The efficacy of religious service attendance in reducing depressive symptoms

Purpose

To examine whether religiosity may help people ward off depression, we investigated the association between religious service attendance and depressive symptom scores in a community-based 30-year follow-up longitudinal study.

Methods

This study used data on 754 subjects followed over 30 years and evaluated at four time points. Linear mixed effects models were used to assess the association between religious service attendance and depressive symptoms development; frequency of attendance and age also were used as predictors. Demographic factors, life-time trauma, family socioeconomic status, and recent negative events were considered as control variables.

Results

Depressive symptom scores were reduced by an average of 0.518 units (95 % CI from ?0.855 to ?0.180, p < 0.005) each year in subjects who attended religious services as compared with subjects who did not. The more frequent the religious service attendance, the stronger the influence on depressive symptoms when compared with non-attendance. Yearly, monthly, and weekly religious service attendance reduced depression scores by 0.474 (95 % CI from ?0.841 to ?0.106, p < 0.01), 0.495 (95 % CI from ?0.933 to ?0.057, p < 0.05) and 0.634 (95 % CI from ?1.056 to ?0.212, p < 0.005) units on average, respectively, when compared with non-attendance after controlling for other covariates.

Conclusion

Religious service attendance may reduce depressive symptoms significantly, with more frequent attendance having an increasingly greater impact on symptom reduction in this 30-year community-based longitudinal study.     

The Role of Spirituality in the Relationship Between Religiosity and Depression in Prostate Cancer Patients

Purpose

This study aims to develop a theoretical framework of the relationship among religiosity, spirituality, and depression, potentially explaining the often mixed and inconsistent associations between religiosity and depression.

Methods

In this cross-sectional study, 367 men (average age of 66?±?9 years) with prostate cancer completed measures of religiosity (extrinsic/intrinsic), spirituality (Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale), quality of life (FACT-G), and depression (Hospital Anxiety and Depression Scale).

Results

There was a small relationship between intrinsic religiosity and depression (r?=??0.23, p?<?0.05) but a strong association between spirituality and depression (r?=??0.58, p?<?0.01). Using a mediation model, the meaning/peace subscale of the spirituality measure mediated the relationship between intrinsic religiosity and depression. This model controlled for age, marital status, stage of disease, time since diagnosis, hormone therapy, quality of life, and anxiety.

Conclusions

When examining religiosity and spirituality, the main component that may help reduce depression is a sense of meaning and peace. These results highlight the potential importance of developing a patient’s sense of meaning through activities/interventions (not exclusive to religious involvement) to achieve this goal.     

Relationship Between Alcohol Use,Spirituality, and Coping

Authors investigated a relationship between the frequency of alcohol consumption, spirituality, and coping with everyday life events in a cross-sectional, community-based sample of 320 adults in Ukraine, the country with one of the highest alcohol consumption levels in the world. Face-to-face interviews with participants took place in rural and urban locations across Eastern, Southern, and Central Ukraine. Results of the ordinary least-squares regression suggest that a higher frequency of alcohol consumption was related with the lower use of positive reappraisal (β = ?.27, p < .001), higher use of escape-avoidance (β = .23, p < .01) and confrontive (β = .15, p < .05) coping strategies, lower spirituality (β = ?.20, p < .001), and younger age (β = ?.11, p < .05). On the whole, current findings suggest that specific coping behaviors, younger age, and lower spirituality are involved in higher frequency of alcohol consumption among Ukrainian adults.     

Effects of a Multiple Health Behavior Change Intervention for Colorectal Cancer Survivors on Psychosocial Outcomes and Quality of Life: a Randomized Controlled Trial

Background

Multiple health behavior change can ameliorate adverse effects of cancer.

Purpose

The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life.

Methods

A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months.

Results

Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p?p?=?0.033), spirituality at 6 months (1.8, p?=?0.011), acceptance at 6 months (0.2, p?=?0.005), and quality of life at 6 (0.8, p?=?0.049) and 12 months (0.9, p?=?0.037).

Conclusions

The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (Trial Registration Number: ACTRN12608000399392).     

The role of stress sensitization in progression of posttraumatic distress following deployment

Purpose

Military personnel exposed to combat are at risk for experiencing post-traumatic distress that can progress over time following deployment. We hypothesized that progression of post-traumatic distress may be related to enhanced susceptibility to post-deployment stressors. This study aimed at examining the concept of stress sensitization prospectively in a sample of Dutch military personnel deployed in support of the conflicts in Afghanistan.

Method

In a cohort of soldiers (N = 814), symptoms of post-traumatic stress disorder (PTSD) were assessed before deployment as well as 2, 7, 14, and 26 months (N = 433; 53 %) after their return. Data were analyzed using latent growth modeling. Using multiple group analysis, we examined whether high combat stress exposure during deployment moderated the relation between post-deployment stressors and linear change in post-traumatic distress after deployment.

Results

A higher baseline level of post-traumatic distress was associated with more early life stressors (standardized regression coefficient = 0.30, p < 0.001). In addition, a stronger increase in posttraumatic distress during deployment was associated with more deployment stressors (standardized coefficient = 0.21, p < 0.001). A steeper linear increase in posttraumatic distress post-deployment (from 2 to 26 months) was predicted by more post-deployment stressors (standardized coefficient = 0.29, p < 0.001) in high combat stress exposed soldiers, but not in a less combat stress exposed group. The group difference in the predictive effect of post-deployment stressors on progression of post-traumatic distress was significant (χ²(1) = 7.85, p = 0.005).

Conclusions

Progression of post-traumatic distress following combat exposure may be related to sensitization to the effects of post-deployment stressors during the first year following return from deployment.     

Diet and Exercise Intervention Adherence and Health-Related Outcomes among Older Long-Term Breast,Prostate, and Colorectal Cancer Survivors

Background

Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence.

Purpose

We examined associations between adherence to components of a diet–exercise intervention and survivors’ physical and mental health.

Methods

A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention.

Results

Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β?=?0.11, p?p?p?p?p?Conclusions Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).     

Outcomes from a Diabetes Self-management Intervention for Native Hawaiians and Pacific People: Partners in Care

Background

Culturally adapted interventions are needed to reduce diabetes-related morbidity and mortality among Native Hawaiian and Pacific People.

Purpose

The purpose of this study is to pilot test the effectiveness of a culturally adapted diabetes self-management intervention.

Methods

Participants were randomly assigned in an unbalanced design to the Partners in Care intervention (n?=?48) or wait list control group (n?=?34). Assessments of hemoglobin A1c, understanding of diabetes self-management, performance of self-care activities, and diabetes-related distress were measured at baseline and 3 months (post intervention). Analysis of covariance was used to test between-group differences. The community steering committee and focus group data informed the cultural adaptation of the intervention.

Results

There were significant baseline adjusted differences at 3 months between the Partners in Care and wait list control group in intent-to-treat (p?<?0.001) and complete case analyses (p?<?0.0001) for A1c, understanding (p?<?0.0001), and performing diabetes self-management (p?<?0.0001).

Conclusions

A culturally adapted diabetes self-management intervention of short duration was an effective approach to improving glycemic control among Native Hawaiian and Pacific Islanders.     

Multidimensional health locus of control and depressive symptoms in the multi-ethnic population of the Netherlands

Purpose

Ethnic inequalities in health in Western societies are well-documented but poorly understood. We examined associations between health locus of control (HLC) and depressive symptoms among native and non-native Dutch people in the Netherlands.

Methods

We used hierarchical multiple linear regression analyses on a representative sample of the multi-ethnic population of Amsterdam and The Hague (n = 10,302). HLC was measured with the multidimensional health locus of control scale. Depressive symptoms were measured with the Kessler Psychological Distress scale.

Results

Multivariate analyses showed that HLC contributes to ethnic differences in the prevalence of depressive symptoms. Respondents who scored high on external locus of control (PHLC) were more likely to have depressive symptoms than those with a low score on PHLC (β = 0.133, p < 0.001). Conversely, respondents scoring high on internal locus of control (IHLC) were less likely to have depressive symptoms compared to those scoring low on IHLC (β = ?0.134, p < 0.001). The associations were most pronounced among Turkish-Dutch and Moroccan-Dutch respondents.

Conclusion

Our findings suggest that HLC contributes to ethnic inequalities in depressive symptoms, especially among Turkish and Moroccan ethnic groups. Professionals (e.g. clinicians and policy makers) need to take HLC into account when assessing and treating depression among ethnic minority groups, particularly in Turkish and Moroccan populations. Future research should look further into the associations within these groups.     

Quantitative indices of baroreflex-sympathoneural function: application to patients with chronic autonomic failure

Purpose

Chronic autonomic failure syndromes such as Parkinson disease with orthostatic hypotension (PD + OH), multiple system atrophy (MSA), and pure autonomic failure (PAF) typically feature arterial baroreflex failure. Identifying baroreflex-sympathoneural failure from hemodynamic responses to the maneuver usually has been qualitative. We report quantitative methods for evaluating baroreflex-sympathoneural function, based on beat-to-beat systolic blood pressure (BPs) responses to the Valsalva maneuver.

Method

Using the trapezoid rule, we calculated the area under the curve (baroreflex area, BRA) between baseline systolic blood pressure (BPs) and the BPs for each beat in Phase II (BRA-II) and Phase IV (BRA-IV) in 136 autonomic failure patients and 171 controls. The sum of the areas was defined as total BRA (BRA-T). We compared individual values by the BRA approach with those by other measures.

Results

Mean values for log BRA-II, BRA-IV, and BRA-T were higher in PD + OH, PAF, and MSA than in controls (p < 0.001 each). The log of BRA-T correlated negatively with the fractional orthostatic change in total peripheral resistance (r = ?0.41, p < 0.001), fractional orthostatic change in plasma norepinephrine (r = ?0.27, p < 0.001), orthostatic change in BPs (r = ?0.62, p < 0.001), fall in BPs in Phase II of the Valsalva (r = 0.58, p < 0.001), and log of baroreflex-cardiovagal slope (r = ?0.40, p < 0.001). Areas under receiver operating characteristic curves were 0.85 for BRA-T and 0.89 for BRA-IV (p < 0.001).

Conclusion

The BRA approach provides quantitative measures of baroreflex-sympathoneural function. Chronic autonomic failure syndromes entail deficiencies of both the cardiovagal and sympathoneural limbs of the arterial baroreflex.     

Heart rate variability associates with asymptomatic coronary atherosclerosis

Purpose

Heart rate variability (HRV) becomes impaired in symptomatic coronary artery disease (CAD), particularly, after myocardial infarction. The mechanism how CAD results in impairment of cardiac autonomic regulation is not known. Whether it results rather from coronary atherosclerosis itself than myocardial ischemia and myocardial injury has remained elusive.

Methods

Quantitative coronary angiography was performed in 30 subjects without history of myocardial ischemia, but with high familial risk for CAD. HRV was measured from 24-h ambulatory ECG recordings in time and frequency domain and also non-linear HRV variables SD1 and SD2 in Poincare plot were calculated. Myocardial ischemia was excluded by Tc-99m sestamibi scintigraphy at rest and during exercise.

Results

Coronary angiography revealed mean diameter stenosis of 32 ± 19 % in left anterior descending coronary artery, 26 ± 16 % in left circumflex coronary artery and 25 ± 20 % in right coronary artery. An inverse correlation was found between pNN50 and global severity of coronary artery diameter stenosis (r = ?0.415, p < 0.05). Correspondingly, power of HF spectral component correlated negatively with global extent of coronary atherosclerosis (r = ?0.366, p < 0.05). In Poincare plot, SD1/SD2 ratio correlated with global extent (r = ?0.394, p < 0.05) and global burden (r = ?0.388, p < 0.05) of coronary arteries.

Conclusions

The severity and extent of coronary atherosclerosis were related to a shift of cardiac autonomic regulation towards sympathetic predominance in asymptomatic subjects without evidence of myocardial ischemia.     

Mental health of internally displaced preschool children: a cross-sectional study conducted in Bogotá, Colombia

Purpose

Ongoing armed conflicts, like the one in Colombia, have forcibly displaced millions of people including many young children. This study aimed to assess the mental health of internally displaced preschoolers in Bogotá Colombia and to identify correlates of mental health in these children.

Methods

Cross-sectional study conducted among 279 children attending four kindergartens in a deprived neighbourhood in Bogotá. Child mental health was assessed with the Child Behaviour Checklist (CBCL) 1.5–5 years, a parent-report. Univariate analyses and multivariate logistic regressions were performed to assess the association between displacement and child mental health and to identify correlates of mental health in displaced children.

Results

Displaced children (n = 90) more often met borderline cut-off scores for the CBCL scales than non-displaced children (n = 189) (e.g. total problems 46.7 vs. 22.8 %; p < 0.001). The association between displacement and presence of CBCL total problems remained after adjustment for socio-demographic factors (Adjusted OR 3.3, 95 % CI 1.5; 6.9). Caretaker’s mental health partly explained the association. In displaced children, caretaker’s mental health (p < 0.01) and family functioning (p < 0.01) were independently associated with child mental health. Exposure to traumatic events and social support was also associated with child mental health; however, associations were not independent.

Conclusion

In this deprived neighbourhood in Bogotá, preschool children registered as internally displaced presented worse mental health than non-displaced peers. Family functioning and caretaker’s mental health were strongly and independently associated with displaced children’s mental health.     

Displacement, county social cohesion, and depression after a large-scale traumatic event

Background

Depression is a common and potentially debilitating consequence of traumatic events. Mass traumatic events cause wide-ranging disruptions to community characteristics, influencing the population risk of depression. In the aftermath of such events, population displacement is common. Stressors associated with displacement may increase risk of depression directly. Indirectly, persons who are displaced may experience erosion in social cohesion, further exacerbating their risk for depression.

Methods

Using data from a population-based cross-sectional survey of adults living in the 23 southernmost counties of Mississippi (N = 708), we modeled the independent and joint relations of displacement and county-level social cohesion with depression 18–24 months after Hurricane Katrina.

Results

After adjustment for individual- and county-level socio-demographic characteristics and county-level hurricane exposure, joint exposure to both displacement and low social cohesion was associated with substantially higher log-odds of depression (b = 1.34 [0.86–1.83]). Associations were much weaker for exposure only to low social cohesion (b = 0.28 [?0.35–0.90]) or only to displacement (b = 0.04 [?0.80–0.88]). The associations were robust to additional adjustment for individually perceived social cohesion and social support.

Conclusion

Addressing the multiple, simultaneous disruptions that are a hallmark of mass traumatic events is important to identify vulnerable populations and understand the psychological ramifications of these events.     

High Throughput Phenotyping for Dimensional Psychopathology in Electronic Health Records

Background

Relying on diagnostic categories of neuropsychiatric illness obscures the complexity of these disorders. Capturing multiple dimensional measures of neuropathology could facilitate the clinical and neurobiological investigation of cognitive and behavioral phenotypes.

Employment Status and Mental Health: Mediating Roles of Social Support and Coping Strategies

Although it has been established that unemployment and underemployment increase distress and depression, the psychological mechanisms involved are not very clear. This study examines the roles of social support and coping strategies as mediators of the association between employment status and mental health, as well as gender and age differences as moderators. Residents from the epidemiological catchment area of south-west Montreal responded to a randomized household survey for adults in 2009. A follow-up was conducted based on participants’ employment status 2 and 4 years later. ANOVAs tests were computed with SPSS to evaluate group differences, and structural equation modeling was performed with AMOS to test mediation effects. At baseline, among participants between 18 and 64 years old (n = 2325), 14.3 % were unemployed/not studying, 14.4 % worked part-time, and 56.5 % worked full-time. Employment status was found to significantly affect depression among those under 45 years old (chi-square = 23.4, p < 0.001). Results showed a negative association of full-time employment with depression, which was fully mediated by social support, less coping with drugs/medication, and less distress. A negative association with full-time employment was also noted with distress, which was partially mediated by increased social support, coping with alcohol, and less coping with drugs/medication. The total indirect effect suggests that full-time employees generally have more resources and do not tend to use avoidance strategies like coping with drugs/medication, resulting in less distress (β = ?0.05; p < 0.01) and depression (β = ?0.028; p < 0.01). Results suggest that optimal impact on mental health could be attained when increasing employment, namely full-time employment, in communities.     

Cessation of Diastolic Cerebral Blood Flow Velocity: The Role of Critical Closing Pressure

Background

Reducing cerebral perfusion pressure (CPP) below the lower limit of autoregulation (LLA) causes cerebral blood flow (CBF) to become pressure passive. Further reductions in CPP can cause cessation of CBF during diastole. We hypothesized that zero diastolic flow velocity (FV) occurs when diastolic blood pressure becomes less than the critical closing pressure (CrCP).

Methods

We retrospectively analyzed studies of 34 rabbits with CPP below the LLA, induced with pharmacologic sympathectomy (N = 23) or cerebrospinal fluid infusion (N = 11). Basilar artery blood FV and cortical Laser Doppler Flow (LDF) were monitored. CrCP was trended using a model of cerebrovascular impedance. The diastolic closing margin (DCM) was monitored as the difference between diastolic blood pressure and CrCP. LDF was recorded for DCM values greater than and less than zero.

Results

Arterial hypotension caused a reduction of CrCP (p < 0.001), consistent with decreased wall tension (p < 0.001) and a drop in intracranial pressure (ICP; p = 0.004). Cerebrospinal infusion caused an increase of CrCP (p = 0.002) accounted for by increasing ICP (p < 0.001). The DCM was compromised by either arterial hypotension or intracranial hypertension (p < 0.001 for both). When the DCM reached zero, diastolic FV ceased for a short period during each heart cycle (R = 0.426, p < 0.001). CBF pressure passivity accelerated when DCM decreased below zero (from 1.51 ± 0.51 to 2.17 ± 1.17 % ΔLDF/ΔmmHg; mean ± SD; p = 0.010).

Conclusions

The disappearance of diastolic CBF below LLA can be explained by DCM reaching zero or negative values. Below this point the decrease in CBF accelerates with further decrements of CPP.     

An Electronic Diary Study of the Effects of Patient Avoidance and Partner Social Constraints on Patient Momentary Affect in Metastatic Breast Cancer

Background

Metastatic breast cancer patients experience significance distress. Although talking with close others about cancer-related concerns may help to alleviate distress, patients often avoid such discussions, and their partners can engage in social constraints that may limit subsequent patient disclosures and exacerbate distress.

Purpose

We examined how partner constraints unfold, how they influence patient affect, and whether they exacerbate patient avoidance of cancer-related disclosures.

Methods

Fifty-four patients and 48 of their partners completed electronic diary assessments for 14 days.

Results

Partners’ social constraints carried over from one day to the next, but patients’ avoidance of discussing cancer-related concerns did not. When partners engaged in more social constraints one day, patients reported greater negative affect the following day (p?<?0.05).

Conclusion

Findings suggest a temporal link between partner constraints and patient momentary affect. Helping partners to become aware of their constraining behaviors and teaching them skills to overcome this may facilitate patient adjustment to metastatic breast cancer.     

Social inequalities in depression and suicidal ideation among older primary care patients

Purpose

Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.

Methods

Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.

Results

Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67–2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34–3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38–3.98).

Conclusions

There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.     

Effects of temporal lobectomy on consciousness-impairing and consciousness-sparing seizures in children

Purpose

Most children with medically refractory temporal lobe epilepsy (TLE) become seizure free after temporal lobectomy, but some individuals continue to seize. As studies of temporal lobectomy typically focus on seizure freedom, the effect of surgery on seizure type and frequency among children with persistent seizures is poorly understood. Seizures which impair consciousness are associated with increased morbidity compared to consciousness-sparing seizures.

Methods

A retrospective cohort study was performed to evaluate the effects of temporal lobectomy on seizure type and frequency in children with intractable TLE.

Results

Among 58 pediatric TLE patients with a mean (±SEM) age of 14.0?±?0.7 years who received temporal lobectomy, 46 (79.3 %) individuals achieved an Engel class I seizure outcome, including 38 (65.5 %) children who became completely seizure free (Engel IA). Mean follow-up was 2.7?±?0.4 years. While the number of patients experiencing simple partial seizures (SPSs) (consciousness sparing) decreased by only 23 % after surgery, the number of children having complex partial seizures and generalized tonic–clonic seizures (consciousness impairing) diminished by 87 and 83 %, respectively (p?<?0.01). SPS was the predominant seizure type in only 11.3 % of patients before resection, but in 42.1 % of patients with postoperative seizures (p?<?0.01). Children with postoperative seizures experienced a 70 % reduction in overall seizure frequency compared to baseline (p?<?0.05), having consciousness-impairing seizures 94 % less frequently (p?<?0.05), but having consciousness-sparing seizures 35 % more frequently (p?=?0.73).

Conclusions

Seizure type and frequency are important considerations in the medical and surgical treatment of children with epilepsy, although complete seizure freedom remains the ultimate goal.     

The influence of different types of war experiences on depression and anxiety in a Ugandan cohort of war-affected youth: the WAYS study

Background

War experiences (WE) are frequently associated with mental health problems. Whether different types of WE vary in predicting which problem, or how severe, in former child soldiers (FCS) remains unknown.

Methods

Using data from the first wave of an on-going longitudinal cohort study (the WAYS study), we investigated relations between types of WE and symptoms of depression/anxiety among FCS in Northern Uganda (N = 539, baseline age = 22.39; SD = 2.03, range 18–25). Using robust Maximum Likelihood estimation in SEM, regression analyses were performed to relate binary indicators of types of WE to a single latent factor capturing symptoms of depression/anxiety.

Results

SEM results showed that “direct personal harm”, “witnessing violence”, “deaths”, “threat to loved ones”, “involvement in hostilities”, and “sexual abuse” indicators were related to reported symptoms of depression/anxiety irrespective of gender and age. Multivariable models revealed independent associations of “witnessing violence” (β = 0.29, SE = 0.09, p < 0.001) and “deaths” (β = 0.14, SE = 0.05, p < 0.001) with symptoms of depression/anxiety in both sexes. “Sexual abuse” (β = 0.32, SE = 0.16, p < 0.001) independently predicted symptoms of depression/anxiety for female but not male youths whilst “threat to loved ones” (β = 0.13, SE = 0.07, p < 0.05) independently predicted symptoms of depression/anxiety in male but not female youths.

Conclusions

Dimensions of WE predicted symptoms of depression/anxiety differently, but it is hard to establish their causal status. Our findings suggest that it might be fruitful to consider such exposure variations of WE when designing interventions to mitigate the symptoms of depression/anxiety on male and female FCS.