Psychosocial job characteristics and insomnia: A prospective cohort study using the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) job stress models

ObjectiveTo examine the prospective effects of psychosocial job characteristics evaluated with the Demand-Control-Support (DCS) and Effort–Reward Imbalance (ERI) models on insomnia.MethodsA prospective cohort study with a two-year observation was performed. The subjects were 1022 middle-aged (?39 years) Japanese workers. The following associations were analyzed: high job strain, low social support, effort–reward imbalance, and overcommitment to work at the baseline with self-reported persistence and future onset of insomnia.ResultsAmong those who were insomniacs at the baseline (N = 292), low social support [adjusted odds ratio (95% CI): 2.00 (1.18, 3.40)] and effort–reward imbalance [2.40 (1.13, 5.10)] at the baseline had a significant relationship to insomnia at the follow-up. Among those who were not insomniacs at the baseline (N = 730), overcommitment to work [1.75 (1.16, 2.66)] and high job strain [1.72 (1.06, 2.79)] at the baseline were associated with insomnia at follow-up.ConclusionsProspective effects of psychosocial job characteristics on insomnia differed between its persistence and future onset. Proportionate reward for work effort and sufficient support at work assist recovery from insomnia, while overcommitment to work and high job strain cause future onset of insomnia.     

Évaluation de la charge mentale des téléopérateurs dans un centre d’appel tunisien

BackgroundThe call centers are a growing business sector around the world and currently in Tunisia. However, this occupational activity proves to be a source of many constraints, which can cause multiple complaints among teleoperators.ObjectivesTo evaluate the level of stress at work in a group of teleoperators and identify the factors associated with it.MethodsThis is a cross-sectional study of a random sample of 266 teleoperators from a call center in Sousse (Tunisia). The survey was based on a questionary that included social and occupational data, the assessment of work stress through the Karasek questionnaire, the study of the balance of effort and reward using the Siegrist questionnaire and the evaluation of Nonspecific psychic suffering by the GHQ12 questionnaire.ResultsA total of 264 teleoperators participated in the study, representing a participation rate of 99.2%. Our population was predominant by female (57,6%), with an average age of 29,6 ± 10,1 years. A psychiatric history was found in 4,5% of cases. The stress prevalence calculated using the “effort/rewards” imbalance model was 16,7% while it was 25,8% according to the Karasek model. Psychic suffering was noted in 61,7% of employees. The “effort/reward” imbalance was significantly associated with having parents in charge (p = 0,04). While work stress correlated with tenure (p = 0,032) and history of chronic disease (p = 0,014), psychic suffering was only correlated with gender (p = 0,024).ConclusionThe data of this study, underlines the interest of the improvement of the working conditions in the reduction of stress at work at the teleoperators. These measures will improve not only the satisfaction, the work experience and the quality of life of these employees, but also their services.     

Psychologically adverse work conditions are associated with CD8+ T cell differentiation indicative of immunesenescence

Numerous studies have demonstrated associations between psychosocial stress and indices of poor health, and much research is now dedicated to identifying the responsible biological mechanisms. The current study examined the hypothesis that stress may impact health by promoting immunesenescence.Participants were 537 factory workers (89% male; mean age 44; range 18–65 years). Blood was analyzed for two components of the aging ‘immune risk phenotype’: the number and proportion of late-differentiated (CD27?CD28?) CD8 T cells (CTLs) and CD4:CD8 ratio. Psychological assessment focussed on work-related stressors which have previously been found to predict morbidity and mortality. This assessment included measures of work load, effort–reward imbalance, and social support at work.High levels of job stress (low reward, high effort–reward imbalance) and low social support at work were associated with a significantly lower CD4:CD8 ratio. Also, the number of CD27?CD28? CTLs was 30% to 50% higher in employees classified in the highest tertile of each stress parameter as compared to employees in the corresponding lowest tertile (p < .01). These associations withstood adjustment for a wide range of demographic, life style, medical, and socio-economic indicators. The associations between CTL phenotype and low social support became stronger with increasing age.These results suggest that psychosocial stress may contribute to immunological aging. Prospective studies should address the long-term consequences of these associations for healthy aging.     

Depression and markers of inflammation as predictors of all-cause mortality in heart failure

BackgroundIn patients with heart failure (HF) depressive symptoms have been associated with mortality, as well as biological risk factors, including inflammation, nitric oxide (NO) regulation, and oxidative stress. We investigated the joint predictive value of depressive symptoms, inflammation and NO regulation on all-cause mortality in patients with HF, adjusted for covariates.MethodsSerum levels of inflammation (TNFα, sTNFr1, sTNFr2, IL-6, hsCRP, NGAL), NO regulation (l-arginine, ADMA, and SDMA), and oxidative stress (isoprostane 8-Epi Prostaglandin F2 Alpha) were measured in 104 patients with HF (mean age 65.7 ± SD 8.4 years, 28% women). Depressive symptoms (Beck Depression Inventory, BDI) were measured as continuous total, cognitive, and somatic symptoms, as well as categorized presence of mild/moderate depression (cut-off BDI ⩾10). In Cox proportional hazard models we adjusted for age, sex, poor exercise tolerance and comorbidity.ResultsAfter on average 6.1 years follow-up (SD = 2.9, range 0.4–9.2), 49 patients died. Total and somatic depressive symptoms, mild/moderate depression, higher NGAL, sTNFr2, IL-6, hsCRP and SDMA serum levels were significantly associated with a higher all-cause mortality rate, adjusted for covariates. The findings were most consistent for CRP level and somatic depressive symptoms. When combined, both depressive symptoms and markers of inflammation and NO regulation remained significantly associated with all-cause mortality. These associations were not confounded by age, sex, poor exercise tolerance and comorbidity.ConclusionDepressive symptoms and markers of inflammation and NO regulation are codominant risk factors for all-cause mortality in heart failure.     

Auditory verbal memory and psychosocial symptoms are related in children with idiopathic epilepsy

ObjectiveIdiopathic epilepsies are considered to have relatively good prognoses and normal or near normal developmental outcomes. Nevertheless, accumulating studies demonstrate memory and psychosocial deficits in this population, and the prevalence, severity and relationships between these domains are still not well defined. We aimed to assess memory, psychosocial function, and the relationships between these two domains among children with idiopathic epilepsy syndromes using an extended neuropsychological battery and psychosocial questionnaires.MethodsCognitive abilities, neuropsychological performance, and socioemotional behavior of 33 early adolescent children, diagnosed with idiopathic epilepsy, ages 9–14 years, were assessed and compared with 27 age- and education-matched healthy controls.ResultsCompared to controls, patients with stabilized idiopathic epilepsy exhibited higher risks for short-term memory deficits (auditory verbal and visual) (p < 0.0001), working memory deficits (p < 0.003), auditory verbal long-term memory deficits (p < 0.0021), and more frequent psychosocial symptoms (p < 0.0001). The severity of auditory verbal memory deficits was related to severity of psychosocial symptoms among the children with epilepsy but not in the healthy controls.SignificanceResults suggest that deficient auditory verbal memory may be compromising psychosocial functioning in children with idiopathic epilepsy, possibly underscoring that cognitive variables, such as auditory verbal memory, should be assessed and treated in this population to prevent secondary symptoms.     

Posttraumatic stress disorder and somatic complaints: Contrasting Vietnam and OIF/OEF Veterans' experiences

ObjectiveTo replicate and expand upon the relationship of somatic symptoms and posttraumatic stress disorder (PTSD) by comparing symptoms among service eras in US Veterans.MethodData were collected from 226 Vietnam and 132 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who were referred to a Veterans Affairs (VA) hospital PTSD outpatient clinic between 2005 and 2013. Veterans were administered self-report inventories and a clinical interview to measure somatic symptoms and PTSD severity. A subset of Veterans (n = 185) screening positive for PTSD were administered the Clinician Administered PTSD Scale (CAPS) to measure PTSD severity. Multiple moderated linear regressions were used to examine the influence of service era on the relationship between somatic and PTSD symptoms.ResultsThere were no significant differences between service eras in pain severity, pain interference, and total somatic symptoms reported. Vietnam Veterans were more likely to report limb/join pain (p < .05), fainting (p < .01), and shortness of breath (p < .001), whereas OIF/OEF Veterans were more likely to complain of headaches (p < .001). A significant interaction effect occurred between service era and dizziness (p < .05) and chest pain (p < .01), with OIF/OEF Veterans reporting higher levels of these symptoms significantly more likely than Vietnam Veterans to also experience more severe PTSD.ConclusionFindings are consistent with previous research demonstrating the relationship of somatic symptoms and PTSD across service eras but provide additional data concerning similarities and differences of somatic symptoms between eras. Potential explanations for observed service era differences in somatic symptoms are discussed.     

Psychosocial assessment of living kidney donors: What implications have temperament and character for decision-making?

ObjectiveWe compared the personality of kidney donor candidates to non-donor controls and analyzed the personality profile of candidates psychosocially at risk.Methods49 consecutive living kidney donor candidates underwent an extensive psychosocial evaluation. Psychosocial risk factors concerning knowledge of donation risks (1), donor–recipient-relationship (2), and/or mental health (3) were rated on a 3-point rating scale (0 = high risk, 2 = no risk). Furthermore, candidates as well as 49 age-and gender-matched non-donor controls filled in questionnaires concerning psychological distress (Symptom Checklist 90-R) and personality (Temperament and Character Inventory).ResultsThere were no significant differences between candidates and controls concerning psychological distress or personality. Psychosocial assessment identified 13 candidates (26.5%) with increased psychosocial risk. This group displayed compared to candidates without psychosocial risk no difference concerning age, gender, formal education, donor–recipient relationship and psychological distress. However, this group scored significantly higher on reward dependence compared to suitable donors and controls (p < 0.05). Reward dependence was associated with a lack of adequate knowledge on donation (r = − 0.35, p < 0.05).ConclusionReward dependence has important implications for decision-making, because it is associated with an increased tendency to deny potential risks of donation. Careful identification and assessment of reward dependent donor candidates is needed to ensure a free-willed decision.     

Socioeconomic and psychosocial gradients in cardiovascular pathogen burden and immune response: The multi-ethnic study of atherosclerosis

BackgroundThe biologic mechanisms linking socioeconomic position and psychosocial factors to cardiovascular disease (CVD) are not well understood. Immune response to persistent pathogens may be one of these mechanisms.MethodsWe analyzed cross-sectional data from the multi-ethnic study of atherosclerosis (N = 999) composed of adults age 45–84. Log-binomial regression and ordinal logistic regression models were used to examine associations of socioeconomic factors and psychosocial factors with pathogen burden and immune response among those infected. Pathogen burden was assessed based on seroprevalence of Helicobacter pylori, cytomegalovirus, herpes simplex virus-1, and Chlamydia pneumoniae and antibody levels were used to characterize high immune response to all four pathogens.ResultsLow education was a strong and significant independent predictor of higher pathogen burden after adjustment for covariates (adjusted odds ratio (OR) 95% confidence interval (CI) 1.37, 1.19–1.57). Among subjects seropositive for all four pathogens, low education and a higher level of chronic psychosocial stress showed a positive association with higher antibody response, although associations were no longer significant in models with all covariates included (OR = 1.64, 95% CI 0.82–3.31 for lowest vs. highest educational category and OR = 1.29, 95% CI 0.96–1.73 for a one level increase in chronic stress).ConclusionPathogen burden and heightened immune response may represent a biological pathway by which low socioeconomic position and chronic stress are related to increased rates of cardiovascular disease.     

Validity of the Center for Epidemiological Studies Depression scale in Type 2 diabetes

ObjectiveDepressive symptoms are common among people with Type 2 diabetes mellitus (T2DM). This study aimed to validate the 3-factor structure of the 14-item Center for Epidemiological Studies Depression (CES-D) scale proposed by Carleton et al. (2013) in a T2DM population.MethodsThe CES-D was administered to consecutive patients with T2DM entering a rehabilitation program. Construct validity was assessed using confirmatory factor analysis. Subscale viability, differential item functioning, and associations with clinical characteristics were tested in bifactor models.ResultsAmong adults with T2DM (n = 305, age 56.9 ± 11.1, 44.9% male, duration of diabetes 7.8 ± 7.9 years, HbA1c 0.076 ± 0.014%), the construct validity of Carleton's 3-factor solution (negative affective, positive affective and somatic symptoms) was confirmed, although negative affective and somatic symptoms were highly correlated (r = 0.926). The CES-D items can be summed to arrive at a total score (ω_H = 0.869), but not subscale scores (ω_S > 0.7). Differential item functioning was not found based on age or body mass index (BMI), but Item 1 (“I was bothered by things that don't usually bother me”) was inflated in women and Item 7 (“I felt that everything I did was an effort”) was inflated in those with higher glycosylated haemoglobin (HbA1c). The general depression factor decreased with age (β = − 0.247, p < 0.001) and increased with BMI (β = 0.102, p = 0.041) but not HbA1c (β = 0.065, p = 0.461). Negative affective symptoms (β = 0.743, p = 0.001), but not other depressive symptoms, were higher in women.ConclusionsThe 14-item CES-D retained construct validity in adults with T2DM. Depressive symptoms were associated with younger age, female gender and BMI, but not with glycemic control.     

Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence

ObjectiveTo effectively diagnose and treat women who have experienced intimate partner violence (IPV), it is important to identify the full range of physical and mental health consequences, including hidden wounds such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). We aimed to identify the occurrence of IPV-related TBI and associated PTSD symptoms among women veterans who experienced IPV.MethodsA web-based survey was administered in 2014 to a national sample of U.S. women veterans. Among 411 respondents (75% participation rate), 55% reported IPV during their lives. These participants (N = 224) completed screening measures of IPV-related TBI, PTSD, and past-year IPV and comprised the current sample.ResultsA total of 28.1% (n = 63) met criteria for IPV-related TBI history, and 12.5% (n = 28) met criteria for IPV-related TBI with current symptoms. When adjusting for race, income, and past-year IPV, women with IPV-related TBI with current symptoms were 5.9 times more likely to have probable IPV-related PTSD than those with no IPV-related TBI history. Despite symptom overlap between TBI and PTSD, women with IPV-related TBI with current symptoms were significantly more likely to meet criteria for all four DSM-5 PTSD symptom clusters compared to women with an IPV-related TBI history without current symptoms (Cramér's V′s = .34–.42).ConclusionFindings suggest there may be clinical utility in screening women who experience lifetime IPV for both TBI and PTSD symptoms in order to help clinicians better target their examinations, treatment, and referrals.     

Prevalence and psychosocial correlates of food addiction in persons with obesity seeking weight reduction

IntroductionFood addiction is a controversial concept. The potential influence of food addiction on patients' psychosocial functioning and well-being has not been well established. The purpose of this study was to examine the relationships between psychosocial functioning (depressive symptoms and health-related quality of life [HRQOL]) and food addiction as measured by the Yale Food Addiction Scale (YFAS). We also explored whether food addiction contributed additional variance in explaining psychosocial functioning, beyond demographic and clinical factors (e.g., binge eating).MethodsThe sample included 178 participants (mean age = 44.2 ± 11.2 years; BMI = 40.9 ± 5.9 kg/m²; 88.2% female; 70.8% Black) with obesity seeking treatment for weight loss. Participants completed the Medical Outcomes Study 36-Item Short-Form Health Survey, Impact of Weight on Quality of Life-Lite, Patient Health Questionnaire, YFAS, and Questionnaire on Eating and Weight Patterns-5.ResultsTwelve (6.7%) participants met criteria for food addiction, with 4 (33.3%) of these participants having co-occurring binge eating disorder. After adjusting for covariates, the number of food addiction symptoms accounted for 6.5% to 16.3% of additional variance in general HRQOL, 5.0% to 21.5% in weight-related HRQOL, and 19.1% in symptoms of depression.ConclusionsIn this treatment-seeking sample of participants, we found a low prevalence of food addiction, suggesting that addictive-like eating is unlikely to be a causal mechanism for most people with obesity. However, individuals who met criteria for food addiction had reduced psychosocial functioning compared to those who did not meet criteria. Individuals with addictive-like eating may require additional psychosocial support.     

Patient satisfaction and psychological well-being after internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor: A randomized controlled trial

Objective and methodsDespite its value for the management of psychological burden, little is known about the efficacy of and patient satisfaction with internet-based cognitive behavioral stress management (IB-CBSM) for women with preterm labor. The present study sets out to analyze stress/anxiety reduction, patient satisfaction and patient's working alliance in a group of 58 women with preterm labor participating in an online psychological stress management project. As part of the project, women were randomly assigned to online stress management or a control condition.ResultsLevels of stress and anxiety decreased significantly in both conditions from pre- to post-treatment measure. Participants in IB-CBSM reported significant higher working alliance inventory (WAI) scores in the task and goal subscale (p < .001; p < .05) than women in the control condition. In Addition the IB-CBSM group showed significant correlations of the WAI subscale task and goal and the stress/anxiety outcome. Regarding patient satisfaction, women in the IB-CBSM reported significantly higher satisfaction scores (p < .001) than women in the control condition. WAI explained nearly 40% of the variance in patient satisfaction. Furthermore, WAI mediates, at least in part, the relationship between group condition and patient satisfaction.ConclusionThe current analysis indicated that participants in IB-CBSM had higher WAI scores and were more satisfied with the program. In addition only the IB-CBSM group showed significant correlations of the WAI with the stress/anxiety reduction outcome. Based on these findings, it can be presumed that measures of agreement with working alliance parameters, especially task and goal components, are substantially important for more effective and satisfactory therapeutic interventions.     

Neurobehavioral effects of exposure to propionic acid revisited—Does psychosocial stress interfere with distractive effects in volunteers?

Local irritants stimulate the nervous system via chemosensory pathways that trigger cognitive distraction, subjective complaints about impaired health, and physiological defense reflexes (e.g. eye-blinks). At workplaces and in the environment chemical exposures often co-occur with psychosocial stress. This study investigated if stress modulates adverse effects of exposure to the local irritant and malodorant propionic acid (PA). Forty-eight participants were randomly assigned to an experimental (false negative feedback + salient surveillance) or control group. In a cross-over design, both groups were exposed for 4 h to PA in concentrations of 0.3 and 0–20 ppm (time-weighted average = 10 ppm). In the experimental group, the stress protocol induced moderate psychosocial stress as indicated by salivary cortisol and subjective responses. Despite concentration-dependent increases in chemosensory perceptions and symptoms, the level of exposure to PA had no impact upon the results of four out of six neurobehavioral tests. In the sustained attention test, there was a significant increase in error rates that corresponded to the exposure levels. However, a concentration-dependent impairment of spatial working memory and an adverse increase in eye-blink frequency were restricted to the control group. Stressed participants had shorter simple reaction times and high eye-blink frequency irrespective of exposure suggesting enhanced alertness. Psychosocial stress increased complaints, ocular irritation and unspecific symptoms at the end of the 0.3 ppm exposure to a level that was comparable with that in the control group during exposure to 0–20 ppm. Results indicate that the adverse effects of a local irritant and psychosocial stress are non-additive.     

Young women post-MI have higher plasma concentrations of interleukin-6 before and after stress testing

ObjectivesYoung women have poorer prognosis after myocardial infarction (MI) and a higher rate of mental stress-induced ischemia compared with similarly aged men. A higher inflammatory status may help explain these sex differences.MethodsWe examined 98 patients (49 women and 49 men) age 18–59 years with recent MI (past 6 months). Women and men were matched for age, type of MI, and time since MI. Interleukin 6 (IL-6) concentrations were measured at baseline, after mental stress using a speech task, and after exercise/pharmacologic stress (60 and 90 min). Depressive symptoms were measured with the Beck Depression Inventory (BDI-II) and angiographic coronary artery disease (CAD) severity was quantified with the Gensini score. Single-photon emission computed tomography (SPECT) was used to obtain a computerized measurement of stress-induced ischemia (summed difference score, or SDS) and determine whether severity of stress-induced ischemia affects the inflammatory response to stress. Analysis was stratified by the median age of 50. Geometric mean concentrations of IL-6 were obtained from general linear regression models.ResultsIn both age groups, women had less angiographic CAD and a similar level of conventional risk factors compared with men. Despite this, baseline IL-6 geometric means before both mental and physical stress were twice as high in women ⩽50 years of age compared to age-matched men (3.8 vs. 1.8 pg/mL, p = 0.001, across both conditions), while they were similar in women and men age >50 years (2.3 vs. 2.2 pg/mL, p = 0.83). After mental stress, IL-6 concentrations increased in both women and men in a similar fashion and remained twice as high in women ⩽50 years than men at both 60 min (5.4 vs. 2.6 pg/mL, p = 0.002) and 90 min (5.9 vs. 3.4 pg/mL, p = 0.01). No significant difference was found between women and men >50 years of age at any time point after mental stress. Results were similar for physical stress. After accounting for SDS, IL-6 concentrations in young women remained higher after both mental and physical stress. Baseline IL-6 concentrations were not significantly related to inducible ischemia.ConclusionsAfter MI, young women aged 50 years or younger, compared with age-matched men, have remarkably higher concentrations of inflammation at baseline and after both mental and physical stress, with a similar inflammatory response to both stressors. Sustained concentrations of inflammation in young women, not their response to stress, may contribute to their adverse outcomes post-MI.     

The association of somatic arousal with the symptoms of upper airway resistance syndrome

ObjectivesWe tested the hypothesis that the symptoms of upper airway resistance syndrome (UARS) are manifestations of chronic stress. To accomplish this, we utilized the score on a self-report questionnaire for somatic arousal (a component of stress) to compare somatic arousal between UARS patients and healthy controls and, among all participants, to correlate the level of somatic arousal with the severity of UARS symptoms.MethodsWe administered the Mood and Anxiety Symptom Questionnaire anxious arousal subscale (MASQaas; a 17-item questionnaire with increasing levels of arousal scored 17–85) to 12 UARS patients and 12 healthy controls and compared scores between groups. For all participants, we correlated the MASQaas scores with scores for the Epworth Sleepiness Scale (ESS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale, Pittsburgh Sleep Quality Index (PSQI), SF-36 Health Survey, and Perceived Deficits Questionnaire (PDQ; assessing cognitive function).ResultsCompared to healthy controls, UARS patients demonstrated increased somatic arousal (MASQaas scores of 18 ± 2 and 28 ± 7, respectively; p < 0.0001). For all participants, the MASQaas scores correlated significantly with scores of the ESS (r = 0.64; p = 0.0008), the FACIT-Fatigue scale (r = −0.89; p < 0.0001), the PSQI (r = 0.70; p = 0.0002), SF-36 Physical component (r = −0.78; p < 0.0001), SF-36 Mental component (r = −0.74; p < 0.0001), and the PDQ (r = 0.89; p < 0.0001).ConclusionsOur findings suggest that UARS patients have increased levels of the stress component, somatic arousal, proportionate to the severity of their symptoms.     

Depression and anxiety among high-risk obstetric inpatients

ObjectiveTo assess the following among women hospitalized antenatally due to high-risk pregnancies: (1) rates of depression symptoms and anxiety symptoms, (2) changes in depression symptoms and anxiety symptoms and, (3) rates of mental health treatment.MethodsSixty-two participants hospitalized for high-risk obstetrical complications completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD-7) and Short-Form 12 weekly until delivery or discharge, and once postpartum.ResultsAverage length of total hospital stay was 8.3±7.6days for women who completed an initial admission survey (n= 62) and 16.3±8.9 (n= 34), 25.4±10.2 (n= 17) and 35±10.9 days (n= 9) for those who completed 2, 3 and 4 surveys, respectively. EPDS was ≥ 10 in 27% (n= 17) and GAD-7 was ≥ 10 in 13% (n= 8) of participants at initial survey. Mean anxiety (4.2±6.5 vs. 5.2±5.1, p= .011) and depression (4.4±5.6 vs. 6.9±4.8, p= .011) scores were lower postpartum compared to initial survey. Past mental health diagnosis predicted depression symptoms [odds ratio (OR)=4.54; 95% confidence interval (CI) 1.91–7.17] and anxiety symptoms (OR=5.95; 95% CI 3.04–8.86) at initial survey; however, 21% (n= 10) with no diagnostic history had EPDS ≥ 10. Five percent (n= 3) received mental health treatment during pregnancy.ConclusionHospitalized high-risk obstetrical patients may commonly experience depression symptoms and/or anxiety symptoms and not receive treatment. A history of mental health treatment or diagnosis was associated with depression symptoms or anxiety symptoms in pregnancy. Of women with an EPDS ≥ 10, > 50% did not report a past mental health diagnosis.     

Does mental health history explain gender disparities in insomnia symptoms among young adults?

BackgroundInsomnia is the most commonly reported sleep disorder, characterized by trouble falling asleep, staying asleep, or waking up too early. Previous epidemiological data reveal that women are more likely than men to suffer from insomnia symptoms. We investigate the role that mental health history plays in explaining the gender disparity in insomnia symptoms.MethodsUsing logistic regression, we analyze National Health and Nutritional Examination Survey (NHANES) III interview and laboratory data, merged with data on sociodemographic characteristics of the residential census tract of respondents. Our sample includes 5469 young adults (ages 20–39) from 1429 census tracts.ResultsConsistent with previous research, we find that women are more likely to report insomnia symptoms compared to men (16.7% vs. 9.2%). However, in contrast to previous work, we show that the difference between women’s and men’s odds of insomnia becomes statistically insignificant after adjusting for history of mental health conditions (OR = 1.08, p > .05).ConclusionsThe gender disparity in insomnia symptoms may be driven by higher prevalence of affective disorders among women. This finding has implications for clinical treatment of both insomnia and depression, especially among women.     

Increased hair cortisol and antecedent somatic complaints in children with a first epileptic seizure

ObjectiveStress is the most frequent seizure-precipitating factor reported by patients with epilepsy, while stressful life events may increase seizure susceptibility in humans. In this study, we investigated the relations between both biological and behavioral measures of stress in children with a first epileptic seizure (hereafter called seizure). We hypothesized that hair cortisol, a biomarker of chronic stress reflecting approximately 3 months of preceding exposure, might be increased in children with a first seizure. We also employed standardized questionnaires to examine presence of stress-related behavioral markers.MethodsThis was a cross-sectional clinical study investigating stress-related parameters in children with a first seizure (First Epileptic Seizure Group (FESG), n = 22) in comparison to healthy children without seizures (Control Group, n = 29). Within 24 h after a first seizure, hair samples were collected from children for the determination of cortisol. In parallel, perceived stress and anxiety and depressive symptoms were examined with appropriate self- and parent-completed questionnaires, and history of stressful life events during the past year was recorded. Emotional and behavioral problems were also assessed by parent-reported validated and widely-used questionnaires.ResultsHigher hair cortisol measurements were observed in the FESG than control children (7.5 versus 5.0 pg/mg respectively, p = 0.001). The former were more likely to complain of somatic problems than the latter (59.8 vs. 55.4 according to DSM-oriented Scale, p = 0.021); however, there were no differences in perceived stress and anxiety or depressive symptoms between the two groups. Using ROC analysis of hair cortisol measurements for predicting disease status, the maximum sensitivity and specificity were observed for a cut-off point of 5.25 pg/mg.SignificanceIncreased hair cortisol indicates chronic hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis prior to the first seizure. This might have contributed to the epileptogenesis process and may help explain the higher incidence of antecedent somatic complaints in the first seizure group.     

A systematic review and meta-analysis of the percentage of revised diagnoses in functional somatic symptoms

BackgroundFunctional somatic symptoms (FSS) are bodily complaints of unclear etiology, which are (currently) not fully explained by well-recognized somatic pathology. Doctors are often hesitant to diagnose FSS, due to the risk to miss a somatic disease. The purpose of this study is to review available literature on the percentage of patients diagnosed with FSS reported to have an underlying somatic disease that explains their symptoms previously labeled as FSS.MethodsWe performed a systematic search of Medline, Embase and PsycINFO databases and reference lists of selected articles. We included studies published between January 1980 and July 2014 without language restrictions. Studies that measured the percentage of underlying somatic diseases after a diagnostic evaluation or naturalistic follow-up period in adult patients initially diagnosed with FSS were included. As primary outcome measure the weighted percentage of revised diagnoses was calculated using meta-analyses.ResultsSix diagnostic evaluation studies (total N = 1804 patients) and 16 follow-up studies (total N = 2440 patients) were included. The percentage of revised diagnosis in patients initially diagnosed with FSS was 8.8% (95% CI 1.0 to 22.2, p = 0.007) in diagnostic evaluation studies and 0.5% (95% CI 0.01 to 1.5, p = 0.03) in follow-up studies. Partially or possibly related diagnoses were rarely found. No specific somatic diagnosis seemed to be missed systematically.ConclusionsThe percentage of underlying somatic diseases in patients previously diagnosed with FSS is relatively small but unneglectable.     

Associations between work stress and suicidal ideation: Individual-participant data from six cross-sectional studies

ObjectiveEpidemiological evidence suggests that work stress is associated with suicidal ideation (SI). However, only few studies in this area have drawn on well-established theoretical work stress models (i.e., the job-demand-control [JDC] model, the effort-reward-imbalance [ERI] model, and the model of organizational injustice [OJ]). Utilization of such models allows though for theory-based assessments and workplace interventions. Since evidence on those models' relationship with suicide-related outcomes is currently inconclusive (with regard to JDC), markedly sparse (OJ) or lacking (ERI), we aimed to provide additional or initial evidence.MethodsWe drew on original data from six cross-sectional studies, which were conducted in four countries (i.e., South Korea, China, Australia, and Germany). Work stress was measured by established questionnaires and was categorized into tertiles. In each study, SI was assessed by either one or two items taken from validated scales. Associations of work stress with SI were estimated for each study and were pooled across studies using multivariate random-effects logistic modeling.ResultsIn the pooled analyses (n = 12,422) all three work stress models were significantly associated with SI with odds ratios fluctuating around 2. For instance, the pooled odds ratios for highest versus lowest work stress exposure in terms of job strain, OJ, and ERI equalled 1.91 (95% confidence interval [CI] = 1.52, 2.41), 1.98 (95% CI = 1.48, 2.65), and 2.77 (95% CI = 1.57, 4.88), respectively. Patterns of associations were largely consistent across the individual studies.ConclusionOur study provides robust evidence of a positive association between work stress and SI.