Depression and risk of heart failure among the elderly: a prospective community-based study

OBJECTIVE: Although 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. METHODS: We examined the effect of depression (assessed by means of the Center for Epidemiological Studies Depression Scale (CES-D) with a cutoff point of > or =21) on the incidence of heart failure in a community sample of persons aged > or =65 years who were participants in the New Haven cohort of the Established Populations for Epidemiological Studies in the Elderly. RESULTS: At 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). CONCLUSIONS: Depression is an independent risk factor for heart failure among elderly women but not elderly men.     

The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes

ObjectiveThe aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes.MethodThis study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples'' state anxiety scores were re-evaluated after embryo transfer (ET).ResultsA significant relationship was found between the depression score of women and pregnancy outcome (p < 0.05). It was determined that anxiety scores for both men and women were higher before the ART procedure, but their anxiety scores decreased after ET (p < 0.05). Spouses of women with a negative pregnancy outcome had higher trait and state anxiety mean scores (p > 0.05) and lower depression scores (p <0.05) than spouses of women with a positive pregnancy outcome.ConclusionStudy results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey.     

冠心病患者血浆BNP、HCY、CRP水平变化分析

目的 :检测冠心病患者血浆中BNP、HCY、CRP水平变化 ,探讨冠心病发病机制及不稳定性心绞痛治疗前后对其影响。方法 :用化学发光和酶联免疫分析 ,对 14 6例冠心病患者和 30例正常对照者血浆BNP、HCY、高敏 -CRP水平变化及相关性进行研究 ,同时对 5 2例UAP经皮冠状动脉成形术 (PTCA)治疗前后对上述三项指标的变化进行分析。结果 :冠心病患者与正常对照组比较BNP水平有显著性差异 (p <0 0 1) ,尤其是AMI和UAP组比SAP组升高更明显 ;CRP水平比正常对照组明显增高 (p <0 0 5 ) ,特别是不稳定心绞痛和急性心肌梗塞组升高明显 (p <0 0 0 1) ;AMI组血浆中HCY水平明显高于正常和其它两组 ,HCY、CRP、BNP三项在UAP组中治疗前后比较差异显著 (p <0 0 5 )。 结论 :BNP、CRP、HCY参与了冠心病的发病过程 ,并可预测心肌梗塞病人远期心功能恢复的情况 ,UAP组经PTCA支架术后三项指标均明显降低 ,可作为疗效观察的一个重要参数 ,HCY参与了冠状动脉粥样硬化的全过程及急性心肌梗塞的发病始末。但其参与的机制有待进一步探讨。     

Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women

OBJECTIVE: To explore the relationship between anxiety, depression, vasomotor symptoms, and menopausal status among middle-aged women. DESIGN: A population-based study involving a rural Taiwanese population. Participants received a structured questionnaire, which included the hospital anxiety and depression scale (HADS), gynecological history and a checklist of menopausal symptoms in the most recent 2 weeks. RESULTS: A total of 1273 women with no history of surgical menopause and hormonal therapy history participated. The mean anxiety, depression, and total HADS scores were 4.3 +/- 3.3, 3.3 +/- 2.8 and 7.6 +/- 5.3, respectively, and did not differ according to menopausal status. A total of 10.5% participants reported hot flashes within the previous 2 weeks. After controlling for educational status and insomnia, anxiety (6.0 +/- 3.8 versus 4.1 +/- 3.1) and depression scores (4.0 +/- 3.3 versus 3.2 +/- 2.7) were significantly higher (p < 0.001) compared with those without hot flashes. These differences were attributed to peri- and postmenopausal subjects. CONCLUSIONS: Hot flashes in peri- and postmenopausal women were associated with anxious and depressive symptoms in East Asian population with low prevalence of vasomotor symptoms.     

综合医院住院患者整体抑郁焦虑状况

目的:运用"阳光心灵-中国抑郁焦虑健康教育项目"模式调查综合医院住院患者的抑郁、焦虑发生率,不同科室、病种之间的差异,以及年龄、性别、婚姻状况与抑郁、焦虑发生率的关系。方法:选取大庆龙南医院19个病区的1339名住院患者,指导患者完成PHQ-9、GAD-7和基本调查问卷的填写。结果:1住院患者抑郁焦虑发生率47.4%,单纯抑郁43.6%,单纯焦虑33%,合并抑郁焦虑30%;2焦虑发生率前3位的科室依次是胸外科、肾内科、血液肿瘤(χ2=121.81,P0.001);抑郁发生率前3位的是胸外科、呼吸内科、血液肿瘤科,(χ2=136.88,P0.001);合并抑郁焦虑前3位的是胸外科、消化内科和肿瘤科(χ2=128.10,P0.001);3疾病中以"待查"患者抑郁发生率最高(χ2=120.41,P0.001);4女性住院患者的焦虑得分显著高于男性患者(P0.01);年龄与抑郁、焦虑均相关,随着年龄的增大,抑郁和焦虑得分都显著升高(P0.001);5离异、丧偶患者在抑郁上的得分高于已婚和未婚患者(F=19.01,P0.001)。离异、丧偶患者在焦虑上的得分高于已婚患者(F=10.83,P0.001)。结论:1焦虑抑郁问题广泛存在于各科室、病种的住院患者中,只是在发生率上存在明显差异;2"疾病待查"患者与已明确诊断的患者相比更容易出现抑郁;婚姻不幸对人情绪影响较大,如离异、丧偶者更容易出现抑郁焦虑问题;女性患者与男性相比更容易焦虑;3"阳光心灵-中国抑郁焦虑健康教育项目"模式用于综合医院抑郁焦虑的筛查和治疗评估,简便实用,对于临床非精神科医生而言便于复制,并为精神疾病的联络会诊、治疗干预提供可靠依据。     

Lifetime History of Depression, Type 2 Diabetes, and Endothelial Reactivity to Acute Stress in Postmenopausal Women

Background

Coronary heart disease is a major cause of mortality in women and persons with diabetes. Mental stress and major depressive disorder have both been associated with coronary heart disease. Endothelial functioning is a clinically meaningful manifestation of CHD that is detectable in its earliest stages.

Purpose

This study aims to determine whether acute stress and lifetime history of major depressive disorder are associated with functional and biochemical markers of endothelial function and whether this relationship varies by diabetes status.

Methods

Resting endothelial function was assessed for n?=?215 postmenopausal women with no known or suspected coronary artery disease participated. Of these, 108 had a positive lifetime major depressive disorder (L-MDD; assessed through structured clinical interview) and had been free of major depressive disorder for >6?months; 103 had type?2 diabetes. Endothelial reactivity to acute mental stress was assessed for n?=?114 of the participants. Endothelial function was assessed by flow-mediated dilation of the brachial artery (FMD) by total plasma nitrite, the cumulative molecule from nitric oxide (NO) generation, and by plasma endothelin-1 (ET-1).

Results

Participants with L-MDD had lower NO and lower FMD compared to never-depressed controls. Secondary analyses suggest that among participants with L-MDD, antidepressant medications are associated with higher NO. Participants with diabetes had higher NO but lower FMD than nondiabetic controls. Mental stress affected FMD in the entire sample. Diabetes moderated the effect of mental stress on NO and L-MDD moderated the effect of mental stress on ET-1.

Conclusions

History of depression, even in full remission, is associated with impaired endothelial functioning regardless of diabetes status. Acute mental alters FMD, NO, and ET-1 differentially among subgroups.     

Antagonistic behavior, dominance, hostility, and coronary heart disease

PURPOSE: This study investigated the relationship between antagonistic behavior, dominance, attitudinal hostility, and coronary heart disease (CHD). METHODS: One hundred one men and 95 women referred for thallium stress testing were administered the Structured Interview and the Cook-Medley Hostility Scale. The Hostile Behavior Index, derived from the Structured Interview and developed by Haney et al., served as an index of antagonism, and the frequency with which interviewees interrupted their interviewer served as a measure of dominance. On the basis of their medical history and thallium stress test results, patients were classified as having (N = 44) or not having (N = 99) CHD. RESULTS AND CONCLUSIONS: Multivariate logistic regressions (with age, gender, disease, and lifestyle risk factors in the model) revealed that both the Hostile Behavior Index and dominance were significant independent risk factors for CHD (relative risk [RR] = 1.22 and 1.47, p < .03). Of the two Hostile Behavior Index component scores, indirect challenge and irritability, only the latter correlated significantly with CHD (RR = 1.27, p < .03). Separate logistic regressions for men and women suggest that subtle, indirect manifestations of antagonism confer CHD risk in women and that more overt expressions of anger confer risk in men. A significant univariate correlation between hostility scale scores and CHD became not significant when we adjusted for socioeconomic status.     

Infidelity and separations precipitate major depressive episodes and symptoms of nonspecific depression and anxiety

This study examined whether humiliating marital events (HMEs; husbands' infidelity, threats of marital dissolution) precipitated Major Depressive Episodes (MDEs) when controlling for marital discord. Participants were 25 women who recently experienced an HME and 25 control women who did not experience an HME. Both groups reported similar levels of marital discord. Results indicated that HME participants were 6 times more likely to be diagnosed with an MDE than control participants. These results remained even after controlling for family and lifetime histories of depression. HME participants also reported significantly more symptoms of nonspecific depression and anxiety than control participants. However, HME and control participants did not report significantly different numbers of anhedonic depression and anxious arousal symptoms. The research and clinical implications of these findings are discussed.     

Disclosing genetic risk for coronary heart disease: effects on perceived personal control and genetic counseling satisfaction

We investigated whether disclosure of coronary heart disease (CHD) genetic risk influences perceived personal control (PPC) and genetic counseling satisfaction (GCS). Participants (n = 207, age: 45–65 years) were randomized to receive estimated 10‐year risk of CHD based on a conventional risk score (CRS) with or without a genetic risk score (GRS). Risk estimates were disclosed by a genetic counselor who also reviewed how GRS altered risk in those randomized to CRS+GRS. Each participant subsequently met with a physician and then completed surveys to assess PPC and GCS. Participants who received CRS+GRS had higher PPC than those who received CRS alone although the absolute difference was small (25.2 ± 2.7 vs 24.1 ± 3.8, p = 0.04). A greater proportion of CRS+GRS participants had higher GCS scores (17.3 ± 5.3 vs 15.9 ± 6.3, p = 0.06). In the CRS+GRS group, PPC and GCS scores were not correlated with GRS. Within both groups, PPC and GCS scores were similar in patients with or without family history (p = NS). In conclusion, patients who received their genetic risk of CHD had higher PPC and tended to have higher GCS. Our findings suggest that disclosure of genetic risk of CHD together with conventional risk estimates is appreciated by patients. Whether this results in improved outcomes needs additional investigation.     

Risk factors for coronary heart disease in a black population.

A matched case control study using population-based controls was done over a 2-year period in an urban, public hospital setting. The object of the study was to determine if the established risk factors for coronary heart disease--hypertension, diabetes mellitus, hypercholesterolemia, cigarette smoking, low socioeconomic status (as reflected by occupational class and educational level), marital status, and obesity were associated with coronary heart disease in a black population. The established risk factors were found to be significant in this patient population, as was obesity. Being divorced or separated was a risk factor for women but not for men.     

Screening and pathways to maternal mental health care in a South African antenatal setting

In low-resource settings, a stepped care approach is necessary to screen and provide care for pregnant women with mental health problems. This study sought to identify screening items that were most robust at differentiating women experiencing psychological distress and requiring counselling [assessed by screening with the Edinburgh Postnatal Depression Scale (EPDS) and a Risk Factor Assessment (RFA)] from those with a psychiatric disorder as diagnosed by a psychiatrist. Case records of women in an antenatal mental health service in Cape Town were reviewed. Composite scores and individual items on screening scales (EPDS, RFA) of participants who qualified for counselling (n?=?308) were compared to those of participants who were diagnosed with a psychiatric disorder (n?=?58). All participants with a psychiatric disorder were diagnosed with either depression or anxiety disorders. These participants had higher mean scores on the EPDS and RFA than those who qualified for counselling (p?<?0.01). Logistic regression and ROC analyses suggested that the best items to distinguish women with depression or anxiety from those qualifying for counselling were ‘I have felt sad and miserable’, ‘I am not pleased about being pregnant’ and ‘I have had serious depression, panic attacks or problems with anxiety before’ (sensitivity 0.655, specificity 0.750 for this combination of three items). A small number of items may be useful in screening for mental illness in pregnancy which requires higher levels of care. Such screening may contribute to a more efficient stepped care approach.     

Effects of maternal breathing rate, psychiatric status, and cortisol on fetal heart rate

Women's experiences during pregnancy are predictive of variation in neurobehavioral profiles in their children. Few studies have assessed these relationships during the prenatal period. In 113 women in the 36^th –38^th gestational week (mean age 26.3 ± 5.4 years), electrocardiogram, blood pressure, respiration, salivary cortisol, and fetal heart rate (HR) were measured during baseline, a psychological challenge (Stroop color–word matching task), and a standardized paced breathing protocol. Subjects underwent the Structured Clinical Interview for DSM‐IV prior to testing and were grouped as: depressed, co–morbid for depression and anxiety, anxiety disorder only, and control. There was a significant main effect of maternal diagnostic group on fetal HR only during the Stroop task: fetuses of women in the co–morbid group had a greater HR increase compared to controls (p < .05). Overall, fetuses showed robust increases in HR during paced breathing (p < .0001), and there was no significant difference by maternal diagnosis. For both tasks, changes in fetal HR were independent of women's concurrent cardiorespiratory activity. Finally, although cortisol was higher in the co‐morbid group (p < .05), across all participants, there was a trend for maternal baseline cortisol to be positively associated with average fetal HR (p = .06). These findings indicate that variation in fetal HR reactivity—an index of emerging regulatory capacities—is likely influenced by multiple acute and chronic factors associated with women's psychobiology. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 53:221–233, 2011.     

同型半胱氨酸、脂蛋白(a)和超敏CRP的变化与冠状动脉粥样硬化的关系

探讨血清同型半胱氨酸(Hcy)、脂蛋白(a)[LP(a)]、超敏C反应蛋白(hs-CRP)的变化与冠状动脉粥样硬化及其程度的关系.应用冠状动脉造影判定144例患者冠状动脉粥样硬化及其程度,同时抽取患者血液测定血清中Hcy、LP(a)及hs-CRP的水平.结果表明冠状动脉粥样硬化的患者血清Hcy、LP(a)及hs-CRP的水平比冠状动脉正常的患者明显增高,二者有显著性差异(P＜0.01);且血清Hcy、LP(a)及hs-CRP的水平随病变支数增加而增高.Hcy、LP(a)、hs-CRP作为独立的动脉粥样硬化危险因素对冠心病的诊断及程度的判定有积极的临床意义.     

Risk factors for depressive symptoms during pregnancy

The present study examined risk factors for depression during pregnancy in a very large population sample. Two research questions have been addressed: first, the association between demographic factors and past negative obstetrical outcomes on depression severity scores, and second, the differences in these factors between women recruited at a university medical center and maternal health centers (MHC). The study included more than 5,000 pregnant women attending regular appointments at the University Obstetrics and Gynecology Clinic or at several MHCs in Eastern Iowa. Participants completed a Beck depression inventory (BDI) and a demographic questionnaire. We performed a statistical analysis on the association between risk factors and depression severity scores. Regression analysis revealed that week of pregnancy, site of recruitment, years of education, income, marital status, employment, and number of miscarriages and stillbirths were significant predictors of total BDI score. Compared to their university counterparts, participants at MHCs had more depressive symptoms, were younger, mostly single, and had lower socioeconomic status and more past negative obstetrical outcomes. Our study can inform providers about some of the risk factors during depression screening in pregnancy to increase diagnostic vigilance and tailor the level of prenatal care accordingly.     

Binge eating in overweight treatment-seeking adolescents

OBJECTIVE: To examine the frequency and recency of binge eating in relation to psychopathology in overweight, treatment-seeking adolescents. METHODS: We investigated psychological correlates of the frequency and recency of reported loss of control (LOC) eating episodes in 160 overweight (body mass index [BMI]: 40.7 +/- 8.8 kg/m(2)) adolescents. On the basis of the responses to the eating disorder examination (EDE), participants were categorized into one of four groups: full-syndrome binge eating disorder (BED); recent but infrequent binge eating (episodes within the 3 months before interview; RECENT-BINGE); remote and infrequent LOC eating (episodes occurring >3 months before assessment; PAST-LOC), or no history of LOC episodes (NE). RESULTS: The BED group reported higher EDE scores (global, p < .01), and more negative mood and anxiety than all other groups (p's < .01). Compared with NE, RECENT-BINGE also reported more anxiety and higher EDE scores (p's < .01). CONCLUSIONS: Overweight, treatment-seeking adolescents with BED are clearly distinguishable from teens without the disorder on measures of eating-related psychopathology, mood, and anxiety. RECENT-BINGE, but not PAST-LOC, is also associated with significantly greater eating-related and general psychopathology.     

Psychological predictors of survival in cancer patients undergoing radiation therapy

In a prospective study to identify psychological factors affecting survival in cancer patients receiving radiation therapy, 101 consecutive patients were evaluated for anxiety, depression, and perception of the seriousness of the condition. In 3 years, the survivors were compared to the nonsurvivors. The survivors had significantly higher mean trait anxiety (p less than 0.05) than the nonsurvivors. State anxiety and depression scores also tended to be higher in the survivors (p less than 0.01). Self-assessment of the seriousness of their disease did not differentiate the two groups. The nonsurvivors had significantly more pain (p less than 0.05). Within the nonsurvivor group, survival time was negatively correlated with state anxiety (p less than 0.01), trait anxiety (p less than 0.02), and depression (p less than 0.01). In the nonsurvivors, women rated their condition to be significantly more serious than men (p less than 0.01). Female nonsurvivors tended to rate their condition to be more serious than female survivors (p less than 0.1), while male nonsurvivors rated their condition to be significantly less serious than male survivors (p less than 0.01). Only among female nonsurvivors did the seriousness rating correlate significantly with anxiety (p less than 0.01). The sex differences confirm our previous finding that men may tend to cope with cancer with more massive denial than women. We hypothesize that patients with higher anxiety and depression in the nonsurvivor group had a massive defensive failure, while those who had high anxiety levels in the survivor group had been more realistic about their disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Interaction of the cholesteryl ester transfer protein I405V polymorphism with alcohol consumption in smoking and non-smoking healthy men, and the effect on plasma HDL cholesterol and apoAI concentration

Three hundred and sixteen healthy Icelandic men and women were examined for the effect of the cholesteryl ester transfer protein (CETP) I405V polymorphism on plasma triglycerides, HDL cholesterol (HDLC) and apoAI concentration. Genotyping was performed using an allele specific oligomelting assay and the frequency of the V allele was 0.31 (95 CI for men 0.23–0.33 and for women 0.29–0.39). In women no significant difference was associated with the V405 genotype for any plasma lipid trait. However, men who were homozygous for the V405 allele had 9% higher apoAI and 14% higher HDLC levels (p < 0.05) than those homozygous for the common 1405 allele. The genotype effect was seen only in the non-smokers (p = 0.07 and <0.05, respectively), and in those consuming alcohol (p < 0.05 for both). Analysis of interaction between the environmental, life-style factors and genotype in men for the traits of HDLC and apoAI showed statistically significant interaction of the genotype only with alcohol consumption. The non-smoking men who reported alcohol consumption and who were homozygous for the CETP V405 allele had 16% higher plasma apoAI concentration than those who carried the 1405 allele, and up to 20% higher apoAI level than smokers. On the basis of prospective studies carried out on the Icelandic population, non-smoking, alcohol-consuming men who are homozygous for the V405 allele could have from 32% to 40% lower risk of having a heart attack.     

Interoceptive awareness,positive affect,and decision making in Major Depressive Disorder

Background

Little work has examined the relation between interoceptive awareness and symptoms of Major Depressive Disorder (MDD). Existing research suggests that depressed individuals exhibit impaired heartbeat perception, though the results of this research have been equivocal. Importantly, depressed participants in these studies have had comorbid anxiety disorders, making it difficult to draw inferences about interoceptive awareness in MDD. The current study addresses this issue by assessing heartbeat perception in depressed women without current anxiety disorders and exploring the relation between interoception and perturbations in both affective intensity and decision making, components of MDD postulated to be related to bodily awareness.

Methods

Depressed women without concurrent anxiety disorders (n=25) and never-disordered controls (n=36) performed a heartbeat perception task. Participants completed the self-report Affect Intensity Measure (AIM), and decision-making difficulty was assessed in MDD participants using the Structured Clinical Interview for DSM-IV.

Results

Depressed women exhibited poorer heartbeat perception accuracy than did control participants. Impaired accuracy in MDD participants was associated with reduced positive affectivity and difficulty in decision making.

Limitations

Our sample was composed exclusively of females and was heterogeneous with respect to treatment status, thereby limiting our ability to generalize results to depressed males and to exclude the contribution of exogenous factors to the observed group differences.

Conclusions

Results of this study suggest that for depressed individuals without anxiety comorbidities, disrupted perception of bodily responses reduces both the experience of positive arousal and the ability to use interoceptive feedback to inform decision making.     

Antenatal prevention of postnatal depression

Summary Twenty three women at risk for postpartum depression were offered ten classes in pregnancy and postpartum, focusing on parenting and coping strategies. Twenty one controls attended standard six antenatal classes. Postpartum there were no differences in depression scores, however, anxiety was less at six weeks postpartum in the intervention group. Over time both groups had reduced numbers and reduced satisfaction with supports, but this was greater in the control group. With respect to the marital relationship, this was also less satisfactory postpartum in the control group. The intervention group was well attended and participants satisfied with the alternative antenatal class format; larger studies for all first time mothers are recommended.     

A prospective study of postmenopausal estrogen therapy and coronary heart disease

To clarify the possible role of postmenopausal estrogen use in coronary heart disease, we surveyed 121,964 female nurses, aged 30 to 55 years, with mailed questionnaires, beginning in 1976. Information on hormone use and other potential risk factors was updated and the incidence of coronary heart disease was ascertained through additional questionnaires in 1978 and 1980, with a 92.7 per cent follow-up. End points were documented by medical records. During 105,786 person-years of observation among 32,317 postmenopausal women who were initially free of coronary disease, 90 women had either nonfatal myocardial infarctions (65 cases) or fatal coronary heart disease (25 cases). As compared with the risk in women who had never used postmenopausal hormones, the age-adjusted relative risk of coronary disease in those who had ever used them was 0.5 (95 per cent confidence limits, 0.3 and 0.8; P = 0.007), and the risk in current users was 0.3 (95 per cent confidence limits, 0.2 and 0.6; P = 0.001). The relative risks were similar for fatal and nonfatal disease and were unaltered after adjustment for cigarette smoking, hypertension, diabetes, high cholesterol levels, a parental history of myocardial infarction, past use of oral contraceptives, and obesity. These data support the hypothesis that the postmenopausal use of estrogen reduces the risk of severe coronary heart disease.