Increases in job strain are associated with incident hypertension in the CARDIA study

Background: Job strain, defined as high job demands and low decision latitude, has been associated with increased blood pressure levels in some studies, but most of these studies have been cross-sectional.Purpose: We sought to determine whether changes in job strain during young adulthood were associated with the development of hypertension, using the Coronary Artery Risk Development in Young Adults cohort.Methods: A total of 3,200 employed, initially normotensive participants, aged 20 to 32 in 1987–1988, were followed for 8 years; the Job Content Questionnaire was completed twice: initially and 8 years later. Hypertension at follow-up was defined as systolic blood pressure (SBP) of 160 or higher and diastolic blood pressure of 95 mmHg or higher, or reporting being on antihypertensive medication.Results: Job strain (based on job demands above the median and decision latitude below the median of the sample) was associated with hypertension incidence (ps < .05) for the entire cohort and among White women and men. Adjustment for baseline SBP, education, body mass index (BMI), change in BMI, and age did not alter these relations. The ratio of increasing demands relative to decreasing decision latitude was also associated with greater incidence of hypertension in the entire cohort in the multivariate model (odds ratio=2.06, 95% confidence interval=1.01–4.26).Conclusions:Anincrease in job strain is associated with incident hypertension, particularly among Whites. This article was presented in part at the meeting of the American Psychosomatic Society, March 2000. This research was supported by Contracts N01-HC-48047, N01-HC-48048, N01-HC-48049, N01-HC-48050, and N01-HC-95100 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.     

Alcohol abstinence and binge drinking: the intersections of language and gender among Hispanic adults in a national sample, 2002–2018

Purpose

Prior research examining alcohol use using national data has often overlooked vital heterogeneity among Hispanics, especially that related to language dominance and gender. We examine the prevalence of alcohol abstinence and—given prior research suggesting that many Spanish dominant Hispanics do not drink—examine rates of binge drinking among past-year alcohol users with a focus on the intersections of language and gender among Hispanics, while drawing comparisons with non-Hispanic (NH) White and NH Black adults.

Methods

Drawing from the National Survey on Drug Use and Health—a nationally representative survey between 2002 and 2018—we examine the year-by-year prevalence of alcohol abstinence and binge drinking among adults ages 18 and older in the United States.

Results

A disproportionate number of Spanish-dominant Hispanics abstain from alcohol use (54%), with particularly high levels of alcohol abstinence observed among Spanish dominant women (men: 39%, women: 67%). The prevalence of alcohol abstinence among English-dominant Hispanic men (24%) and women (32%) is far lower, approximating that of NH Whites (men: 23%, women: 32%). Importantly, however, among Spanish-dominant drinkers, the prevalence of binge drinking (men: 52%, women: 33%) is comparable to or greater than NH Whites (men: 42%, women: 32%). Binge drinking levels among English-dominant Hispanic men (50%) and women (37%) are greater than among their NH White counterparts.

Conclusion

Findings paint a complex picture; consistent with prior research, we see that many Hispanics abstain from alcohol, but we also see new evidence underscoring that—among Hispanic drinkers—the prevalence of binge drinking is disconcertingly elevated.

     

Poor response to antidepressant medication of patients with depression accompanied by somatic symptomatology in the STAR*D Study

Studies suggest that the gender difference in the prevalence of depression results because women exhibit higher prevalence than men of a depressive phenotype associated with somatic symptoms. Because this phenotype has been found to be based in psychosocial forces, it may not respond well to antidepressant medication. In this study, data from the STAR*D Study were analyzed to compare remission rates in response to an SSRI and to several other antidepressants of patients exhibiting depression accompanied by somatic symptomatology versus other patients. Scores on the Clinician Rated Quick Inventory of Depressive Symptomatology were used to measure clinical remission in response to medication. Patients exhibiting depression accompanied by somatic symptomatology exhibited less remission to the SSRI Citalopram (31% versus 43%) and to the various medications administered in level 3 (14% versus 25%) than did other patients in STAR*D. The low rates of remission in response to medication of patients exhibiting somatic symptomatology were not due to the greater proportion of women, nor to the greater proportion of patients exhibiting anxiety disorders, among patients exhibiting somatic symptomatology. Remission rates were found to be related to exhibiting somatic symptomatology not to exhibiting nonsomatic symptoms.     

Association between obesity and depressive symptoms among U.S. Military active duty service personnel, 2002

PURPOSE: The association between obesity and depression remains equivocal. The purpose of this study was to describe the prevalence and association of obesity and depressive symptoms among military personnel. METHODS: A cross-sectional analysis was performed using data (N=10,040) from the U.S. Department of Defense (DoD) Survey of Health-Related Behaviors. Prevalence odds ratios were calculated to describe the association between obesity and depressive symptoms. RESULTS: Approximately 10% of active duty men and 4% of active duty women were obese. The prevalence of depressive symptoms ranged from approximately 16% of overweight men to 49% of obese women. Obese men and women and underweight men had increased odds of depressive symptoms as compared with normal-weight individuals. CONCLUSIONS: The DoD should emphasize prevention and regular screening for obesity and depressive symptoms to improve readiness and reduce health care costs and disease burden in this cohort.     

Ethnicity, psychosocial risk, and perinatal depression--a comparative study among inner-city women in the United Kingdom

OBJECTIVE: The objective of this study was to explore the relationships between psychosocial risk, ethnicity, and prevalence of depressive symptoms in the perinatal period. A comparative study among a cohort of Black Caribbean and White British women was undertaken. METHODS: A predominantly inner-city sample (N=301) was recruited at a large teaching hospital and at community antenatal clinics in the north of England. Women were screened for depressive symptoms in the last trimester of their pregnancy and 6 weeks their delivery with the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Black Caribbean women reported higher levels of psychosocial risk for perinatal depression compared with their White British counterparts. They were more socially and socioeconomically deprived. To elaborate, the Black Caribbean women were more likely to live in the most deprived areas of the city (P=.002), to live on benefits (P=.014), and to be lone parents (P<.0001). However, despite higher levels of deprivation and other known risks for perinatal depression, Black Caribbeans were not more likely than White British women to score above the threshold on the EPDS (cutoff point, 12/13). CONCLUSIONS: During and after pregnancy, approximately a quarter of the Black Caribbean women in this study recorded symptom scores suggestive of clinically significant morbidity. These findings are not reflected in clinical practice, suggesting that there may be substantial levels of undetected and untreated perinatal depression among this ethnic group. This has potentially serious implications not only for the mental health and well-being of individual women but also for their families.     

Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk

Purpose

This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose.

Methods

Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015–2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels.

Results

Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + .

Conclusion

Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.

     

Prävalenz von Essstörungen unter Studierenden

A sample of 507 social work students completed the Bulimic Investigatory Test Edinburgh (BITE). Simulating diagnoses according to DSM-IV criteria, we found three women suffering from bulimia nervosa (BN). This represents a total prevalence of 0.6%, 0.8% in women, and 0.9% in female probands up to the age of 30 years. In the same way, we identified one case of anorexia nervosa (AN), i.e. a total prevalence of 0.2%, 0.3% in women, and 0.3% in female probands up to the age of 30. Nineteen students also fulfilled DSM-IV research criteria for binge-eating disorder (BED), showing a total prevalence of 3.7%, 3.8% in women, 3.5% in men, and 4.3% in female probands up to the age of 30. Thus, BED is the most common eating disorder and also occurs in men. In light of the association between weight discontent and eating disorders, suggestions are made for the management of overweight patients and both normal and underweight clients with eating disorders.     

Impact of binge eating disorder in the psychopathological profile of obese women

Objective

Our objective was to evaluate the psychopathological profile of obese women with binge eating disorder (BED) using the Symptom Checklist-90 (SCL-90).

Methods

Two hundred twelve obese women who seek for weight loss treatment were sequentially selected to participate in the study. Binge eating disorder was diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Binge eating disorder severity was assessed using Binge Eating Scale. Depressive symptoms were assessed using Beck Depression Inventory. The psychopathological profile was assessed using the SCL-90.

Results

Binge eating disorder was diagnosed in 54 patients (26.6%). Obese patients with BED presented significant higher scores in all domains of SCL-90 (P < .05 for all) in comparison with obese patients without BED. A significant relationship was found among Binge Eating Scale, Beck Depression Inventory, and all domains of the SCL-90 (P < .05 for all). After linear regression, obsessivity-compulsivity (P = .03), interpersonal sensitivity (P = .0064), paranoid ideas (P = .03), and psychoticism (P = .01) were independently related to the severity of BED.

Conclusion

Obese women with BED presented a more severe psychopathological profile than obese controls. Among all, obsessivity-compulsivity, interpersonal sensitivity, paranoid ideas, and psychoticism seem to be strongly linked to BED severity.     

Black-white Differences in Left Ventricular Hypertrophy Rates Among Young Adults with Ischemic Stroke

ObjectivesFew studies have addressed Black-White differences in left ventricular hypertrophy (LVH) in young stroke patients without a history of hypertension.MethodsA case-only cross-sectional analysis performed in 2019 of data from the Stroke Prevention in Young Adults Study, a population-based case-control study of ischemic stroke patients ages 15–49. The main outcomes were hypertension indicators at the time of stroke hospitalization: self-reported history of hypertension, LVH by echocardiography (Echo-LVH) and LVH by electrocardiogram (ECG-LVH). The prevalence of Echo-LVH was further determined in those with and without a history of hypertension. Adjusted odds ratios and 95% confidence intervals comparing blacks and whites were calculated by logistic regression.ResultsThe study population included 1028 early-onset ischemic stroke patients, 48% Black cases, 54% men, median age 43 years (interquartile range, 38–46 years). Overall, the prevalence of hypertension history, Echo-LVH and ECG-LVH were 41.3%, 34.1% and 17.5%, respectively. Each of the hypertension indicators were more frequent in men than in women and in Black cases than in White cases. Black patients without a history of hypertension had higher rates of Echo-LVH than their white counterparts, 40.3% vs 27.7% (age and obesity adjusted OR 1.8; 95% CI 1.02–3.4) among men and 20.9% vs 7.6% (adjusted OR 2.7; 95% CI 1.2–6.2) among women.ConclusionsLVH was common in young patients with ischemic stroke, regardless of self-reported history of hypertension. These findings emphasize the need for earlier screening and more effective treatment of hypertension in young adults, particularly in the Black population.     

Sex differences in biopsychosocial correlates of binge eating disorder: a study of treatment-seeking obese adults in primary care setting

Objective

Although community-based studies suggest equivalent levels of physical and psychological impairment by binge eating disorder (BED) in men and women, men with BED are still underrepresented in clinical studies. This study aimed to provide a comprehensive analysis of sex differences in biopsychosocial correlates of treatment-seeking obese patients with BED in primary care.

Method

One hundred-ninety obese adults (26% men) were recruited in primary care settings for a treatment study for obesity and BED.

Results

Very few significant sex differences were found in the developmental history and in current levels of eating disorder features, as well as psychosocial factors. Women reported significantly earlier age at onset of overweight and dieting and greater frequency of dieting. Men reported more frequent strenuous exercise. Men were more likely than women to meet criteria for metabolic syndrome; men were more likely to show clinically elevated levels of triglycerides, blood pressure, and fasting glucose levels.

Conclusion

Despite few sex differences in behavioral and psychosocial factors, metabolic problems associated with obesity were more common among treatment-seeking obese men with BED than women. The findings highlight the importance of including men in clinical studies of BED and active screening of BED in obese men at primary care settings.     

Cardiovascular reactivity to mental arithmetic and cold pressor in African Americans,Caribbean Americans,and White Americans

Background: Caribbean Americans and African Americans, two of the largest Black ethnic groups in the United States, differ in cardiovascular-disease-related mortality rates.Purpose: Cardiovascular reactivity to psychological stress may be an important marker or mediator of risk for cardiovascular disease development in Blacks in the United States, yet little attention has been paid to ethnicity among Blacks in reactivity research. This study examined cardiovascular reactivity to psychological stress in African American, Caribbean American, and White American participants.Methods: Forty-five women and 43 men performed mental arithmetic and hand cold pressor (CP) tasks.Results: Caribbean Americans displayed larger decreases in heart period variability during mental arithmetic than White Americans (p = .02). White Americans exhibited a pre-ejection period decrease, whereas African Americans and Caribbean Americans displayed pre-ejection period increases during CP (p = .023). African Americans exhibited greater decreases in interbeat interval during CP than White Americans (p = .013). Caribbean Americans displayed greater decreases in cardiac output than White Americans during CP (p = .009). White Americans exhibited significantly greater increases in systolic blood pressure than Caribbean Americans during CP (p = .014).Conclusions: These findings suggest that differences in reactivity to psychological stress exist among Black ethnic groups in the United States and underscore the need to consider ethnicity as a factor in reactivity research with Black Americans. This study was supported by the National Institute of Mental Health Grant 1 F31 MH12330-01A1 to Carlotta M. Arthur. We thank Stefan Wiens and William Guethlein for programming assistance. We also thank Robert M. Kelsey, Ronald Friend, K. Daniel O’Leary, Richard P. Sloan, Laura D. Kubzansky, Ichiro Kawachi, and Norman B. Anderson for their valuable comments.     

A family history study of binge-eating disorder

Family studies of anorexia nervosa and bulimia nervosa have yielded important information about the etiologies of these eating disorders. By contrast, little is known about familial factors of etiologic importance for binge-eating disorder (BED). The purpose of the current family history study was to assess the prevalence of comorbid psychopathology in a non-treatment seeking female sample of 31 probands with BED, 32 control probands without BED, and their 283 first-degree relatives. In-person semistructured clinical interviews were conducted with the probands, who also served as informants for all of their first-degree relatives. Significantly higher lifetime rates of major depressive disorder, dysthymic disorder, and social phobia were found among women with BED compared with control women. Significantly higher lifetime rates of bipolar (I or II) disorder, any depressive disorder, nearly all anxiety disorders, anorexia nervosa, and BED were reported among the first-degree relatives of women with BED compared with the first-degree relatives of control women. Furthermore, female relatives of women with BED were reported to have higher rates of substance use disorders and dysthymic disorder compared with female relatives of control women without BED. Nearly all disorders that were elevated in relatives of women with BED followed a pattern of independent transmission from BED. The primary exception was substance use disorder among female relatives, whose transmission pattern was consistent with that of a shared etiology with BED. Thus, BED and substance use disorder may share a common mechanism of familial transmission among women.     

Explicit memory bias for positively valenced body-related cues in women with binge eating disorder

Overweight women with and without binge eating disorder (BED) are characterized by a marked body dissatisfaction, which may in part be due to the negative comments about their weight. Weight-related teasing and discrimination is reported both by healthy overweight women and women with BED, whereas body dissatisfaction is markedly increased among women with BED. Therefore, a memory bias for negatively valenced body-related cues is suspected to occur as a mediating factor in women with BED. In an experimental study, 18 women with BED were compared to 18 overweight healthy female controls (HC) on a free recall task containing four word categories: positively valenced with and without body-related content and negatively valenced with and without body-related content. While both groups showed a bias towards negatively valenced shape-/weight-related words, women with BED retrieved positively valenced shape-/weight-related words significantly less often compared to overweight HC. Findings suggest that it may be the reduced ability to attend to positively valenced shape-/weight-related information, rather than the activation of negative body schemata that differentiates overweight women with BED from overweight women without BED. Results are discussed in the context of cognitive biases in the maintenance of body dissatisfaction.     

Factors Associated With High Rates of Depressive Symptomatology in Older People in Vietnam

ObjectivesThis study aimed to identify the prevalence and correlates of depressive symptomatology among Vietnamese older people.MethodWe used baseline survey data collected in 2018 from the Longitudinal Study of Ageing and Health in Vietnam (LSAHV) conducted across seven regions and comprising 6,050 people aged 60 years and over of whom 4962 completed the brief 11-item Center for Epidemiological Studies-Depression (CES-D) scale. Clinically significant depressive symptomatology was a CES-D score of 8.8 or higher. The association between demographic, physical, and mental factors with depressive symptomatology was examined using univariate and multivariable logistic regression.ResultsThe prevalence of depressive symptomatology was 31.3% (95% CI 29.8% - 32.9%). Depressive symptomatology was highest among people living in the Central Coast region (46.8%, 95% CI 44.5% - 49.2%). Factors associated with depressive symptomatology from the multivariable model included female sex (OR 1.3, 95% CI: 1.1-1.6), rural residence (OR 1.4, 95%CI: 1.1-1.7), not having a partner (OR 1.6, 95% CI: 1.3-1.9), low income (OR 1.8, 95% CI: 1.5-2.1), and health-limitations on activities (OR 1.3, 95% CI: 1.1-1.6). Poorer self-rated mental health (OR 2.1, 95% CI:1.8-2.5) or general health status (OR 1.5, 95% CI: 1.3-1.9) was associated with a higher prevalence of depressive symptomatology, as was poorer function with respect to different activities of daily living, and dissatisfaction with current life (OR 6.1, 95% CI: 4.4-8.4).ConclusionsDepressive symptomatology was frequent among older Vietnamese. Efforts to improve mental health in older persons in Vietnam, including prevention, early intervention and better medical care, appear warranted.     

Compensatory behaviors among racial and ethnic minority undergraduate women

ABSTRACT

Limited research has examined prevalence rates of disordered eating across racial and ethnic groups. The current study aimed to assess the prevalence of compensatory behaviors across minority undergraduate women. Self-report responses (N = 3,430) on the Eating Disorder Examination Questionnaire were analyzed from 2,094 White (55.9%), 684 Hispanic/Latina (18.3%), 508 Asian (13.6%), 235 Black (6.3%), and 65 Native American/Alaskan Native (1.7%) women attending college within the United States. Racial and ethnic differences were significant across all compensatory behaviors. Most notably, Asian and Native American women engage in compensatory behaviors comparable to or more than their White peers, and Black women consistently reported the lowest prevalence rate of any behavior. Findings were compared to the existing literature, noting general trends across studies that may help inform screening, assessment, and treatment of eating pathology as well as suggest future directions for intervention science.     

Comparing weight gain in the year prior to treatment for overweight and obese patients with and without binge eating disorder in primary care

Objective

To examine weight change trajectories among overweight and obese patients with binge eating disorder (BED) versus without (NBO) during the year prior to seeking treatment.

Methods

Participants were 97 (75 women, 22 men) overweight and obese patients recruited for the same weight-loss treatment in primary care; 26 (27%) met DSM-5 BED criteria. Participants were assessed with the Eating Disorder Examination and completed self-report questionnaires about their weight histories and the Beck Depression Inventory-II.

Results

Participants' self-reported current weight and measured current weight were significantly correlated and did not statistically differ. Reported weight changes during the year prior to seeking treatment differed significantly by group: BED patients gained an average of 18.3 lb (8.2 kg) whereas NBO patients gained an average of 1.5 lb (0.7 kg). Among BED patients, but not NBO, weight change during the prior year was positively correlated with greater eating-disorder psychopathology, binge-eating frequency, frequency of overeating at lunch and dinner, and depression scores. For the overall group, BED status and binge-eating frequency each made independent significant contributions to predicting weight change in the past year.

Conclusion

Findings suggest BED patients are gaining considerably more weight during the year prior to treatment than NBO patients. BED treatment may interrupt a steep weight gain trajectory and prevent further weight gain for BED patients suggesting need for early intervention. Primary care physicians should screen for BED when overweight and obese patients present with rapid weight gain.     

Social inequalities contribute to racial/ethnic disparities in depressive symptomology among men who have sex with men

Purpose

Racial/ethnic minorities experience disproportionate rates of depressive symptoms in the United States. The magnitude that underlying factors—such as social inequalities—contribute to these symptoms is unknown. We sought to identify exposures that explain racial/ethnic differences in clinically significant depressive symptomology among men who have sex with men (MSM).

Methods

Data from the Multicenter AIDS Cohort Study (MACS), a prospective cohort study, were used to examine clinically significant symptoms of depression (Center for Epidemiologic Studies Depression Scale score ≥ 20) among non-Latinx White, non-Latinx Black, and Latinx MSM. We included 44,823 person-visits by 1729 MSM seen in the study sites of Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles from 2000 to 2017. Regression models estimated the percentage of depressive symptom risk explained by social, treatment, and health-related variables related to race/ethnicity. Machine-learning methods were used to predict the impact of mitigating differences in determinants of depressive symptoms by race/ethnicity.

Results

At the most recent non-missing MACS visit, 16% of non-Latinx White MSM reported clinically significant depressive symptoms, compared to 22% of non-Latinx Black and 25% of Latinx men. We found that income and social-environmental stress were the largest contributors to racial/ethnic disparities in risk for depressive symptoms. Similarly, setting the prevalence of these two exposures to be equal across racial/ethnic groups was estimated to be most effective at reducing levels of clinically significant depressive symptoms.

Conclusion

Results suggested that reducing socioeconomic inequalities and stressful experiences may be effective public health targets to decrease racial/ethnic disparities in depressive symptoms among MSM.

     

PTSD and obesity in the Detroit neighborhood health study

Objective

Posttraumatic stress disorder (PTSD) has been associated with adverse health consequences, including overweight, obesity and cardiovascular disease. African Americans, particularly women, have among the highest rates of overweight and obesity in the U.S. compared to other racial groups. High rates of violence exposure in urban African Americans may lead to the development of PTSD and increase risk for overweight and obesity. The current study investigated the comorbidity of lifetime PTSD and overweight/obesity in a population-based African American, urban sample.

Method

Data were from 463 African American male and female participants of the Detroit Neighborhood Health Study. Multivariable logistic regression models estimated the impact of lifetime PTSD on risk for overweight and obesity.

Results

The prevalence of obesity was significantly higher among women (60.9%) than men (33.1%; P< .001). In sex-stratified models, after controlling for demographic variables, PTSD was associated obesity (odds ratio=4.4, 95% confidence interval: 1.3, 14.3) only among women.

Conclusions

PTSD was associated with obesity, after controlling for confounding variables, among African American women. Results underscore the contribution of PTSD to obesity among African American women and the importance of addressing the physical health correlates of women with PTSD.     

Carrying the Burdens of Poverty,Parenting, and Addiction: Depression Symptoms and Self-Silencing Among Ethnically Diverse Women

Depression among women commonly co-occurs with substance abuse. We explore the association between women’s depressive symptoms and self-silencing accounting for the effects of known childhood and adult risk indicators. Participants are 233 ethnically diverse, low-income women who abused alcohol/drugs prenatally. Depressive symptomatology was assessed using the Addiction Severity Index. Multivariate logistic regression models examined the association between self-silencing and the dependent depression variable. The full model indicated a 3% increased risk for depressive distress for each point increase in self-silencing score (OR = 1.03; P = .001). Differences in depressive symptomatology by ethnic groups were accounted for by their differences in self-silencing.