses we found that, compared with self-esteem, self-efficacy was a better predictor of all aspects of self-care and HbA1c in cross-sectional analyses, in addition to diet and exercise self-care, and a better predictor of HbA1c in longitudinal analyses. The data also supported the cross-sectional and longitudinal mediational model in which better self-care helped account for the association between greater self-efficacy and better HbA1c.ConclusionsSelf-efficacy is an important factor for management of self-care practices and physiological outcomes among young adults with Type I diabetes, and self-care may be an important mechanism by which self-efficacy influences HbA1c levels.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveThis systematic review and meta-analysis examined the strength of association between rheumatoid arthritis and depression. In addition, we investigated the extent to which sociodemographic characteristics, level of pain, and method of assessing depression might affect the degree of depression.MethodsCD-ROM databases and bibliographies were searched to identify all studies comparing depression in patients with rheumatoid arthritis and control subjects using standardized assessments. Effect sizes (Pearson’sr) and probabilities were combined across studies. We examined the extent to which the association between rheumatoid arthritis and depression could be attributed to level of pain (using contrasts), sociodemographic differences between groups (combining methodologically restricted studies), and methods of assessing depression (examining heterogeneity across studies).ResultsTwelve independent studies comparing depression in patients with rheumatoid arthritis with depression in healthy control subjects were found. Effect sizes for depression were small to moderate (r= .21,p< .0001; heterogeneous). This effect was not reduced in studies controlling for sociodemographic characteristics (r= .27,p< .0001). The effect sizes did vary in a linear manner in proportion to the effect size for pain (z = 2.67,p= .0064). The effect sizes produced by different measures of depression were heterogeneous (&khgr;2for Fisher’s Z = 24.6,p= .0002), with the Hospital Anxiety and Depression Scale giving effect sizes most dissimilar to those of other measures.ConclusionsDepression is more common in patients with rheumatoid arthritis than in healthy individuals. This difference is not due to sociodemographic differences between groups, but it may be attributable, in part, to the levels of pain experienced. Variation in the methods of assessing depression partly accounts for the differences among studies examining the levels of depression in patients with rheumatoid arthritis.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveTo investigate the determinants of mental health among severe hearing-impaired adults in the Netherlands, separately by prelingual and postlingual age of onset.MethodsFive hundred twenty-three face-to-face interviews were carried out by persons with practical skills in communication with hearing-impaired people.ResultsOf prelingually and postlingually deaf men, 27.1% and 27.7%, respectively, reported mental distress (scores on the General Health Questionnaire ≥ 2), and among women these figures were 32.4% and 43.2%. These rates are higher than in the general population (men: 22.0%; women: 26.6%). Among the prelingual category, none of the demographic or hearing loss-related characteristics was associated with mental health status as measured by the General Health Questionnaire (GHQ). Of these variables, only additional impairment or serious illness was associated with the brief Symptom Checklist (SCL-8D). Among the postlingual category, female gender and equilibrium disturbance was associated with both the GHQ and SCL-8D, and additional impairment or serious illness with the SCL-8D. For both categories, the risk of mental distress also was higher in those with more communication problems, lower levels of self-esteem, and poorer acceptance of the hearing loss. Opportunities for identification in youth and social support were not associated with mental health.ConclusionsMental health status differs between the hearing-impaired and the general population, but not as much as is sometimes suggested. Mental distress is greater in those in certain categories of the hearing-impaired.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectiveMindfulness-Based Stress Reduction (MBSR) is a clinical program, developed to facilitate adaptation to medical illness, which provides systematic training in mindfulness meditation as a self-regulatory approach to stress reduction and emotion management. There has been widespread and growing use of this approach within medical settings in the last 20 years, and many claims have been made regarding its efficacy. This article will provide a critical evaluation of the available state of knowledge regarding MBSR and suggestions for future research.MethodsA review of the current literature available within the medical and social sciences was undertaken to provide an evaluation regarding what we know about the construct of mindfulness, the effectiveness of MBSR, and mechanisms of action.ResultsThere has been a paucity of research and what has been published has been rife with methodological problems. At present, we know very little about the effectiveness of this approach. However, there is some evidence that suggests that it may hold some promise.ConclusionsThe available evidence does not support a strong endorsement of this approach at present. However, serious investigation is warranted and strongly recommended.

ISSN:0033-3174    

出版商:OVID    

年代:2002

数据来源: OVID