ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThe literature on the mortality of depression was assessed with respect to five issues: 1) strength of evidence for increased mortality, 2) controlling for mediating factors, 3) the contribution of suicide, 4) variation across sample types, and 5) possible mechanisms.MethodAll relevant English language databases from 1966 to 1996 were searched for reviews and studies that included 1) a formal assessment of depressive symptoms or disorders, 2) death rates or risks, and 3) an appropriate comparison group.ResultsThere were 57 studies found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better studies on the strength of evidence scale used in this study, but there are too few comparable, well-controlled studies to provide a sound estimate of the mortality risk associated with depression. Only six studies controlled for more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in medical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk.ConclusionThe studies linking depression to early death are poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease. Future well-controlled studies of high risk groups may guide efforts to develop treatments that reduce the mortality risk of depression.

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectivePrevious research has shown that hospital length of stay among medical patients is significantly increased by comorbid mental illness, in particular depression. However, few studies have examined the length of stay effect of comorbid physical and mental illness among psychiatric patients.MethodThe present study examined the effect of comorbid physical and psychiatric illness on hospital length of stay among 2323 psychiatric inpatient admissions over a 5-year period. Patients were grouped into seven diagnostic categories.ResultsAverage length of stay was significantly longer for patients with comorbid physical diagnoses (mean = 20.01 days) than for patients with no physical diagnoses (mean = 16.63 days). Analyses of the psychiatric categories revealed that the average length of stay for depressed patients was significantly greater for those with comorbid physical diagnoses (mean = 19.73 days) than for depressed patients with no comorbid physical diagnoses (mean = 13.96 days). No other psychiatric group evidenced a significant increase in length of stay for comorbid physical illness.ConclusionsResults suggest that comorbid physical diagnosis increases length of stay among psychiatric patients overall, with increased hospitalization stay for depressed patients, in particular.

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to assess gender differences in the impact of depression on 1-year cardiac mortality in patients hospitalized for an acute myocardial infarction (MI).MethodsSecondary analysis was performed on data from two studies that used the Beck Depression Inventory (BDI) to assess depression symptoms during hospitalization: a prospective study of post-MI risk and a randomized trial of psychosocial intervention (control group only). The sample included 896 patients (283 women) who survived to discharge and received usual posthospital care. Multivariate logistic regression analysis was used to assess the risk of 1-year cardiac mortality associated with baseline BDI scores.Resultsor=to10 (at least mild to moderate symptoms of depression); 8.3% of the depressed women died of cardiac causes in contrast to 2.7% of the nondepressed. For depressed men, the rate of cardiac death was 7.0% in contrast to 2.4% of the nondepressed. Increased BDI scores were significantly related to cardiac mortality for both genders [the odds ratio for women was 3.29 (95% confidence interval (CI) = 1.02-10.59); for men, the odds ratio was 3.05 (95% CI = 1.29-7.17)]. Control for other multivariate predictors of mortality in the data set (age, Killip class, the interactions of gender by non-Q wave MI, gender by left ventricular ejection fraction, and gender by smoking) did not change the impact of the BDI for either gender.ConclusionsDepression in hospital after MI is a significant predictor of 1-year cardiac mortality for women as well as for men, and its impact is largely independent of other post-MI risks.

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThis study examines the psychometric properties of the Intrusive Thoughts Questionnaire (ITQ) and its utility as a predictor of distress among trauma victims.MethodVictims of three types of trauma, a motor vehicle accident (N = 115), a hurricane (N = 182), and recovery work after an airline disaster (N = 159), completed the ITQ along with the Impact of Event Scale (IES) and the Symptom Checklist-90, Revised (SCL-90-R), at several different time points after their exposure.ResultsThe ITQ was a reliable and valid instrument that was positively related to concurrent measures of distress as well as a predictor of long-term stress responding. Characteristics of intrusive thoughts reflecting the extent to which they were unwanted or controllable, were identified as key determinants of distress.ConclusionsThe ITQ is a useful adjunct to current measures of intrusions, allowing for greater specificity in analyses of responses to trauma. Evaluation of characteristics of intrusions indicated that frequency of intrusions was neither the only predictor of distress nor the best predictor of trauma-related outcomes.

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThis study was conducted to investigate associations between psychosocial risk factors, including social isolation, anger and depressive symptoms, and heart rate variability in healthy women.MethodsThe study group consisted of 300 healthy women (median age 57.5 years) who were representative of women living in the greater Stockholm area. For the measurement of social isolation, a condensed version of the Interpersonal Support Evaluation List was used and household size assessed. Anger was measured by the anger scales previously used in the Framingham study and depressive symptoms by a questionnaire derived from Pearlin. Health behaviors were measured by means of standard questionnaires. From 24-hour ambulatory electrocardiographic monitoring, both time and frequency domain measures were obtained: SDNN index (mean of the SDs of all normal to normal intervals for all 5-minute segments of the entire recording), VLF power (very low frequency power), LF power (low frequency power), HF power (high frequency power), and the LF/HF ratio (low frequency by high frequency ratio) were computed.ResultsSocial isolation and inability to relieve anger by talking to others were associated with decreased heart rate variability. Depressive symptoms were related only to the LF/HF ratio. Adjusting for age, menopausal status, exercise and smoking habits, history of hypertension, and BMI did not substantially change the results.ConclusionsThese findings suggest heart rate variability to be a mediating mechanism that could explain at least part of the reported associations between social isolation, suppressed anger, and health outcomes.

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article presents a model that identifies effects of blood pressure variability (BPV) as a possible mechanism by which psychological/psychiatric factors and health behaviors confer increased risk of coronary artery disease (CAD) and acute coronary syndromes.Recent research in vascular biology and dynamics of coronary artery blood flow suggests that BPV may have pathogenic effects on the coronary endothelium, plaque formation, and plaque stability. Thus, BPV may be a risk factor for cardiovascular disease independent of mean arterial pressure. The model proposes that autonomic control of the heart exerts a buffering or inhibitory influence on oscillations in blood pressure. Established psychological/behavioral risk factors for CAD, such as depression, hostility, and anxiety, as well as physical deconditioning and aging, are associated with diminished autonomic control of the heart, which may disinhibit pathogenic BPV. Together, these data suggest a coherent, testable psychophysiological model of CAD. In this article, we review these data and make recommendations for research to examine the model.

ISSN:0033-3174    

出版商:OVID    

年代:1999

数据来源: OVID