Coping with life-threatening events was associated with better self-perceived health in a naval cross-sectional study

ObjectiveWe studied the relationship between experiencing and coping with life-threatening events and self-perceived health in navy personnel operating mainly under peaceful circumstances.MethodsThe data were collected in a cross-sectional study from a questionnaire sent by mail at the end of 2002 to all employees in the Royal Norwegian Navy (N=3878) as part of a general health study. Both military and civilian personnel with different types of work on ships and ashore participated in the study. Logistic regression analyses were performed to study the relationship between the number of life-threatening events, occupational status, sex, age, and the extent of putting these events behind. The possible trends between the degree of putting the events behind and each of the eight SF-36 scales were calculated by bivariate correlations.ResultsMilitary personnel had experienced life-threatening events more often than civilians, but the military personnel appeared 5.5 times more likely to have put such events behind themselves than the civilians. The extent of having put life-threatening events behind oneself was clearly correlated to self-perceived health as measured by the SF-36 subscales bodily pain, general health, vitality, social functioning, role-emotional, and mental health. These associations had linear appearances.ConclusionNavy personnel who have experienced a life-threatening event and have not been able to put this event behind them are more likely to report a reduced self-perceived health.     

Oral health of psychiatric inpatients: a survey of central Taiwan hospitals

Objective

The objective was to investigate the status of oral health and its determinants in a group of psychiatric inpatients in central Taiwan.

Method

A cross-sectional study of the oral health of psychiatric inpatients (n=200) in three hospitals in central Taiwan was carried out during a half-year period. Demographic data and data on oral health habits, dental visit frequency, treatment fear and dental health knowledge were collected. Oral health was determined by the Decayed/Missing/Filled Teeth (DMFT) index, Community Periodontal Index (CPI), Plaque Index and Gingival Index.

Results

In terms of prevalence of caries, the mean DMFT score for all patients was 14.9±8.8 (S.D.), which was significantly worse than that in the general population. The CPI showed that only 10% of patients were periodontally healthy, 9.5% had bleeding, 31% had calculus and 49.5% had periodontal pockets. Increasing age, treatment anxiety, neglect of tooth-brushing and chronic ward inpatients were predictive factors for poor periodontal health. The self-awareness of poor oral health was inadequate and the treatment needs were huge in psychiatric inpatients.

Conclusion

The oral health of psychiatric inpatients was poor compared with the general population and was generally ignored by the patients themselves. The phenomenon is universal, occurring in both Western and Eastern countries.     

Diplégie faciale au cours d’une neuropathie démyélinisante inflammatoire aiguë secondaire à une varicelle

Introduction

Primo-infection by varicella-zoster virus (VZV) may be associated with several neurologic complications. Bilateral facial palsy is a rather uncommon manifestation.

Case report

We report the case of a 38-year-old woman who developed bilateral facial diplegia and paresthesia affecting all four limbs with subacute onset several days after varicella virus primoinfection. Ancillary tests showed hyperproteinorachia and signs of demyelinating polyneuropathy in nerve conduction tests. The diagnosis of Guillain-Barré syndrome was retained and a treatment with intravenous immunoglobulines was started, leading to progressive improvement.

Conclusion

Immunotherapy is a possible therapeutic approach in the context of neurologic postinfectious complications after VZV infection where an underlying mechanism is probable.     

The epidemiology of insomnia: Associations with physical and mental health.: The HUNT-2 study

Objective

The aim of the present study was to examine the association of insomnia symptoms with demographic and physical and mental conditions in a large population-based study.

Methods

Cross-sectional data on insomnia and comorbid conditions were gathered from 47,700 individuals aged 20-89 in Norway. Comorbid conditions included anxiety and depression and the following physical conditions: asthma, allergy, cancer, hypertension, diabetes, migraine, headache, osteoporosis, fibromyalgia rheumatoid arthritis, arthrosis, Bechterew's disease, musculoskeletal disorders, and obesity (body mass index >30).

Results

Insomnia symptoms were found in 13.5% of the population and were more prevalent among women, older adults, and in individuals with less education. Reporting insomnia symptoms significantly increased the associations with a range of conditions, especially mental conditions, pain conditions with uncertain etiology and, to a lesser extent, chronic pain conditions. These findings remained significant also when adjusting for a range of potential confounders, whereas the association between insomnia and somatic conditions was largely reduced to a nonsignificant level in the fully adjusted analyses.

Conclusion

This study demonstrates that insomnia symptoms are associated with a range of different conditions. The findings suggest that the independent contribution of insomnia is strongest on conditions characterized by some level of psychological or psychosomatic properties.     

Complex personality disorder in bulimia nervosa

Objective

Recent research has suggested a move toward a dimensional system for the classification of personality disorders (PDs). Tyrer's dimensional model using severity as a form of categorizing PDs was used to compare eating disorder outcome in women with bulimia nervosa (BN) over 3 years.

Method

One hundred thirty-four women with BN were divided into 4 groups based on PD severity: no PD (n = 32), personality difficulty (n = 27), simple PD (n = 29), and complex PD (n = 46). Eating disorder symptoms and attitudes, general psychosocial functioning, and depressive symptoms were examined at pretreatment and at 1-year and 3-year follow-up (posttreatment).

Results

The complex PD group had greater Axis I comorbidity and psychopathology than the remaining 3 groups at pretreatment. At 1-year and 3-year follow-up, there were no differences in eating disorder outcome, general psychosocial functioning, and depressive symptoms across the 4 groups.

Conclusion

These results suggest that having an increased number of PDs comorbid with BN does not influence eating disorder outcome up to 3 years after treatment.     

Association of psychosocial factors and bullying at individual and department levels among naval military personnel

Objective

We studied the associations between bullying at work and psychosocial factors both at the individual and at the department levels.

Methods

The data were collected in a cross-sectional study from a questionnaire sent by mail in 2002 to all military personnel in the Royal Norwegian Navy as part of a general work and health study. Self-experienced and observed bullying as well as scores for psychosocial scales using the General Nordic Questionnaire for Psychological and Social Factors at Work were calculated both for the individuals (n=1604) and as a mean for each Navy department (n=97).

Results

Low scores on the fair leadership, innovative climate, and inequality scales were associated with high occurrence of bullying at the individual level in a backward stepwise multivariate logistic regression, which means that lack of fair leadership and innovative climate and unequal treatment were associated with high occurrence of bullying. At the department level, the three scales were similarly significantly associated with percentage observed bullying when analyzed separately. A low score on the fair leadership scale and lower departmental mean age were associated with high percentage observed bullying in a stepwise multiple linear regression analysis. Repeating the analyses excluding those being bullied did not change the estimates markedly.

Conclusion

Our findings indicate that the work environment as perceived by the individual and at the department level is related to the occurrence of bullying.     

Physical health status assessed during hospitalization for acute coronary syndrome predicts mortality 12 months later

Objective

Self-report measures of health status predict mortality in several groups of patients with cardiovascular disease, although overlap with symptoms of depression may reduce or eliminate this relationship. The association between self-reported health status and mortality has not been examined in patients hospitalized for acute coronary syndrome (ACS). The objective was to investigate whether the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the SF-12 predicted 12-month all-cause mortality after controlling for cardiac risk factors and symptoms of depression.

Methods

The SF-12 and Beck Depression Inventory were administered 2-5 days after admission to 800 ACS patients from 12 coronary care units. Logistic regression was used to assess the relationship of the PCS and MCS with mortality 12 months later, controlling for age, sex, cardiac diagnosis (acute myocardial infarction vs. unstable angina), Killip class, history of myocardial infarction, and in-hospital depressive symptoms.

Results

Lower scores on the SF-12 PCS (worse health) were associated with a significantly higher risk of mortality [odds ratio (OR)=0.94, 95% confidence interval (CI)=0.92-0.97, P<.001]. MCS scores failed to reach significance (OR=0.98, CI=0.95-1.00, P=.053). The PCS significantly predicted mortality even after controlling for other cardiac risk factors and depressive symptoms (OR=0.96, CI=0.93-0.99, P=.008), equivalent to a 34% increase in risk per 10-point (1 SD) decrement in PCS scores.

Conclusion

The brief SF-12 PCS presents an attractive option for improving risk stratification among hospitalized ACS patients.     

The 5-HTTLPR Polymorphism modulates the association of serious life events (SLE) and impulsivity in patients with Borderline Personality Disorder

Background

Impulsivity belongs to the key features of Borderline Personality Disorder (BPD). It has been linked to altered serotoninergic neurotransmission and, genetically, to an over-representation of the short (S) allele of the serotonin transporter promoter-linked polymorphic region polymorphism (5-HTTLPR). On the other hand, serious life events (SLE) are of major importance in the development of BPD. However, the inter-relations between SLEs, impulsivity, and 5-HTTLPR are not understood.

Method

159 BPD patients from Germany were included in this study. Impulsivity was assessed by the Barratt Impulsiveness Scale (BIS). We analysed (1) the effects of SLEs on impulsivity; and (2) modulating effects of the 5-HTTLPR polymorphism on the effects of SLEs on impulsivity.

Results

Regression analyses confirmed a decreasing effect of childhood sexual abuse, the cumulative SLE-related reactions and the impairment by SLEs on BIS sum score. Regarding BIS sum score, all SLEs except for rape were associated with a decrease of impulsivity in SS/SL carriers and an increase of BIS sum score in LL carriers.

Conclusions

This study analyzing a specific gene x environment interaction in BPD patients suggests an interaction between SLEs and the 5-HTTLPR S/L polymorphism in the development of impulsivity in BPD patients. Clinical and research implications are discussed.     

An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis

Objective

To examine the relationships between physical, psychological, and social factors and health-related quality of life (HRQOL) and disability in rheumatoid arthritis (RA).

Methods

A sample of 106 patients with rheumatoid arthritis (RA) completed measures of self-reported disease activity and psychosocial functioning, including coping, personal mastery, social network, perceived stress, illness beliefs, the SF-36 and Health Assessment Questionnaire Disability Index (HAQ-DI). In addition, physician-based assessment of disease activity using the Disease Activity Scale (DAS-28) was obtained. Hierarchical multiple regression analyses were used to evaluate the relationships between psychosocial factors and scores on the SF-36 and HAQ-DI.

Results

Lower self-reported disease activity was associated with higher SF-36 physical functioning scores, while the contribution of active coping, passive coping, and helplessness was significant only as a block. Lower self-reported disease activity, higher personal mastery, and lower perceived stress contributed to higher SF-36 mental health functioning, and higher self-reported disease activity and lower helplessness were associated with greater disability, as indexed by the HAQ-DI. The DAS-28, an objective of measure of disease activity, was unrelated to any of these outcomes.

Conclusions

The findings highlight the importance of targeting psychological factors to enhance HRQOL and disability in the clinical management of RA patients.     

Quality of life in patients with idiopathic subclavian vein thrombosis

Introduction

Idiopathic subclavian vein thrombosis (SVT) is a rare disease but these otherwise healthy patients often suffer from prolonged clinical manifestations. The aim of this retrospective study was to assess the range and severity of thrombosis-related disability of the upper extremity in patients after an episode of documented idiopathic SVT in the long-term follow-up.

Materials and Methods

The quality of life (QoL) of 37 patients with documented idiopathic SVT was assessed by two standardized questionnaires (DASH and SF 36). The DASH and SF-36 questionnaire each use a 100 point scale. 0 stands for uncompromised functioning, 100 for maximum limitation in the DASH, while in the SF-36 0 marks the lowest rating of QoL and 100 indicates the best imaginable quality of life.

Results

Mean follow-up time was 120 ± 80.1 months (range: 14 to 286 months). The mean DASH score was 10.7 ± 12 and the mean scores for the SF-36 dimensions Physical Component Summary (PCS) and Mental Component System (MCS) were 52 ± 9.3 and 46.3 ± 9.5, respectively.

Conclusions

Patients suffering from idiopathic SVT report good overall QoL judged by the mean DASH and satisfactory QoL by the SF-36 score in the long-term follow-up. These patients deal well with their physical limitations.     

Single-dose adjustment versus no adjustment of warfarin in stably anticoagulated patients with an occasional international normalized ratio (INR) out of range

Background

Well-controlled patients on warfarin may still have occasional International Normalized Ratios (INRs) outside the therapeutic range. It is unclear whether there is any benefit of a single-dose correction in this situation.

Aim

To evaluate whether patients with very stable INR results should continue with the maintenance dose of warfarin without a single-dose correction, even when the result unexpectedly is moderately below or above the therapeutic range.

Methods

A) We reviewed retrospectively 364 patients with unchanged maintenance dose for at least 6 months and an occasional INR outside the therapeutic range regarding decision on dosing and the effect on the next INR. B) We randomized 160 patients with at least 3 months of unchanged maintenance dose, an occasional INR deviating to a minimum of 1.5 or a maximum of 4.4 and unexplained or temporary, removable cause to a single-dose Change or No change. Follow-up INRs and telephone interviews were obtained after 2 weeks.

Results

A) Retrospectively, the proportion of follow-up INRs outside the therapeutic range was 29.9% after No change, 27.1% after Increased dose and 25.7% after Skipped/reduced dose. However, the decision on No change was mainly taken in case of minimal INR deviations. B) Forty-eight (60%) of the patients randomized to Change were within the therapeutic range at follow-up versus 45 (56%) of those with No change, odds ratio 1.17 (95% confidence interval 0.59-2.30). For baseline INRs deviating down to 1.6 or up to 3.6 (therapeutic range, INR 2.0-3.0) the 2-week INRs did not differ between the groups.

Conclusion

Our results suggest only a small or no difference between the two managements of an occasional INR out of range in terms of the 2-week follow-up INR. In stable patients on warfarin with an occasional INR outside the therapeutic range it seems reasonable to continue with the same dose without a single-dose change and perform a repeat test in about 2 weeks. (ClinicalTrials.gov number, NCT00814177.)     

Social anxiety disorder and social fears in the Canadian military: Prevalence, comorbidity, impairment, and treatment-seeking

Background

Military mental health research has rarely investigated social anxiety disorder, despite its known serious consequences in the general population, and what work has been conducted has used specialized samples (e.g., veterans) not representative of all military personnel.

Methods

Data were from the 2002 Canadian Community Health Survey—Canadian Forces Supplement, a representative survey of 8441 active regular and reserve military personnel.

Results

Social anxiety disorder has a high lifetime (8.2%) and past-year (3.2%) prevalence in the military. It is associated with increased odds of depression, panic attacks/disorder, generalized anxiety disorder, and post-traumatic stress disorder (AOR range 4.16-16.29). Being female, ages 35-44, or separated/divorced/widowed increases the odds of having social anxiety disorder, while being an officer or a reservist decreases the odds. Treatment-seeking, as in the general population, is relatively rare. Overall, military personnel with social anxiety disorder experience significant rates of role impairment in all domains (53.1-88.3% report some impairment), with the rate of role impairment increasing with the number of social fears. Notably, many (70.6%) report at least some impairment at work (i.e., in their job with the military).

Conclusion

Social anxiety disorder is an important disorder to take into account when considering military mental health. Observing low rates of treatment-seeking for social anxiety disorder among military personnel highlights the importance of initiatives to allow its identification and treatment.     

Perfectionism and sensory phenomena: phenotypic components of obsessive-compulsive disorder

Background

The aim of the study was to investigate how perfectionism and sensory phenomena (SP) interact as possible phenotypic components of obsessive-compulsive disorder (OCD).

Methods

Forty-seven adult outpatients, meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for OCD, and a control group of 41 community subjects were assessed using the Frost Multidimensional Perfectionism Scale (FMPS), the University of São Paulo-Sensory Phenomena Scale, and other standard measures of OCD severity.

Results

Three of the FMPS subscales (“concern over mistakes,” “doubts about action,” and “parental criticism”) were significantly different between OCD patients and control subjects. All subtypes of SP were significantly more frequent and more severe in OCD than in control subjects. The “incompleteness” subtype of SP was associated with high scores on all dimensions of the FMPS, whereas the “just-right” subtype of SP was only associated with “doubts about action,” “personal standards,” and “organization” subscales of the FMPS.

Conclusions

Presence and severity of SP and specific elements of perfectionism clearly distinguish OCD patients from healthy control subjects. Some SP subtypes are associated with specific FPMS subscale scores, whereas others are not. These results emphasize the relevance of assessing different subtypes of perfectionism and SP in OCD patients as important subcomponents of the OCD phenotype.     

Predictors of emotional distress reported by soldiers in the combat zone

Objective

Few studies have examined rates of distress of military personnel during deployment to a war zone. Our study sought to (a) identify rates of self-reported posttraumatic stress disorder (PTSD) and depression symptoms during combat deployment, (b) characterize higher order dimensions of emotional distress experienced by soldiers during deployment, and (c) identify predictors of these dimensions of emotional distress.

Method

Participants were 2677 National Guard soldiers deployed as part of Operation Iraqi Freedom in 2006-07. We performed a principal components factor analysis on items of the PTSD Checklist - Military Version and the Beck Depression Inventory to identify dimensions of emotional distress, followed by multiple regression analyses to identify factors that predicted these dimensions of distress.

Results

Rates of PTSD and depression in our sample were 7% and 9%, respectively. Five dimensions of emotional distress emerged: negative affect/cognitions, trauma-specific re-experiencing and avoidance, vegetative symptoms, loss of interest/numbing symptoms, and arousal/irritability. Two dimensions, trauma-specific symptoms and arousal/irritability, appeared to be more indicative of trauma sequelae, while the other three dimensions were more indicative of depressive symptoms. Demographic factors, combat exposure (including injury and exposure to explosive blast), and attitudinal variables predicted trauma-specific aspects of distress. Symptoms characteristic of depression or generalized distress were predicted by female gender, recent prior deployment, and attitudinal factors but were not predicted by blast exposure or injury.

Conclusions

These findings suggest specific targets for contextual and individual interventions to reduce deployment-related distress and point out the need for longitudinal follow-up to determine long-term implications for post-deployment functioning.     

Psychological stress and wound healing in humans: A systematic review and meta-analysis

Objective

The current review aims to synthesize existing knowledge about the relationship between psychological stress and wound healing.

Methods

A systematic search strategy was conducted using electronic databases to search for published articles up to the end of October 2007. The reference lists of retrieved articles were inspected for further studies and citation searches were conducted. In addition, a meta-analysis of a subset of studies was conducted to provide a quantitative estimation of the influence of stress on wound healing.

Results

Twenty-two papers met the inclusion criteria of the systematic review and a subsample of 11 was included in a meta-analysis. The studies assessed the impact of stress on the healing of a variety of wound types in different contexts, including acute and chronic clinical wounds, experimentally created punch biopsy and blister wounds, and minor damage to the skin caused by tape stripping. Seventeen studies in the systematic review reported that stress was associated with impaired healing or dysregulation of a biomarker related to wound healing. The relationship between stress and wound healing estimated by the meta-analysis was r=−0.42 (95% CI=−0.51 to −0.32) (P<.01).

Conclusion

Attention now needs to be directed towards investigating potential moderators of the relationship, mediating mechanisms underpinning the association, as well as the demonstration of a causal link by the development of experimental interventions in healthy populations.     

Screening for depression in patients with hepatitis C using the Beck Depression Inventory-II: do somatic symptoms compromise validity?

Objective

The objective of the study was to evaluate the validity of the Beck Depression Inventory-II (BDI-II) when used to measure depression in patients with hepatitis C virus (HCV).

Method

Factor analysis was utilized to validate the BDI-II in a sample of 671 patients with HCV recruited from a large Veterans Affairs medical center. The data were split randomly: the first half was subjected to exploratory factor analysis, and confirmatory factor analysis was used with the second half to confirm the model. Diagnostic data were retrieved from the electronic medical records.

Results

Subjects were 97.0% male, average age was 52.8 years, 16.1% had a cirrhosis diagnosis, 62.9% had a current major depressive disorder diagnosis, and 42.3% endorsed significant depressive symptoms on the BDI-II. A two-factor model was an excellent fit for the data; the factors were labeled Cognitive-Affective and Somatic. Patients scored significantly higher on the Somatic factor than on the Cognitive-Affective factor (P<.001), and this discrepancy increased when comparing patients based on whether they had a diagnosis of cirrhosis.

Conclusions

When screening for depression in HCV patients, questions targeting cognitive and affective symptoms of depression may provide a more valid measurement of depression than questions targeting somatic symptoms of depression, particularly for patients with more advanced liver disease.     

Dimensional correlates of poor insight in obsessive-compulsive disorder

Background

Cross-sectional studies have associated poor insight in patients with obsessive-compulsive disorder (OCD) with increased OCD symptom severity, earlier age of onset, comorbid depression, and treatment response. The goal of this current study was to examine the relationship between dimensions of OCD symptomatology and insight in a large clinical cohort of Brazilian patients with OCD. We hypothesized that poor insight would be associated with total symptom severity as well as with hoarding symptoms severity, specifically.

Methods

824 outpatients underwent a detailed clinical assessment for OCD, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Brown Assessment of Beliefs Scale (BABS), a socio-demographic questionnaire, and the Structured Clinical Interview for axis I DSM-IV disorders (SCID-P). Tobit regression models were used to examine the association between level of insight and clinical variables of interest.

Results

Increased severity of current and worst-ever hoarding symptoms and higher rate of unemployment were associated with poor insight in OCD after controlling for current OCD severity, age and gender. Poor insight was also correlated with increased severity of current OCD symptoms.

Conclusion

Hoarding and overall OCD severity were significantly but weakly associated with level of insight in OCD patients. Further studies should examine insight as a moderator and mediator of treatment response in OCD in both behavioral therapy and pharmacological trials. Behavioral techniques aimed at enhancing insight may be potentially beneficial in OCD, especially among patients with hoarding.     

Hypervigilance in irritable bowel syndrome compared with organic gastrointestinal disease

Objective

Irritable bowel syndrome (IBS) patients are suggested to selectively attend to gastrointestinal (GI) sensations compared with healthy controls. However, it remains unclear whether there are differences between IBS and other chronic GI disorders. We aimed to evaluate the presence of hypervigilance towards the GI tract in IBS compared with patients with organic GI diseases.

Methods

We included 36 IBS patients and 40 age- and gender-matched patients with organic GI disease. They completed the Hospital Anxiety and Depression Scale (HADS) and underwent three tests: (1) word association—write down as many words as possible representing signs of disease; (2) word recognition (tachistoscope)—four categories of words (positive affects, non-GI symptoms, GI symptoms, negative affects) displayed for increasing time until identified; (3) word recollection—memorize words (10 GI symptoms, 10 positive affects, 10 negative affects).

Results

The word-association task did not show group differences. IBS patients were significantly faster than organic GI patients at recognizing words representing GI symptoms (21 vs. 26 ms; P=.04) and negative affects (27 vs. 34 ms; P=.03), but also tended to be faster at recognizing positive affects (24 vs. 29 ms; P=.08) and non-GI symptoms (22 vs. 27 ms; P=.2). Both groups remembered a similar number of words, but IBS patients tended to recall more incorrect GI words than organic patients (1.3 vs. 1.0; P=.06). There were no group differences in HADS scores.

Conclusion

Compared to patients with organic GI disease, IBS patients seem to be hypervigilant for information regarding GI sensations and maybe also negative information.     

Anhedonia as predictor of clinical events after acute coronary syndromes: a 3-year prospective study

Background

Depression after acute coronary syndromes (ACS) is an important risk factor for further coronary events; but the influence of anhedonia, the decreased capacity to experience pleasure, has received little attention. The aim of the study was to investigate the effects of anhedonia on prognosis at 3-year follow-up in patients hospitalized for ACS.

Method

Consecutively admitted ACS patients (n = 291) completed the Chapman Physical Anhedonia Scale (PAS) and the Hospital Anxiety and Depression Scale depression subscale (HAD-D) at baseline (1-4 days after their admission). Two definitions of anhedonia were taken into account: dimensional definition using PAS score as well as categorical definition using several cutoff scores (hedonics: PAS less than 23 or 29; anhedonics: PAS equal to or greater than 23 or 29). Patients were followed during 3 years for adverse clinical events divided into severe cardiac events (mortality or myocardial infarction [MI]) and clinical events (mortality, MI, recurrence of ACS, hospital readmission, and onset or deterioration of heart failure).

Results

At follow-up, there were 176 clinical events (36 deaths, 8 MIs, 58 ACS, 55 hospital readmissions, 19 heart failures). Dimensional anhedonia and depression were associated with poor prognosis, but anhedonia was the only predictor of severe cardiac events and clinical events after adjusting for demographic and clinical variables. Contrary to depression, categorical anhedonia (PAS >23) was an independent and significant predictor of severe cardiac events after adjusting for clinical variables. The incidence of death/MI in hedonics vs anhedonics was 11.1% vs 22.1% (hazard ratio = 2.18; 95% confidence interval, 1.11-4.26).

Conclusions

Dimensional and categorical anhedonias predicted independently severe cardiac events and clinical events after ACS.     

Positive life events and mood disorders: Longitudinal evidence for an erratic lifecourse hypothesis

Background

An unresolved issue in psychiatry research concerns the assumption that detrimental effects of negative life events on mental health may be buffered by a multitude of positive life events. However, there is clear lack of empirical evidence for this assumption, and one may even argue that positive life events act as additional stressors and thus increase (and not decrease) the risk for affective disorders.

Methods

Data were used from 4796 adults aged 18-64, who participated in 2 waves (i.e., 1997 and 1999) of NEMESIS, a prospective-epidemiological study. Measures were based on diagnoses of DSM-III-R mood disorders, and a life events questionnaire employed in the NEMESIS study.

Results

Although the prevalence of mood disorders correlated positively with both the number of negative and positive life events experienced, a multivariate path analysis (Mplus) demonstrated that only negative life events longitudinally predicted mood disorders. Positive life events predicted subsequent mood disorders only when in the same time period a high number of negative events were experienced.

Conclusions

Positive life events do not buffer the detrimental impact of negative ones, but instead may function as additional stressor, in the context of highly erratic life course patterns that may be typical for depressed individuals.