[Show abstract][Hide abstract] ABSTRACT: The metabolic syndrome increases mortality risk. However, as "non-affected" individuals may still have up to two risk factors, the utility of using three or more components to identify the syndrome, and its predictive advantage over individual components have yet to be determined.
Participants, male Vietnam-era veterans (n=4265) from the USA, were followed-up from 1985/1986 for 14.7 years (61,498 person-years), and all-cause and cardiovascular disease deaths collated. Cox's proportional-hazards regression was used to assess the effect of the metabolic syndrome and its components on mortality adjusting for a wide range of potential confounders.
At baseline, 752 participants (17.9%) were identified as having metabolic syndrome. There were 231 (5.5%) deaths from all-causes, with 60 from cardiovascular disease. After adjustment for a range of covariates, the metabolic syndrome increased the risk of all-cause, HR 2.03, 95%CI 1.52, 2.71, and cardiovascular disease mortality, HR 1.92, 95%CI 1.10, 3.36. Risk increased dose-dependently with increasing numbers of components. The increased risk from possessing only one or two components was not statistically significant. The adjusted risk for four or more components was greater than for only three components for both all-cause, HR 2.30, 95%CI 1.45, 3.66 vs. HR 1.70, 95%CI 1.11, 2.61, and cardiovascular disease mortality, HR 3.34, 95%CI 1.19, 9.37 vs. HR 2.81, 95%CI 1.07, 7.35. The syndrome was more informative than the individual components for all-cause mortality, but could not be assessed for cardiovascular disease mortality due to multicollinearity. Hyperglycaemia was the individual strongest parameter associated with mortality.
The metabolic syndrome is informative in predicting mortality, with risk increasing as the number of components increase above the threshold required for diagnosis.
[Show abstract][Hide abstract] ABSTRACT: To examine the cross-sectional associations between generalized anxiety disorder (GAD) and major depressive disorder (MDD), their comorbidity, and hypertension.
Participants (n = 4180) were drawn from a cohort of men who were members of the U.S. army during the Vietnam war era. Occupational, sociodemographic, and health data were collected from military service files, telephone interviews, and medical examinations. Hypertension status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure > or = 140 mm Hg or an average diastolic blood pressure > or = 90 mm Hg at the medical examination. One-year prevalence of GAD and MDD was determined, using Diagnostic and Statistical Manual of Mental Disorders, Third Edition criteria.
In separate regression models adjusting for age and then additionally for place of service, ethnicity, marital status, alcohol consumption, smoking, body mass index, household income, and education grade, both GAD and MDD were related positively to hypertension. In age-adjusted and fully adjusted models comparing comorbid GAD/MDD, GAD alone, MDD alone, and neither condition, comorbidity showed the strongest relationship with hypertension.
Depression has been the main focus for research on mental health and physical health outcomes. The present results suggest that future research should pay equal attention to GAD and, in particular, the comorbidity of GAD and MDD.
Psychosomatic Medicine 11/2009; 72(1):16-9. DOI:10.1097/PSY.0b013e3181c4fca1 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent findings suggest that both low and very high fasting blood glucose concentrations may be linked with depression, though whether type 2 diabetes is associated with depression may depend on awareness of the diagnosis. We explored the association between fasting glucose and type 2 diabetes (undiagnosed and diagnosed) and depression in middle-aged men.
Participants were 4293 US veterans who underwent an examination during which fasting blood glucose was measured, major depression diagnosed using DSM-III criteria, and depressive symptoms assessed with Minnesota Multiphasic Personality Inventory (MMPI) clinical scale for depression.
Compared with those with normal fasting glucose, men with undiagnosed type 2 diabetes had nearly double the odds of major depression, odds ratio (95% confidence interval) 1.80 (1.01, 3.22), and men with diagnosed diabetes had triple the odds of major depression, 3.82 (1.68, 8.70), after adjustment for confounding variables. Men with undiagnosed or diagnosed diabetes had higher MMPI depression scores. There was no curvilinear association between fasting glucose and depression (p > .45).
These findings do not support a U-shaped association between fasting glucose and depression. They suggest that the positive association between type 2 diabetes and depression extends beyond those who are aware they have the disease.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: This study examined the psychosocial predictors of poor sleep quality in parents caring for children with developmental disabilities. Methods Sixty-seven parents of children with developmental disabilities and 42 parents of typically developing children completed the Pittsburgh Sleep Quality Index, and measures of parental stress, child problem behaviors, and social support. Results Parents of children with developmental disabilities reported poorer sleep quality. Further, the majority of these parents met the established 'poor sleepers' criterion. The strongest predictor of poor sleep quality was parental stress. This finding withstood adjustment for a number of potential confounders. Conclusions Parental stress is associated with poor sleep quality in parents of children with developmental disabilities. The monitoring and management of sleep issues in these parental caregivers should be a priority for health professionals.
[Show abstract][Hide abstract] ABSTRACT: How we react physiologically to stress has long been considered to have implications for our health. There is now persuasive evidence that individuals who show large cardiovascular reactions to stress are at increased risk of developing cardiovascular disease, particularly hypertension. By implication, low reactivity is protective or benign. However, there is recent evidence that low reactivity may predict elevated risk for a range of adverse health outcomes, such as depression, obesity, poor self-reported health and compromised immunity. In addition, low cortisol and cardiovascular reactivity may be a characteristic of individuals with addictions to tobacco and alcohol, as well as those at risk of addiction and those who relapse from abstinence. Our ideas about reactivity may have to be revised in the light of such findings.
Social and Personality Psychology Compass 09/2009; 3(5). DOI:10.1111/j.1751-9004.2009.00205.x
[Show abstract][Hide abstract] ABSTRACT: Self-reported health has a well established relationship to later mortality, although the reasons are not entirely understood. This study examined the association of a similar self-reported measure of fitness with mortality and compared it to that of self-reported health.
The study had a prospective cohort design with multiple sampling points.
Participants were 858 men and women from Glasgow and the surrounding area of Scotland, aged 59 when self-reported health and fitness data were first collected in 1991/92. They were re-interviewed at age 64 and 69 and mortality was tracked for 16.5 years in total. Hazard ratios for all cause mortality were estimated for those that reported poor health or poor fitness relative to others their age, taking into account a range of covariates, some of which were also time varying.
In both unadjusted and covariate adjusted models, self-reported fitness was at least as good a predictor of mortality as self-reported health. In a mutually adjusted model, both again emerged as significant predictors. Poor subjective health with poor subjective fitness appeared to be a particularly lethal combination.
Both self-reported health and self-reported fitness were independent predictors of mortality. Where the objective assessment of aerobic fitness is not feasible, a simple measure of subjective fitness could prove a useful alternative.
British Journal of Health Psychology 08/2009; 15(Pt 2):337-46. DOI:10.1348/135910709X466180 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine the relationship between cardiovascular activity in response to acute psychological stress and the antibody response to vaccination.
Fifty-seven healthy participants were vaccinated with the trivalent influenza vaccine and meningococcal A+C polysaccharides. Antibody levels were measured at baseline and 5-weeks post-vaccination. Cardiovascular activity was measured at rest, during, and following a mental arithmetic stress task in 54 participants.
Participants demonstrating a fourfold increase in antibody titre to the A/Panama and B/Shangdong influenza strains and to meningococcal A showed greater blood pressure reactions toward the end of the acute stress task. In addition, there was some evidence of delayed diastolic blood pressure recovery in those who were responders to A/Panama and B/Shangdong influenza strains.
The present results suggest that heightened cardiovascular reactivity to stress and delayed recovery may not necessarily be detrimental to all aspects of health and may be associated with an enhanced immune response to antigen challenge.
Journal of psychosomatic research 08/2009; 67(1):37-43. DOI:10.1016/j.jpsychores.2008.12.002 · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Exaggerated cardiovascular reactions to acute psychological stress have been implicated in a number of adverse health outcomes. This study examined, in a large community sample, the cross-sectional and prospective associations between reactivity and self-reported health. Blood pressure and heart rate were measured at rest and in response to an arithmetic stress task. Self-reported health was assessed concurrently and 5 years later. In cross-sectional analyses, those with excellent/good self-reported health exhibited larger cardiovascular reactions than those with fair/poor subjective health. In prospective analyses, participants who had larger cardiovascular reactions to stress were more likely to report excellent/good health 5 years later, taking into account their reported health status at the earlier assessment. The findings suggest that greater cardiovascular reactivity may not always be associated with negative health outcomes.
[Show abstract][Hide abstract] ABSTRACT: Exaggerated haemodynamic reactions to acute psychological stress have been implicated in a number of adverse health outcomes. This study examined, in a large community sample, the cross-sectional associations between haemodynamic reactivity and self-reported smoking status. Blood pressure and heart rate were measured at rest and in response to a 3-minute arithmetic stress task. Participants were classified as current, ex-, or non-smokers by their response to a simple prompt. Smokers had significantly smaller SBP and DBP reactions to acute stress than ex- and non-smokers; current and ex-smokers had lower HR reactivity. These effects remained significant following adjustment for a host of variables likely to be associated with reactivity and/or smoking. Although the act of smoking acutely increases haemodynamic activity, the present findings contribute to a growing body of literature showing that smokers have blunted reactivity to mental stress. They also support the hypothesis that blunted reactivity may be characteristic of a range of dependencies. The present results also suggest that smoking status needs to be considered in the design and analysis of stress reactivity studies.
International journal of psychophysiology: official journal of the International Organization of Psychophysiology 05/2009; 73(3):273-8. DOI:10.1016/j.ijpsycho.2009.04.005 · 2.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Few studies have explored the relationship between major mental health disorders and metabolic syndrome (MetS), although both have been linked to cardiovascular disease. The present study examined the cross-sectional associations of major depressive disorder (MDD) and generalized anxiety disorder (GAD) with MetS in a large study of male US veterans.
The analyses were cross-sectional. Participants (n = 4256) were drawn from the Vietnam Experience Study. From military service files, telephone interviews, and a medical examination, occupational, socio-demographic, and health data were collected. One-year prevalence of MDD and GAD was determined with DSM-III criteria. Metabolic syndrome was ascertained from data on: body mass index, fasting blood glucose or a diagnosis of diabetes, blood pressure, high-density lipoprotein cholesterol, and triglyceride levels.
In models that adjusted for age (p = .01) and additionally for place of service, ethnicity, marital status, smoking, alcohol consumption, IQ at enlistment, household income in midlife, and education grade achieved (p = .02), GAD was positively associated with MetS. Major depressive disorder was not related to MetS.
Depression has very much been the focal condition for studies on mental health and physical health outcomes. The current data suggest that future research should perhaps pay equal attention to GAD.
[Show abstract][Hide abstract] ABSTRACT: To examine whether the 1-year prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and their comorbidity were associated with subsequent all-cause and cardiovascular disease (CVD) mortality during 15 years in Vietnam veterans.
Participants (N = 4256) were from the Vietnam Experience Study. Service, sociodemographic, and health data were collected from service files, telephone interviews, and a medical examination. One-year prevalence of MDD and GAD was determined through a diagnostic interview schedule based on the Diagnostic and Statistical Manual of Mental Disorders (version IV) criteria. Mortality over the subsequent 15 years was gathered from US army records.
MDD and GAD were positively and significantly associated with all-cause and CVD mortality. The relationships between MDD and GAD and CVD mortality were no longer significant after adjustment for sociodemograhics, health status at entry, health behaviors, and other risk markers. Income was the covariate with the strongest impact on this association. In analyses comparing comorbidity and GAD and MDD alone, with neither diagnosis, comorbidity proved to be the strongest predictor of both all-cause and CVD mortality.
GAD and MDD predict all-cause mortality in a veteran population after adjusting for a range of covariates. However, those with both GAD and MDD were at greatest risk of subsequent death, and it would seem that these disorders may interact synergistically to affect mortality. Future research on mental disorders and health outcomes, as well as future clinical interventions, should pay more attention to comorbidity.
Psychosomatic Medicine 04/2009; 71(4):395-403. DOI:10.1097/PSY.0b013e31819e6706 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Older spousal caregivers of dementia patients have been found to show a relatively poor antibody response to medical vaccination. In the present case control study in a different caregiving environment, we sought to compare antibody responses to vaccination in parents of children with disabilities and parents of typically developing children.
At baseline assessment, 32 parents of children with developmental disabilities and 29 parents of typically developing children completed standard measures of perceived stress and child problem behaviors. They also provided a blood sample and were then vaccinated with the thymus-dependent trivalent influenza vaccine. Further blood samples were taken at 1- and 6-month follow-ups.
Relative to parents of typically developing children (mean titer = 458, standard deviation (SD) = 155.7 at 1 month follow-up and mean titer = 265, SD = 483.0 at 6-month follow-up), caregivers (mean titer = 219, SD = 528.4 at 1-month follow-up and 86, SD = 55.0 at 6-month follow-up) mounted a poorer antibody response than controls to the B/Malaysia strain of the vaccine.
The negative impact of caregiving on antibody response to vaccination would not seem to be restricted to older spousal caregivers, but is also evident in younger parents caring for children with developmental disabilities. The behavioral characteristics of the care recipients may be a determinant of whether or not antibody response to vaccination is compromised.
Psychosomatic Medicine 04/2009; 71(3):341-4. DOI:10.1097/PSY.0b013e31819d1910 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The reactivity hypothesis postulates that large magnitude cardiovascular reactions to psychological stress contribute to the development of pathology. A key but little tested assumption is that such reactions are metabolically exaggerated. Cardiac activity, using Doppler echocardiography, and oxygen consumption, using mass spectrometry, were measured at rest and during and after a mental stress task and during graded submaximal cycling exercise. Cardiac activity and oxygen consumption showed the expected orderly association during exercise. However, during stress, large increases in cardiac activity were observed in the context of modest rises in energy expenditure; observed cardiac activity during stress substantially exceeded that predicted on the basis of contemporary levels of oxygen consumption. Thus, psychological stress can provoke increases in cardiac activity difficult to account for in terms of the metabolic demands of the stress task.
[Show abstract][Hide abstract] ABSTRACT: Exaggerated cardiovascular reactions to psychological stress are considered a risk factor for cardiovascular morbidity. Social support may reduce such risk by attenuating cardiovascular reactivity to stress.
To examine the effects of three independent social support variables and their interaction on cardiovascular reactivity to acute stress. The variables were stranger or friend presence, active supportive or passive presence, and male or female presence.
Cardiovascular reactions to mental arithmetic stress were measured in 112 healthy young women tested in one of eight distinct independent conditions: active supportive male friend; active supportive female friend; passive male friend; passive female friend; active supportive male stranger; active supportive female stranger, passive male stranger; and passive female stranger.
Support from a friend rather than a stranger was associated with attenuated blood pressure reactivity, but only when the supporter was a male friend. Support from a male stranger or female friend was associated with augmented blood pressure reactivity.
This interaction between the intimacy and sex of the supporter on cardiovascular reactivity extends the findings of previous laboratory studies of social support and can, to an extent, be interpreted in terms of the Social Comparison Theory.
Annals of Behavioral Medicine 02/2009; 37(1):38-45. DOI:10.1007/s12160-008-9077-0 · 4.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The origins and persistence of psychological morbidity in caregivers are not fully understood. The present analysis examined the relationship between the strain and burden of caregiving and depression and anxiety in a large community sample. Social support and sleep quality were investigated as potential mediators.
Cross-sectional and prospective observational study.
Individuals caring for someone other than their own child (N=393) were identified from a population of 2,079. Caregiving strain and burden, social support, and sleep quality were assessed. Participants completed the hospital anxiety and depression scale at the same time and 5 years later.
Caregiving strain and burden were associated with depression and anxiety symptoms cross-sectionally, and with a worsening of symptoms 5 years later. Sleep quality appeared to mediate the cross-sectional relationships.
The demands of caregiving and associated sleep disruption contribute to symptoms of depression and anxiety in caregivers.
British Journal of Clinical Psychology 02/2009; 48(Pt 4):335-46. DOI:10.1348/014466508X397142 · 1.90 Impact Factor