Ratings of positive and depressive emotion as predictors of mortality in coronary patients

Department of Medicine, Duke University, Durham, North Carolina, United States
International Journal of Cardiology (Impact Factor: 6.18). 04/2005; 100(2):213-6. DOI: 10.1016/j.ijcard.2004.06.016
Source: PubMed

ABSTRACT An extensive body of research has demonstrated an association between negative affective states and health outcomes. Positive emotions may also influence physical health, however, their examination has received far less attention.
Positive and depressive emotion ratings were examined as independent and joint predictors of survival in a sample of 866 cardiac catheterization patients. The mean follow-up was 11.4 years, during which 415 deaths occurred. The mean age of the sample was 60.3 years and 74.3% of the sample were males.
Both positive and depressive ratings were associated with survival (hazard ratio=0.80, 95% CI=0.66-0.97, p<0.025 and hazard ratio=1.32, 95% CI=1.13-1.54, p<0.001, respectively), adjusted for risk factors. Positive emotion ratings were no longer significantly related to mortality when the two emotion measures were simultaneously included in a survival model.
The current findings are consistent with a theory that suggests that the relation between positive emotion and mortality may be partly mediated by depressive emotion.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose ‐ The purpose of this paper is to examine work-related emotion as a mechanism explaining the relationship between perceived organizational support (POS) and employee physical health. Design/methodology/approach ‐ Study participants were employees at a large Canadian health care organization (n=72). A survey methodology was utilized. Findings ‐ POS was positively related to physical health. Negative emotion fully mediated this relationship between POS and health, and positive emotion was found to partially mediate this relationship. Research limitations/implications ‐ Cross sectional survey data is one potential limitation. Findings suggest that further investigation of the links between POS, positive and negative job-related emotion and physical health would be a fruitful avenue of research. Practical implications ‐ Organizations can increase POS through actions that have been investigated in past research. Increasing POS would appear to be one avenue that an organization can utilize to positively influence employee health through its effect on employee work-related emotion. Originality/value ‐ The paper addresses previous calls to investigate mechanisms underlying the relationship between POS and physical health, and shows that job-related emotion plays a role in explaining why POS is positively correlated with physical health.
    International Journal of Workplace Health Management 06/2012; 5(2). DOI:10.1108/17538351211239171
  • [Show abstract] [Hide abstract]
    ABSTRACT: Positive affect can improve survival, but the mechanisms responsible for this association are unknown. We sought to evaluate the association between positive affect and mortality in patients with stable coronary heart disease and to determine biological and behavioral factors that might explain this association. The Heart and Soul Study is a prospective cohort study of 1,018 outpatients with stable coronary heart disease. Participants were recruited between September 11, 2000, and December 20, 2002, and were followed up to June 2011. Baseline positive affect was assessed by using the 10-item positive affect subscale of the Positive and Negative Affect Schedule. Cox proportional hazards regression was used to estimate the risk of mortality (primary outcome measure) and cardiovascular events (heart failure, myocardial infarction, stroke, transient ischemic attack) associated with positive affect, adjusting for baseline cardiac disease severity and depression. We also evaluated the extent to which these associations were explained by potential biological and behavioral mediators. A total of 369 patients (36%) died during a mean ± SD follow-up period of 7.1 ± 2.5 years. Positive affect was not significantly associated with cardiovascular events (hazard ratio [HR]: 0.89; 95% CI, 0.79-1.00; P = .06). However, each standard deviation (8.8-point) increase in positive affect score was associated with a 16% decreased risk of all-cause mortality (HR: 0.84; 95% CI, 0.76-0.92; P = .001). After adjustment for cardiac disease severity and depressive symptoms, positive affect remained significantly associated with improved survival (HR: 0.87; 95% CI, 0.78-0.97; P = .01). The association was no longer significant after adjustment for behavioral factors, and particularly physical activity (HR: 0.92; 95% CI, 0.82-1.03; P = .16). Further adjustment for C-reactive protein and omega-3 fatty acids did not result in any meaningful changes (HR: 0.94; 95% CI, 0.84-1.06; P = .31). In this sample of outpatients with coronary heart disease, positive affect was associated with improved survival. This association was largely explained by physical activity.
    The Journal of Clinical Psychiatry 07/2013; 74(7):716-22. DOI:10.4088/JCP.12m08022 · 5.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Depression has been linked to adverse coronary artery disease outcomes. Whether depression treatment improves or worsens coronary artery disease prognosis is unclear. This 25-year systematic review examines medical outcomes, and, secondarily, mood outcomes of depression treatment among patients with coronary artery disease. Data Sources: We systematically reviewed the past 25 years (January 1, 1986-December 31, 2011) of prospective trials reporting on the medical outcomes of depression treatment among patients with established coronary artery disease using keywords and MESH terms from OVID MEDLINE. Search 1 combined depression AND coronary artery disease AND antidepressants. Search 2 combined depression AND coronary artery disease AND psychotherapy. Search 3 combined depression AND revascularization AND antidepressants OR psychotherapy. Study Selection: English-language longitudinal randomized controlled trials, with at least 50 depressed coronary artery disease patients, reporting the impact of psychotherapy and/or antidepressants on cardiac and mood outcomes were included. Data Extraction: Data extracted included author name, year published, number of participants, enrollment criteria, depression definition/measures (standardized interviews, rating scales), power analyses, description of control arms and interventions (psychotherapy and/or medications), randomization, blinding, follow-up duration, follow-up loss, depression scores, and medical outcomes Results: The review yielded 10 trials. Antidepressant and/or psychotherapy did not significantly influence coronary artery disease outcomes in the overall population, but most studies were underpowered. There was a trend toward worse coronary artery disease outcomes after treatment with bupropion. Conclusions: After an acute coronary syndrome, depression often spontaneously remitted without treatment. Post-acute coronary syndrome persistence of depression predicted adverse coronary artery disease outcomes. Antidepressant and/or psychotherapy, particularly as part of the Coronary Psychosocial Evaluation Studies intervention, may improve prognosis in persistent depression among post-acute coronary syndrome patients. Noradrenergic antidepressants should be prescribed cautiously in patients with coronary artery disease.
    10/2013; 15(5). DOI:10.4088/PCC.13r01509