Expressive writing intervention for adolescents' somatic symptoms and mood.

The effects of a widely used expressive writing intervention on adolescents' somatic symptoms, distress, and positive psychological functioning were evaluated. Eighth-grade (n=106) students were randomly assigned to write about either an emotional or a neutral topic for 3 consecutive days. Students completed measures of somatic symptoms, medical visits, distress, and positive functioning at baseline, postintervention, and 2 and 6 weeks later. Somatic symptoms and medical visits were unchanged as a result of the intervention. However, significant Time Condition effects indicated that optimism scores increased, negative-affect scores decreased, and positive-affect words in student essays increased in the experimental condition. Expressive writing shows promise as a cost-efficient intervention to address the emotional concerns of young adolescents; further work with clinical populations may lead to even more robust results.     

Expressive writing interventions in cancer patients: a systematic review

Decades of research have suggested that expressive writing produces physical and psychological benefits in controlled laboratory experiments among healthy college students. This work has been extended to clinical and medical populations, including cancer patients. Although expressive writing could be a promising and inexpensive intervention for this population, the effects have not been systematically examined in oncology samples. A systematic review using PRISMA guidelines was conducted for experimental trials of cancer patients who participated in an expressive writing intervention. PsycINFO and PubMed/Medline were searched for peer-reviewed studies. Thirteen articles met the inclusion/exclusion criteria. Although the majority of the intervention effects were null, there were several main effects for expressive writing on sleep, pain, and general physical and psychological symptoms. Several moderators were identified, suggesting that expressive writing may be more or less beneficial based on individual characteristics such as social constraints. The reviewed studies were limited due to representativeness of the samples, performance, detection and patient-reported outcomes biases, and heterogeneity of the intervention protocol and writing prompts. Future studies with rigorous designs are needed to determine whether expressive writing is therapeutically effective in cancer patients.     

Expressive writing in context: The effects of a confessional setting and delivery of instructions on participant experience and language in writing

Objectives. Manipulations of the setting and instructions were tested for effects on language use and reported health following expressive writing (EW). Methods. Participants (N = 76) wrote in one of three conditions that differed by setting and the delivery of writing instructions. Results. The results showed that altering the context for EW influences participants' language use and their perceptions of the experience. There was no effect of conditions on self‐reported health. Conclusions. Future research should attend to the ways in which manipulations of EW context affect proposed mediators such as language, as well as outcomes of EW.     

Anxiety and somatic complaints in children with recurrent abdominal pain and anxiety disorders

Objective To compare anxiety symptoms and disorders inchildren and adolescents with recurrent abdominal pain (RAP),anxiety disorders, and healthy control children. Methods Twenty-onechildren with RAP (nine males, mean age = 11.05) were comparedto 21 children with anxiety disorders (11 males, mean age =12.29), and 21 children without pain or anxiety (nine males,mean age = 11.57) using diagnostic interviews and continuousmeasures of anxiety and other internalizing symptoms. Results Sixty-sevenpercent of children with RAP met criteria for an anxiety disorder.Children with RAP were higher than well children but not significantlydifferent from children with anxiety on total internalizingand anxiety symptoms. Conclusions RAP and anxietyare closely related. Further understanding between these disordersis essential to understanding the development and progressionof RAP, and to inform the prevention and treatment of the disorder.     

Fatigue in a community sample of twins

BACKGROUND: Fatigue is a complex symptom associated with many physiological, psychological and pathological processes. Its correlates and typology remain inadequately understood. METHOD: These data were from two large, longitudinal twin studies. Trained interviewers enquired as to the presence of a > or = 5 day period in the previous year of fatigue or tiredness that interfered with daily activities. A range of potential correlates was assessed in a structured interview: demography; health beliefs; the presence of nine physical disorders; mood, anxiety and addictive disorders; neuroticism and extraversion; recollections of parental rearing; and nine stressful life events. Statistical analyses included logistic regression, CART, MARS, latent class analysis and univariate twin modelling. RESULTS: Data were available for interfering fatigue (IF) on 7740 individual twins (prevalence 9.9% in the previous year). IF was significantly associated with 42 of 52 correlates (most strongly with major depression, generalized anxiety disorder, reported major health problems and neuroticism). Multivariate analyses demonstrated that IF is a highly complex construct with different sets of correlates in its subtypes. There were two broad clusters of correlates of IF: (a) major depression, generalized anxiety disorder and neuroticism; and (b) beliefs of ill health coexisting with alcoholism and stressful life events. Twin analyses were consistent with aetiological heterogeneity--genetic effects may be particularly important in women and shared environmental effects in men. CONCLUSIONS: IF is a complex and common human symptom that is highly heterogeneous. More precise understanding of the determinants of IF may lead to a fuller understanding of more extreme conditions like chronic fatigue syndrome.     

Affective temperaments and ego defense mechanisms associated with somatic symptom severity in a large sample

Background

Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown.

Methods

We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable.

Results

Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense.

Limitations

The data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness.

Conclusions

Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.     

Association of cancer worry and perceived risk with doctor avoidance: an analysis of information avoidance in a nationally representative US sample

Fear of receiving bad news about one’s health can lead people to avoid seeking out health information that, ironically, may be crucial for health maintenance. Using a nationally representative US sample, the present study examined whether perceived likelihood of developing cancer and worry about cancer were associated with reports of avoiding visits to one’s doctor, in respondents under and over age 50. Cancer worry, but not perceived risk of cancer, predicted doctor avoidance in respondents aged 50 and older, whereas the opposite pattern held for respondents under age 50. Moreover, in respondents aged 50 and older, cancer worry and perceived cancer risk interacted such that cancer worry was linked to doctor avoidance only when respondents also perceived a high likelihood of cancer. The latter result is consistent with the notion that worry may motivate information seeking when people expect information to dispel worry and information avoidance when the information is seen as highly likely to confirm one’s fears. Findings suggest a need for communication strategies that can influence worry and perceived risk differentially. Research should also assess the effectiveness of other behavioral strategies (e.g., automatic scheduling of appointments) as a means for reducing doctor avoidance.     

Suicidal ideation is associated with nighttime wakefulness in a community sample

Study ObjectivesNocturnal wakefulness is a risk factor for suicide and suicidal ideation in clinical populations. However, these results have not been demonstrated in general community samples or compared to sleep duration or sleep quality. The present study explored how the timing of wakefulness was associated with suicidal ideation for weekdays and weekends.MethodsData were collected from 888 adults aged 22–60 as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization study. Suicidal ideation was measured by the Patient Health Questionnaire-9, while timing of wakefulness was estimated from the Sleep Timing Questionnaire. Binomial logistic regressions estimated the association between nocturnal (11 pm–5 am) and morning (5 am–11 am) wakefulness and suicidal ideation.ResultsNocturnal wakefulness was positively associated with suicidal ideation on weekdays (OR: 1.44 [1.28–1.64] per hour awake between 11:00 pm and 05:00 am, p < 0.0001) and weekends (OR: 1.22 [1.08–1.39], p = 0.0018). Morning wakefulness was negatively associated with suicidal ideation on weekdays (OR: 0.82 [0.72–0.92] per hour awake between 05:00 am and 11:00 am, p = 0.0008) and weekends (OR: 0.84 [0.75–0.94], p = 0.0035). These associations remained significant when adjusting for sociodemographic factors. Additionally, nocturnal wakefulness on weekdays was associated with suicidal ideation when accounting for insomnia, sleep duration, sleep quality, and chronotype (OR 1.25 [1.09–1.44] per hour awake, p = 0.002).ConclusionWakefulness at night was consistently associated with suicidal ideation. Additionally, morning wakefulness was negatively associated with suicidal ideation in some models. Although these findings are drawn from a non-clinical sample, larger longitudinal studies in the general population are needed to confirm these results.     

Suicidal imagery in a previously depressed community sample

This study sought to replicate previous findings of vivid suicide-related imagery in previously suicidal patients in a community sample of adults with a history of depression. Twenty-seven participants were interviewed regarding suicidal imagery. Seventeen participants reported prior suicidal ideation or behaviour in the clinical assessment, and the vast majority of these also reported experiencing suicide-related imagery when at their most depressed and despairing, in many cases in the form of flash-forwards to imagined future suicidal acts. Interestingly, five of the 10 participants who did not report suicidal ideation or behaviour in the clinical interview also described prominent imagery related to themes of death and suicide, but in several cases, these images were associated with meanings that seemed to act to reduce the likelihood of subsequent suicidal acts. Severity of prior suicidality was associated with lower levels of imagery-related distress and higher levels of imagery-related comfort. These findings support the idea that suicide-related imagery is an important component in the phenomenology of depression and despair and hint at potentially important differences in the meaning associated with such imagery between those individuals who report experiencing suicidal ideation or behaviour when depressed and those who do not. The findings are consistent with Joiner's model of acquired capability for suicide through habituation to pain and fear of suicide and suggest that it may be useful to tackle such imagery directly in the treatment of suicidal patients.     

Intrusions,avoidance and overgeneral memory in a non‐clinical sample

Previous studies have shown a positive relationship between intrusions, effortful avoidance and overgeneral memory in people suffering from (mild) depression or PTSD. The purpose of the present study was to investigate these relationships in a non‐clinical sample. As part of a mass testing session, a written version of the Autobiographical Memory Test was administered to 175 first‐year psychology students. Furthermore, intrusion and avoidance symptoms were measured with the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979), and depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). The data demonstrated a significant correlation between avoidance symptoms and categoric memory to negative cue words. This relationship remained significant after controlling for depressive symptoms. These results concur with other findings that overgeneral memory tends to be related to symptoms of effortful avoidance. Copyright © 2006 John Wiley & Sons, Ltd.     

Psychosocial indexes and cardiovascular risk factors in a community sample

BACKGROUND: Psychosocial characteristics might contribute to a more comprehensive understanding of cardiovascular disease as it is increasingly recognised that biomedical risk factors do not fully explain its dynamics. This study aimed to describe psychometric indexes in a Portuguese community sample relating them to known cardiovascular disease risk factors. METHODS: Anthropometric, blood pressure, serum measurements and information on demographic, social, medical and behavioural characteristics were obtained for 215 women and 156 men. Self-administered questionnaires were used for the psychometric evaluation (Bortner scale, Beck Depression Inventory, Hopkins Symptom Distress Checklist 90-Revised, Psychological General Well-Being and the Nottingham Health Profile, NHP). RESULTS: There were significant differences according to gender regarding almost every psychometric dimension assessed. After adjusting for the presence of different biomedical risk factors, significant decreasing mean behaviour pattern scores were found with increasing age. Mean depression scores were significantly higher in women and in individuals with lower educational level. As to general psychological well-being, the highest scores were obtained for men and individuals with higher educational level. For the assessed dimensions of quality of life, as well as indexes of psychopathology, men scored better than women. No significant differences in mean scores of behaviour pattern, depression, psychological general well-being and dimensions of NHP were found according to the presence of an increasing number of cardiovascular risk factors. CONCLUSIONS: The study shows that the clustering of multiple biomedical risk factors does not result in additive deleterious psychological effects and that psychometric indexes are mainly dependent on gender and education, common confounders in most studies evaluating cardiovascular risk factors.     

Life events and depression in a community sample of siblings

BACKGROUND: The overall aim of the GENESiS project is to identify quantitative trait loci (QTLs) for anxiety/depression, and to examine the interaction between these loci and psychosocial adversity. Here we present life-events data with the aim of clarifying: (i) the aetiology of life events as inferred from sibling correlations; (ii) the relationship between life events and measures of anxiety and depression, as well as neuroticism; and (iii) the interaction between life events and neuroticism on anxiety/depression indices. METHODS: We assessed the occurrence of one network and three personal life-event categories and multiple indices of anxiety/depression including General Health Questionnaire, Anhedonic Depression, Anxious Arousal and Neuroticism in a large community-based sample of2150 sib pairs, 410 trios and 81 quads. Liability threshold models and raw ordinal maximum likelihood were used to estimate within-individual and between-sibling correlations of life events. The relationship between life events and indices of emotional states and personality were assessed by multiple linear regression and canonical correlations. RESULTS: Life events showed sibling correlations of 0-37 for network events and between 0-10 and 0.19 for personal events. Adverse life events were related to anxiety and depression and, to a less extent, neuroticism. Trait-vulnerability (as indexed by co-sib's neuroticism, anxiety and depression) accounted for 11% and life events for 3% of the variance in emotional states. There were no interaction effects. CONCLUSIONS: Life events show moderate familiality and are significantly related to symptoms of anxiety and depression in the community. Appropriate modelling of life events in linkage and association analyses should help to identify QTLs for depression and anxiety.