The effect of natural habituation on coagulation responses to acute mental stress and recovery in men

Blood coagulation activation might be one mechanism linking acute mental stress with coronary events.We investigated the natural habituation of coagulation responses and recovery to short-term mental stress. Three times with one-week intervals, 24 men (mean age 47 +/- 7 years) underwent the same 13-min stressor (preparation, job interview, mental arithmetic). During each visit venous blood was obtained four times (baseline, immediately post-stress, 45 min of recovery, 105 min of recovery). Eight blood coagulation parameters were measured at weeks one and three. Acute stress provoked increases in von Willebrand factor antigen, fibrinogen, clotting factor FVII activity (FVII:C), FVIII:C, FXII:C (p's < or = 0.019), and D-dimer (N.S.). All coagulation parameters experienced full recovery except FVIII:C (p = 0.022). Stress did not significantly affect activated partial thromboplastin time and prothrombin time. At all time points FVIII:C and FXII:C levels were significantly higher at week one compared to week three (p's < or = 0.041). Before catheter insertion, systolic blood pressure (p = 0.001) and heart rate (p = 0.026) were relatively higher at week one. Unlike the magnitude of systolic blood pressure response to stress (p = 0.007) and of cortisol recovery from stress (p = 0.002), the magnitude of all coagulation responses to stress and the recovery from stress were similar in week one and week three. Sympathetic activation with anticipatory stress best explained increased baseline activity in FVIII and FXII at week one. An incapacity of the coagulation system to adapt to stress repeats is perhaps a consequence of evolution, but might also contribute to increased coronary risk in some individuals, particularly in those with cardiovascular diseases.     

Effects of ethanol on cardiovascular and catecholamine responses to mental stress

The purpose of this study was to examine the effects of ethanol on heart rate, blood pressure and plasma noradrenaline and adrenaline responses to mental stress, involving reactions to anxiety and excitement produced using a cognitive task with electric shock and a competitive electronic game respectively. Twenty subjects were studied, each subject acting as his own control by participating twice, with and without prior ethanol consumption. Mental stress was associated with significant increases in all variables except plasma noradrenaline during the cognitive task. Ethanol raised baseline heart rate and plasma adrenaline, but significantly reduced the responses of these variables to the cognitive task but not to the electronic game. Systolic blood pressure responses to both experimental stressors and diastolic blood pressure responses to the electronic game were also significantly reduced after ethanol. These results may reflect a tension-reducing effect of ethanol in situations associated with anxiety, but suggest a more general effect of ethanol on blood pressure reactivity.     

Inflammatory and hemostatic responses to repeated mental stress: individual stability and habituation over time

An important assumption underlying psychobiological studies relating stress reactivity with disease risk is that individuals are characterized by stable response profiles that can be reliably assessed using acute psychophysiological stress testing. Previous research has mainly focused on the stability of cardiovascular, neuroendocrine, and cellular immune responses to repeated stressors, and less attention has been given to inflammatory and platelet responses. We therefore examined both average stability and individual test-retest stability of cardiovascular, neuroendocrine, hemostatic, inflammatory, and subjective responses to mental stress over two repeated stress sessions, four weeks apart. Ninety-one healthy, non-smoking men (mean age 33.2 years) completed a 3-min speech task followed by a 5-min mirror tracing task on two separate occasions. Blood samples were taken at baseline and 10 min after the stress tasks while cardiovascular activity, saliva samples, and subjective ratings were measured repeatedly. There was significant cardiovascular and cortisol activation to the stressors and stress-induced increases in plasma C-reactive protein, von Willebrand factor antigen, and platelet activation indexed by leukocyte-platelet aggregates. The magnitude of stress responses did not differ between sessions in any variable. Significant test-retest correlations between sessions were observed for baseline and stress values of all variables (r=0.47-0.74, p<.001), but reactivity (change scores) for C-reactive protein, von Willebrand factor, cortisol, and platelet activation were not significantly correlated. Our results demonstrate that the stress-induced responses did not habituate between sessions, though the small magnitude of acute inflammatory, cortisol, and platelet responses limits the test-retest reliability of stress reactivity assessments.     

Sex differences in vascular and endothelial responses to acute mental stress

Objective  Our objective was to assess the differences in systemic vascular and endothelial function in response to acute mental stress between men and women. The endothelium plays a pivotal role in vascular homeostasis and the development of atherosclerotic heart disease. The mechanism and presentation of cardiovascular events show a sex-based difference, although the sex difference in the vascular and endothelial response to mental stress is not known. Methods  Male (n = 34) and female (n = 53) subjects participated in a series of three different mental stress tasks during which vascular response was measured non-invasively using peripheral arterial tonometry. Endothelial function was assessed using reactive hyperemia peripheral arterial tonometry. Double product (systolic blood pressure × heart rate) was calculated. Results  Males had a greater double product response (27.2 + 3.6% increase in double product vs. 19.2 + 1.7%; P = 0.01), and a greater vascular reactivity to mental stress. Females demonstrated a reduced response to reactive hyperemia (−0.47 vs. 13.74%; P = 0.01). Furthermore, a subgroup of females who showed the least vaso-reactivity to mental stress showed the greatest decline in endothelial function (−10.5 + 4% vs. 17.4 + 6.3%; P < 0.001). Interpretation  This study demonstrates sex-based differences in the vascular and endothelial responses to mental stress. The mental stress-induced reduction in endothelial function and increased double product seen in the females might manifest clinically as contributing to the pathophysiology of mental stress-mediated cardiovascular events in female patients and provide further information regarding the potential mechanism for sex differences in cardiac events.     

Relationship between hemoconcentration and blood coagulation responses to acute mental stress

BACKGROUND: Acute mental stress elicits reliable changes in blood coagulation factors. We studied whether stress-related changes in coagulation measures are associated with concomitant hemoconcentration. METHODS: Twenty-two men (mean age 47+/-8 years) underwent the Trier Social Stress Test (TSST) combining 13 min of task preparation, job interview, and mental arithmetic. Venous blood was obtained immediately before the preparation phase and immediately after stress to determine seven measures of coagulation and three measures of hemoconcentration. RESULTS: Clotting factor VII activity (FVII:C; 99.5+/-21.9 vs. 104.5+/-23.7 IU; p=0.016), FVIII:C (96.3+/-18.1 vs. 105.1+/-25.7 IU; p=0.008), FXII:C (95.8+/-26.7 vs. 102.6+/-26.4 IU; p=0.002), and von Willebrand factor antigen (vWF; 103.3+/-36.3 vs. 110.1+/-43.3 IU; p=0.009) all increased from baseline to poststress, with a similar statistical trend observed for d-dimer (177.6+/-85.5 vs. 180.5+/-83.9 ng/ml; p=0.058). The absolute increases in fibrinogen and in soluble tissue factor were not significant. Hematocrit (40.8+/-2.5 vs. 42.7+/-2.8; p<0.001) and hemoglobin (14.5+/-0.81 vs. 15.2+/-0.97; p<0.001) increased, and plasma volume (59.2%+/-2.5 vs. 54.6+/-4.2%; p<0.001) decreased from baseline to poststress. Unlike with heart rate (HR) and blood pressure (BP) reactivity, there emerged no significant relationship between change scores in any hemoconcentration and coagulation measure (all r values<0.4, all p values>0.05). CONCLUSION: We corroborated significant changes in coagulation measures in response to acute mental stress compatible, with the notion that stress may elicit a hypercoagulable state. However, stress hemoconcentration appears not to explain a substantial proportion in coagulation changes elicited by acute mental stress.     

Longitudinal changes of anxiety and depressive symptoms during the COVID-19 pandemic in Germany: The role of pre-existing anxiety,depressive, and other mental disorders

Especially individuals with mental disorders might experience an escalation of psychopathological symptoms during the COVID-19 pandemic. Therefore, we investigated the role of anxiety, depressive, and other mental disorders for levels and longitudinal changes of COVID-19-related fear, anxiety and depressive symptoms during the first months of the COVID-19 pandemic in Germany. In a longitudinal observational design with four assessment waves from March, 27th until June, 15th 2020, a total of 6,551 adults from Germany was assessed. 4,175 individuals participated in one, 1,070 in two, 803 in three, and 503 in all four waves of data collection. Multilevel analyses revealed that across all assessment waves, COVID-19-related fear, anxiety, and depressive symptoms were significantly higher in individuals with vs. without anxiety, depressive, and other mental disorders. All symptoms decreased on average over time, and this decrease was significantly stronger in individuals with vs. without anxiety disorders, and particularly driven by individuals with generalized anxiety disorder. Our findings suggest that individuals with mental disorders, especially anxiety disorders – and in particular those with a generalized anxiety disorder – seem to be vulnerable to experience psychological strain in the context of the pandemic, might likely overestimate potential threat, and should be targeted by preventive and therapeutic interventions.     

Subthreshold depressive and anxiety disorders in the elderly.

The aims of the present study were to compare the current and lifetime prevalences for major and subthreshold affective disorders in elderly subjects in the general population, to assess the influence of demographic variables on prevalence rates, and to examine co-morbidity between these disorders. Major and subthreshold disorders were diagnosed in 286 subjects (aged >/= 60 years). Four-point-nine percent of the subjects had a lifetime diagnosis of major depression, 31.8% either minor or recurrent brief depression, 6.6% a major anxiety disorder, and 18.5% a subthreshold anxiety disorder. The risk for current and lifetime subthreshold anxiety was higher in females than in males, the lifetime prevalence for subthreshold anxiety disorders was increased in elderly subjects and subjects with low professional levels. Increased co-morbidity between major and subthreshold depressive and anxiety disorders could not be observed. In the elderly, subthreshold depressive and anxiety disorders are frequent, more so than major affective disorders. The presence of subthreshold anxiety disorders, but not subthreshold depression, is influenced by age, gender, and previous professional level. Further research focusing on detection, evaluation of risk factors and the relevance for the quality of life in the elderly general population is needed.     

Obesity and depressive symptoms in Chinese elderly

OBJECTIVES: The main objective was to examine the association between obesity and depressive symptoms among Chinese elderly in Hong Kong. METHODS: Cross-sectional data on depressive symptoms and body mass index from 56 167 clients aged 65 or over who enrolled as members of Elderly Health Centres from July 1998 to December 2000 were analysed using multiple logistic regression with adjustment of potential confounders. RESULTS: Among 18 750 men and 37 417 women, the prevalence [95% confidence interval (CI)] of depressive symptoms (based on the Geriatric Depression Scale) was 4.9% (4.6-5.2%) and 7.9% (7.6-8.1%) respectively (p < 0.001). The prevalence of obesity (by World Health Organisation Asian standard: body mass index > or =25.0) in women was significantly higher than that of men (42.1% (41.6-42.7%) vs 36.6% (35.9-37.3%), p < 0.001). Obese men and women were about 20% less likely to suffer from depressive symptoms compared with those with normal weight after adjustment for confounders, with odds ratios (95% CI) of 0.82 (0.69-0.97) and 0.78 (0.71-0.86) respectively. Negative linear trends were observed between depressive symptoms and BMI categories in both sexes, and women showed a greater slope and stronger statistical significance than men. CONCLUSIONS: Both obese elderly men and women in Hong Kong were less likely to suffer from depressive symptoms than those of normal weight. The results support the 'jolly fat' hypothesis previously restricted to men, and extend the hypothesis to female elderly. Chinese traditional culture and positive values towards obesity may be protective against depressive symptoms.     

Association of vital exhaustion and depressive symptoms with changes in fibrin D-dimer to acute psychosocial stress

Objective

Vital exhaustion and depression are psychosocial risk factors of coronary artery disease. A hypercoagulable state in response to acute psychosocial stress contributes to atherothrombotic events. We aimed to investigate the hypothesis that vital exhaustion and depression correlate with stress-induced changes in the hypercoagulability marker D-dimer.

Methods

Thirty-eight healthy and nonsmoking school teachers (mean age 50±8 years, 55% women) completed the nine-item Maastricht Vital Exhaustion Questionnaire and the seven-item depression subscale of the Hospital Anxiety and Depression Scale. Within 1 week, subjects twice underwent the Trier Social Stress Test (i.e., preparation phase, mock job interview, and mental arithmetic that totaled 13 min). Plasma D-dimer levels were determined at five time points during the protocol.

Results

Vital exhaustion (P=.022; η²=.080) and depressive symptoms (P=.011; η²=.090) were associated with stress-induced changes in D-dimer levels over time controlling for sex and age. Elevated levels of vital exhaustion (r=−.46, P=.005) and of depression (r=−.51, P=.002) correlated with reduced D-dimer increase from pre-stress to immediately post-stress. Also, elevated vital exhaustion (r=.34, P=.044) and depression (r=.41, P=.013) were associated with increase (i.e., attenuated recovery) of D-dimer levels between 20 and 45 min post-stress. Controlling for stress hormone and blood pressure reactivity did not substantially alter these results.

Conclusion

The findings suggest an attenuated immediate D-dimer stress response and delayed recovery of D-dimer levels post-stress with elevated vital exhaustion and depressive symptoms. In particular, the prolonged hypercoagulability after stress cessation might contribute to the atherothrombotic risk previously observed with vital exhaustion and depression, even at subclinical levels.     

Effects of IL1B single nucleotide polymorphisms on depressive and anxiety symptoms are determined by severity and type of life stress

Interleukin-1β is one of the main mediators in the cross-talk between the immune system and the central nervous system. Higher interleukin-1β levels are found in mood spectrum disorders, and the stress-induced expression rate of the interleukin-1β gene (IL1B) is altered by polymorphisms in the region.Therefore we examined the effects of rs16944 and rs1143643 single nucleotide polymorphisms (SNPs) within the IL1B gene on depressive and anxiety symptoms, as measured by the Brief Symptom Inventory, in a Hungarian population sample of 1053 persons. Distal and proximal environmental stress factors were also included in our analysis, namely childhood adversity and recent negative life-events.We found that rs16944 minor (A) allele specifically interacted with childhood adversity increasing depressive and anxiety symptoms, while rs1143643’s minor (A) allele showed protective effect against depressive symptoms after recent life stress. The genetic main effects of the two SNPs were not significant in the main analysis, but the interaction effects remained significant after correction for multiple testing. In addition, the effect of rs16944 A allele was reversed in a subsample with low-exposure to life stress, suggesting a protective effect against depressive symptoms, in the post hoc analysis.In summary, both of the two IL1B SNPs showed specific environmental stressor-dependent effects on mood disorder symptoms. We also demonstrated that the presence of exposure to childhood adversity changed the direction of the rs16944 effect on depression phenotype. Therefore our results suggest that it is advisable to include environmental factors in genetic association studies when examining the effect of the IL1B gene.     

独居老人抑郁症状和抑郁症的调查

目的调查城市独居老人的抑郁症状和抑郁症情况。方法抽查上海市虹口区一个街道、两个居委的12岁以上常住人口共5512名,收集社会人口学资料并应用流调用抑郁量表（CES—D）,对于CES—D评分在16分及以上者使用定式临床检查（SCID）进行诊断,分析60岁以上独居者的人口学、抑郁症状及抑郁症情况。结果60岁以上独居老人占调查对象的1．19％,占60岁以上老年人口的4．20％,独居老人的人口学资料和一般情况与非独居老人差异没有统计学意义。60岁以上老人的抑郁症状检出率为8．26％（118／1428）,高于60岁以下者的抑郁症状检出率（4．2％）;60岁以上老人中抑郁症状检出率独居者高于非独居者（20．00％vs7．74％,χ^2=2．57,P〈0．01）,抑郁症检出率独居者高于非独居者（5．0％vs0．58％,χ^2=14．66,P〈0．01）。结论城市人口老龄化程度高,老年人尤其独居者的抑郁症状及抑郁症检出率较高,应该重视独居老年人心理健康。     

焦虑障碍、抑郁障碍患者的睡眠质量及与焦虑、抑郁症状的相关性

目的 探讨焦虑障碍、抑郁障碍患者的睡眠质量及与焦虑、抑郁症状的相关性.方法 选取2020年8月至2021年8月在深圳市康宁医院焦虑障碍科住院治疗的70例广泛性焦虑障碍、惊恐障碍、抑郁障碍患者,其中抑郁障碍组33例,焦虑障碍组37例.比较两组的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、匹兹堡睡眠质量指数...     

Immune activation in the early puerperium is related to postpartum anxiety and depressive symptoms

The pathophysiology of the postpartum blues, common transient mood disorders in the first week postpartum, has remained elusive. Recently, however, it has been shown that depression and anxiety disorders are accompanied by activation of the inflammatory response system (IRS). This study was developed to determine whether the postnatal blues is associated with IRS activation. Serum concentrations of interleukin-6 (IL-6), IL-6 receptor (IL-6R), gp130 (the IL-6 signaling protein), IL-1R antagonist (IL-1RA) and leukemia inhibitory factor receptor (LIFR) were assayed in 22 nonpregnant women and in 91 pregnant women before delivery and 1 and 3 days after delivery. On each occasion the parturient women completed the State version of the Spielberger State-Trait-Anxiety-Inventory (STAI) and the Zung Depression Rating Scale (ZDS). Serum IL-6, IL-1RA and LIFR were significantly higher in pregnant women at the end of term than in nonpregnant women.     

综合医院门诊患者焦虑抑郁症状的筛查研究

目的 了解综合性医疗机构门诊就诊患者的焦虑和抑郁症状。方法 采用非概率抽样方 法对中国12 个城市的19 家三级甲等医院门诊患者进行调查研究。研究时间为2017 年3— 8 月。门诊患 者使用手机接入医院免费的无线网络时收到推送的调查问卷,匿名填写患者健康问卷-9（PHQ-9）和广 泛性焦虑障碍问卷（GAD-7）。结果 32 631 例门诊患者完成PHQ-9 和GAD-7 填写。8 945 例抑郁症状筛 查阳性,阳性率为27.41%,其中70.30% 的患者同时伴有中度以上的焦虑症状。焦虑症状筛查阳性率为 38.29%,6 285 例患者抑郁症状和焦虑症状均筛查阳性,共病率达19.26%,女性筛查阳性率均略高于男 性。结论 三级甲等综合医院门诊患者抑郁、焦虑症状筛查阳性率较高,且共病情况较严重。     

Impact of depressive symptoms on the treatment of generalized social anxiety disorder

Patients with depression are often excluded from studies on the treatment of social anxiety disorder (SAD), leaving gaps in our knowledge about the impact of depressive affect on treatment for SAD. Patients participated in a randomized, placebo-controlled study of treatment for SAD. As in previous studies, patients were excluded from the study if they met criteria for major depressive disorder in the past 6 months. This exclusion notwithstanding, patients who enrolled in the study exhibited a range of depressive symptoms, permitting an examination of the impact of depressive symptoms on treatment outcome for SAD. Assessment measures included the Clinical Global Impression Scale, Hamilton Rating Scale for Depression, Brief Social Phobia Scale, and Beck Depression Inventory. Higher levels of depressive symptoms were related to more severe social anxiety overall, and to less change in social anxiety symptoms over the course of the study. Patients who were deemed nonresponders to treatment had higher levels of depressive symptoms at pretreatment than those who responded. In addition, patients who dropped out of the study had higher levels of depressive symptoms at pretreatment than those who completed the study. These results suggest that modifications should be made to existing treatments to improve outcomes and decrease attrition in the substantial proportion of patients with SAD who also evidence depressive symptoms. Such modifications are likely to be more important when treating patients with SAD and comorbid major depressive disorder.