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The Head Stands Accused by the Heart! —Depression and Premature Death from Ischaemic Heart Disease

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Open Journal of Depression, 2014, 3, 33-40
Published Online May 2014 in SciRes. http://www.scirp.org/journal/ojd
http://dx.doi.org/10.4236/ojd.2014.32008
How to cite this paper: Thomson, W. (2014). The Head Stands Accused by the Heart! Open Journal of Depression, 3, 33-40.
http://dx.doi.org/10.4236/ojd.2014.32008
The Head Stands Accused by the Heart!
Depression and Premature Death from Ischaemic Heart Disease
Wendy Thomson
University of Bristol, School of Experimental Psychology, Bristol, UK
Email: wendyrthomson@btinternet.com
Received 10 February 2014; revised 18 March 2014; accepted 27 March 2014
Copyright © 2014 by author and Scientific Research Publishing Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/
Abstract
Background: The purpose of this study was to examine whether clinical depression was associated
with higher risk of premature death from ischemic heart disease (IHD). Risk for IHD was exam-
ined separately by sex and sub-type of depression in a long-term follow-up study spanning 49
years. Method: Patients who were diagnosed with depression in the Chichester/Salisbury Catch-
ment Area Study were followed for 49 years. Observed deaths from IHD prior to the age of 70 were
compared with rates that were predicted from historical data on mortality rates from 1960 on-
wards. Results: Significantly higher rates of death from IHD before the age of 70 were found
among males with endogenous depression. Conclusions: The results are discussed in terms of the
broader literature on mortality from natural causes among patients with clinical depression. In
terms of prevention, the results indicate that patients diagnosed with severe clinical depression
particularly men at the very least warrant risk assessment with regard to IHD.
Keywords
Severe Clinical Depression, Ischemic Heart Disease, Mortality, Longitudinal Study, Prospective, Sex
Differences, Risk Assessment
1. Introduction
Heart disease and depression are both very significant contributors to the global burden of mortality and morbid-
ity. WHO currently estimates that 7.3 million deaths are due to heart disease annually and that depression affects
350 million people globally in any one year. Mounting evidence from clinic-based and community samples
suggest that individuals suffering from severe depression are at increased risk for death from natural causes.
Higher rates of mortality from natural causes in depressed individuals have been found in large-scale commu-
nity-based investigations conducted in rural Canada (Murphy, Monson, Oliver, & Leighton, 1987), the United
W. Thomson
34
States (Bruce, Leaf, Rozal Florio, & Hoff, 1994; Kouzis, Eaton, & Leaf, 1995; Zheng, Macera, Croft, Giles,
Davis, & Scott, 1997), Norway (Mykletun, Bjerkeset, Øverland, Prince, Dewey, & Stewart, 2009), and the
United Kingdom (Surtees, Wainwright, Luben, Wareham, Bingham, & Khaw, 2008; Thomson, 1996; Thomson.
2011). In order to more fully understand the processes linking clinical depression with mortality, investigators
have examined the association of depression with specific diseases. Particular attention has been given to the re-
lationship of depression with death from cardiovascular illness. Systematic reviews and meta-analyses of re-
search suggest that depression substantially increases the risk of death from cardiovascular disease among indi-
viduals who initially do not show overt symptoms of cardiovascular impairment (Nicholson, Kuper, & He-
mingway, 2006; Rugulies, 2002; Wulsin, Evans, Ramachandran, Murabito, Kelly-Hayes, & Benjamin, 2005;
Wulsin, Valliant, & Wells, 1999), even when the effects of smoking, obesity, and other risk factors are con-
trolled (Surtees, Wainwright, Luben, Wareham, Bingham, & Khaw, 2008; Aromaa, Raitasalo, Reunanen, Im-
pivaara, Heiovaara, Knect, Lehtinen, Joukamaa, & Naatreka, 1994; Pratt, Ford, Crum, Armenian, Gallo, &
Eaton, 1996; Wulsin, & Singal, 2003). The present study will seek to increase our understanding of the associa-
tion between clinical depression and premature death from IHD by considering the degree to which the strength
of this relationship may differ by sex and depressive subtype, and by utilizing a long-term follow-up period
spanning 49 years.
The present study examines potential differences in the strength of the association between clinical depression
and IHD death by sex. While studies of depression as a risk factor for IHD often control sex differences in de-
pression and IHD, they rarely examine the possibility that the association between depression and IHD may be
stronger for men or for women. The preponderance of available evidence suggests that the effects of depression
and anxiety disorders on IHD mortality may be stronger for men than that for women (Murphy, Monson, Oliver
& Leighton, 1987; Aromaa, Raitasalo, Reunanen, Impivaara, Heiovaara, Knect, Lehtinen, Joukamaa, &
Naatreka, 1994; Coryell, Noyes, & Clancy, 1982; Haugland, Craig, Goodman, & Siegel, 1983; Hoyer, Mor-
tensen, & Olesen, 2000; Lawrence, Holman, Jablensky, & Hobbs 2003; Rorsman, 2007; Week & Vaeth, 1986),
although this finding has not been replicated in all studies (Angst, Stassen, Clayton, & Angst, 2002; Osby,
Brandt, Correia, Ekborn, & Sparen, 2011; Tsuang, Woolson, & Fleming, 1980).
The present study will also examine the possibility that certain types of depression are more closely associ-
ated with increased risk for premature death. In the broader literature on depression and premature death, higher
rates of death from natural causes have been found among patients with endogenous depression (Thomson,
1996), but not those with reactive depression. By contrast, in the literature on IHD mortality, potential differ-
ences in mortality between patients with reactive and endogenous forms of depression have not received atten-
tion. Rather, in IHD research, consideration of the heterogeneity of depression has focused on differences be-
tween unipolar and bipolar patients (Angst, Stassen, Clayton, & Angst, 2002), or differences in mortality associ-
ated with the duration or severity of depressive symptoms (Wulsin, Valliant, & Wells, 1999; Coryell, Noyes, &
Clancy, 1982).
The present study will focus on premature death from IHD mortality across an extended follow-up period. In
the context of trends in life expectancy and IHD mortality in the past 50 years, death from IHD before the age of
70 years merits attention. Between the 1970’s and 2000, mortality rates from IHD for individuals under the age
of 70 declined (Allender, Scarborough, O’Flaherty, & Capewell, 2008). To the extent that depression is associ-
ated with increased risk of premature death from IHD, we would expect to find that rates of IHD death among
depressed individuals are higher than the rate predicted by declining trends. To more adequately assess the in-
cidence of premature IHD death, and its association with depression, the present study will utilize an extended
follow-up period. Characteristically, investigations of IHD mortality have followed subjects for fewer than ten
years. However, initial investigations that have employed a longer follow-up period (Murphy, Monson, Oliver,
& Leighton, 1987; Angst, Stassen, Clayton, & Angst, 2002) suggest that the association between clinical depres-
sion and IHD mortality may span multiple decades. The present investigation will follow IHD deaths up to 49
years after the initial diagnosis of depression. Such an extended time frame enables the investigator to detect
such phenomena as premature IHD death in middle age among patients who have been diagnosed with depres-
sion in young adulthood. The focal hypotheses to be tested in the present investigation posit the following:
Hypothesis 1: Men with endogenous depression will be at higher risk of premature IHD death than men of
comparable age in the general population.
Hypothesis 2: The association between depression and premature IHD death will be stronger among patients
who have been diagnosed with endogenous than reactive depression.
W. Thomson
35
2. Methods
2.1. Participants and Procedures
The sample for the present study is a longitudinal extension of the one that was utilized in the Thomson (Thom-
son, 1996) 24-year follow-up study of depression and premature mortality. In the present work, the timeframe
for the investigation was extended from 24 to 49 years. Permission was granted to use the data collected by
Sainsbury and colleagues (Sainsbury, Walk, & Grad, 1966) to evaluate community care in two distinct health
authorities in England. The present study utilizes data from subjects who have been formally diagnosed with
depression by psychiatrists: clinical severity, rather than being categorized as depressed based on self-report
survey screening measures, thereby implying severity. The total population of patients referred to the two
catchment areas was 1413, of whom 685 were diagnosed as depressed (480 were diagnosed as having endoge-
nous depression, and 205 were diagnosed as having neurotic reactive depression). The mean age of patients with
reactive depression was 44 compared with 58 years for the patients with endogenous depression. Males formed
33.3% of the total cohort, with a mean age at referral of 58.1 years. Females formed 67.7% of the total popula-
tion, with a mean age at referral of 51.2 years. The theory that depression was either endogenous or reactive in
origin was still prevalent in 1960 when the original data was collected, this theory has since lost support. It is
now commonly believed that both environmental and genetic history play a part. Because the present study util-
ized actuarial information about age adjusted death rates, cases were included only if the date of birth and death
could be ascertained. In addition, cases younger than 16.5 years of age at the start of the study were not included.
Of the 685 cases that formed the original cohort, 566 were utilized for the present study based on the availability
of birth and death dates, as well as meeting the age criterion for inclusion.
2.2. Measures and Procedures
Four research psychiatrists made diagnoses of reactive and endogenous depression. A consultant to the research
unit then made an independent diagnosis of each case on a separate visit. The resulting diagnoses have been
found to be reliable and to possess high levels of diagnostic convergence (Kreitman, Sainsbury, Morriset, Tow-
ers, & Scrivener, 1961). Further information concerning the diagnostic procedures has been reported earlier
(Sainsbury, Walk, & Grad, 1966). The Chichester and Salisbury samples focused on patients with a primary di-
agnosis of depression, not depression secondary to physical illnesses such as IHD.
2.3. Endpoint
Information regarding the date and cause of death was collected through the National Health Service Register
(NHSCR). A protocol was submitted to the NHSCR to obtain permission to use these data in the study. Once the
protocol was accepted, information from each patient was put on two cards. One card was sent to the NHSCR
the other was retained. Records of each patient were returned, with the data and cause of death together with the
International Classification of Disease code. Cases were coded as IHD deaths using the same ICD codes as those
published by Allender and colleagues (Allender, Scarborough, O’Flaherty, & Capewell, 2008). Individuals
whose cause of death included IHD or IHD and another cause of death were counted as IHD Deaths.
2.4. Analysis
The present study compared observed IHD death rates in this cohort of patients with normative data from the
entire population of England and Wales that was collected by the Office of Populations and Surveys (OPCS) and
subsequently analyzed in a study of trends in IHD deaths in the past fifty years (Allender, Scarborough,
O’Flaherty, & Capewell, 2008). These tables provided information on the national rate of IHD death by age and
sex for each year of the study. Particular attention was given to death rates for individuals under the age of sev-
enty. For each year of the study, the expected number of deaths was computed based upon the distribution of
cases by age and sex.
3. Results
Analyses were conducted in two stages. Exploratory analyses examined the age of death from IHD and other
natural causes among men and women with reactive and endogenous depression, as well as the relative fre-
W. Thomson
36
quency of death from IHD and other natural causes among individuals under the age of seventy. These explora-
tory analyses suggest that premature IHD death may be more common among men with endogenous depression.
The main analyses of the present study examined the frequency of premature IHD death by sex and type of de-
pression in relation to expected levels of IHD death in the general population. Predicted and observed rates of
IHD death were compiled for each year of the study by sex for patients who were initially diagnosed as having
reactive or endogenous depression. Because almost all of the patients diagnosed with endogenous depression
had died or reached the age of seventy by the fortieth year of the study, a relatively small sample was available
between 2000 and 2009. Hence, the analyses focused on data from 1960 through 1999.
3.1. Exploratory Analyses
Exploratory analyses examined the timing of IHD death, and the relative incidence of IHD death, by sex and
type of depression. Table 1 shows the number of deaths from IHD and all other causes for men and women with
reactive and endogenous depression over the course of the forty-year follow-up. While deaths from IHD occur
frequently across all groups, the age of death from IHD is lower among men with endogenous depression (M =
69.5) than the age of death from other natural causes. Table 2 shows the number of deaths before the age of 70
from IHD and all other natural causes for men and women with reactive and endogenous depressives. IHD is the
leading cause of IHD death among men with endogenous depression: half of deaths arise from IHD. By contrast,
IHD accounted for only 18.7% of the premature deaths among women with endogenous depression, and 19% of
the premature deaths among men with reactive depression. While these findings are consistent with the view that
risk for premature death is higher among men with endogenous depression, more rigorous analysis is needed to
determine whether premature IHD death rates are higher in this group than in the general population. This ques-
tion will be addressed in the following section.
3.2. Main Analyses: Observed and Expected IHD Mortality Rates
The main analyses of the present study computed predicted IHD death rates before the age of 70 for this sample.
As described above, predicted death rates were computed based upon a published analysis of mortality data (Al-
lender, Scarborough, O’Flaherty, & Capewell, 2008). Table 3 shows the number of predicted and observed
deaths for reactive and endogenous depressives between 1960 and 1999. To determine whether the observed
frequency of deaths is significantly higher than the predicted frequency, the Poisson test (Rosner, 2005) was
employed. The null hypothesis stated that the observed frequency of deaths over this forty year period was the
same as a proportion of cases that would die in the general population based on the sex and age distribution of
the sample in each year of the study.
Consistent with Hypothesis 1, the association between depression and premature IHD death was stronger for
men than for women. The Standardized Mortality Ratio (SMR) for men was 1.97, while the SMR for women
was 1.15. Hypothesis 2 was partially supported. The incidence of IHD death was significantly higher than for
males with endogenous depression than it was for men of the same age. However, the incidence of IHD death
was not significantly higher for women with endogenous depression, or for patients with reactive depression.
4. Discussion
The results of the present study support the hypothesis that endogenous depression is associated with higher risk
for IHD among men. Men in this group have almost twice as much risk of dying from IHD before the age of
seventy than their counterparts in the general population. These findings further suggest that the pathways link-
ing depression and IHD mortality may vary depending upon sex and the type of depression: men with endoge-
nous depression were particularly prone to premature death from IHD. The finding of elevated levels of prema-
ture IHD mortality among men with endogenous depression is consistent with earlier findings of elevated IHD
mortality among men who have suffered from clinical depression (Murphy, Monson, Oliver, & Leighton, 1987;
Aromaa, Raitasalo, Reunanen, Impivaara, Heiovaara, Knect, Lehtinen, Joukamaa, & Naatreka, 1994; Coryell,
Noyes, & Clancy, 1982; Haugland, Craig, Goodman, & Siegel, 1983; Hoyer, Mortensen, & Olesen, 2000; Law-
rence, Holman, Jablensky, & Hobbs, 2003; Rorsman, 2007; Week & Vaeth, 1986), although it also raises the
question of whether failures to replicate this finding (Angst, Stassen, Clayton, & Angst, 2002; Osby, Brandt,
Correia, Ekborn, & Sparen, 2011; Tsuang, Woolson, & Fleming, 1980) might be explained in part by differ-
W. Thomson
37
Table 1. Lifespan by sub-type of depression, sex, and cause of death (excluding suicides).
Type of Depression Sex Cause of Death Lifespan (Years)
M SD n
Reactive Male IHD 71.9 10.91 7
Other 69.6 8.95 20
Female IHD 76.9 8.44 14
Other 74.7 10.47 34
Endogenous Male IHD 69.5 10.59 34
Other 75.1 10.12 83
Female IHD 77.5 9.57 35
Other 76.8 11.10 172
Table 2. Frequency of death before age of 70 from IHD and other natural causes by sub-type of depression and sex.
Type of Depression Sex
Cause of Death
IHD Other Natural Causes
n % n %
Reactive Male 2 19.2% 9 81.8%
Female 3 25.0% 9 75.0%
Endogenous Male 18 50.0% 18 50.0%
Female 6 18.7% 26 81.3%
Table 3. Observed and expected IHD deaths before age of 70 by type of depression and sex (40-year follow-up).
Type of Depression Sex Observed Expected p SMR
Reactive Male 2 2.49 0.710 0.80
Female 3 2.00 0.323 1.50
Endogenous Male 18 9.12 0.006 1.97
Female 6 5.23 0.424 1.15
ences in the sub-types of depression that are included in the study. The results of the present study suggest that
sex differences are not as evident among patients who would be characterized as having reactive depression. The
finding of elevated mortality among men with endogenous depression is also of interest given the findings of
research on death from natural causes in this cohort (Thomson, 2011). This broader study found that clinical de-
pression was associated with higher rates of premature mortality from natural causes for men and women, but
that this association was stronger for women than for men (Thomson, 2011). This pattern of findings suggests
that the linkage between depression, sex, and premature mortality from natural causes may differ depending
upon the specific cause of death that is under consideration. Premature death from IHD may be a greater concern
for depressed men, while levels of premature death from other natural causes may be more prevalent among de-
pressed women.
The results of the present study illustrate the value of using long-term follow-up periods to investigate the as-
sociation between depression and mortality from specific causes. The potential benefit to using a thirty or forty-
year follow-up period is the opportunity to record the causes of mortality for almost all of the members of a co-
hort, thereby gaining more data on the health consequences of depression (Murphy, Monson, Oliver, & Leighton,
1987; Angst, Stassen, Clayton, & Angst, 2002). Research conducted with briefer follow-up periods may under-
estimate the effects that chronic depression has on health problems that emerge decades after the initial diagno-
sis of depression is made.
The results of the present investigation suggest further directions for future research. A logical next step in
accounting for the connection between endogenous depression and premature IHD death among men would in-
W. Thomson
38
volve examining the incidence of IHD risk factors in this patient population. To the extent that men with en-
dogenous depression are more likely to engage in unhealthy behavior (excess eating, drinking, smoking; over-
eating and obesity; poor compliance prescribed medications or other treatments to address cholesterol levels),
the link between endogenous and depression and premature IHD death may be explained, and addressed by
these behavioral factors. While increased levels of these risk factors have been found among depressed indi-
viduals (Murphy, Monson, Oliver, & Leighton, 1987; Simon, Von Korff, Saunders, Miglioretti, van Belle, &
Kessler, 2006), further consideration could be given to the extent to which risk factors might be particularly high
for males with endogenous depression. In addition to health risk behaviors, cognitive and affective patterns as-
sociated with depression may have an adverse effect on cardiovascular functioning (Pratt, Ford, Crum, Arme-
nian, Gallo, & Eaton, 1996). A further potential line for investigation might consider the ways in which en-
dogenous depression and related stressors might have a direct physiological impact on cardiovascular function-
ing (Selye, 1956). Such research holds the potential of directing efforts at IHD prevention to depressed patients
through modifications in health-related behaviors and cognitions.
Several limitations of the present study should be noted. The associations found do not necessarily entail that
endogenous depression has a causal role in the etiology of IHD. An alternate explanation of the findings is that
the provision of health care for men with endogenous depression is less adequate than it is for the general popu-
lation (Lawrence, Holman, Jablensky, & Hobbs, 2003). Differential levels of care could possibly arise because
treatment focuses heavily on the symptoms of depression, rather than physical illnesses. In addition, among se-
verely depressed patients, physical symptoms may also be misattributed to depression (Mykletun, Bjerkeset,
Øverland, Prince, Dewey, & Stewart, 2009). A further limitation to the present study arises from regional dif-
ferences in IHD death rates. Because the sample of depressed patients in the present study was drawn from the
South of England, where IHD death rates are below the national average (Selye, 1956), the use of national IHD
death rates may slightly overestimate the expected IHD death rate in the non-depressed population. To the extent
that the predicted IHD death rate is over-estimated, the present study might slightly underestimate the associa-
tion between clinical depression and IHD. National IHD death rates were nonetheless used because they pro-
vided a more comprehensive view of trends in IHD death by age and sex over the past 50 years. A third major
limitation to the present study arises from the lack of information concerning participants’ health status prior to
death. We do not know whether depressed patients were more likely to have suffered from IHD attacks, or
whether they were simply less likely to survive and recover from IHD. As noted earlier, the data do not allow us
to control for the effects of other health behaviors and conditions that are often confounded with depression.
As noted the dichotomy that existed in 1960 between endogenous and reactive depression no longer has sup-
port nevertheless it is particularly interesting that these results do provide support for a dichotomy.
5. Conclusion
In summary, the results of the present study are consistent with those of other investigations that have found an
increased rate of premature IHD death among depressed individuals. The present study shows that the relation-
ship between depression and increased risk of premature IHD death holds when the assessment of depression is
based on a formal and rigorous psychiatric assessment, and when IHD mortality rates are established over an
extended follow-up period. The results of the present study further suggest that the associations between clinical
depression and premature IHD mortality should be considered in the context of sex and type of depression. Men
with endogenous depression appear to be at particularly elevated risk for premature death from IHD, and may be
in particular need of clinical interventions to assess and modify other IHD risk factors.
Acknowledgements
My sincere thanks to: Professor Peter Rogers Bristol University, Dr. Ian Thomson.
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Wulsin, L. R., Valliant, G. E., & Wells, V. E. (1999). A Systematic Review of the Mortality of Depression. Psychosomatic
Medicine, 61, 6-17.
Zheng, D, Macera, C. A., Croft, J. B., Giles, W. H., Davis, D. & Scott, W. K. (1997). Major Depression and All-Cause Mor-
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http://dx.doi.org/10.1016/S1047-2797(97)00014-8
... But what happens with people who suffer with depression? This question has been addressed by a study undertaken by the School of Experimental Psychology, University of Bristol (UK) (Thomson, 2014). ...
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The implementation of lockdown has proved to be one of the most high-profile and unpopular measures ever, and never more so when, for the first time in history, the Chinese government closed down one of its provinces, preventing the free movement of its inhabitants, and dictating that they remain locked in their homes, only to be allowed out to get food for themselves. These were unprecedented measures to date, but they were justified by the health authorities as a way to combat the spread of COVID-19, thereby reducing the possibility of infecting other people. Furthermore, in this way the rest of the country was ‘protected’ from the spread of the disease. A method which was also adopted by Italy when the number of infected rose uncontrollably, and later in many other countries, to a lesser or greater degree. Putting ourselves, for a moment, in the position of somebody in that particular locality, we realise that, overnight, measures have been put in place limiting our movements and confining us to our own home for days and days, without knowing for how long the situation will last, and even if the measures will prove effective. Furthermore, only those with financial resources or who work online will avoid the dilemma which others face, when their money runs out and they are unable to work because everything is closed. But this is the situation which millions of inhabitants have confronted for months, with the added uncertainty of not knowing how the virus is transmitted or whether they themselves are infected or not. An ongoing stressful situation which, dependent upon each individual’s psychological makeup, will affect each one differently, and which, in some cases, will have medium to long term consequences which will continue after lockdown is over. It is therefore predicted that a greater number of cases of depression or post -traumatic stress disorder will occur in this population, compared to those who did not have to undergo home confinement. Similar was observed in 2003, amongst those who isolated in cases of Severe Acute Respiratory Syndrome, which is from the same family as the coronavirus, and which causes severe pneumonia (Luna, 2020). Recommendations are therefore being made by international agencies and professional associations of psychologists, for the preservation of the mental health of those who have to be confined to their homes for months.
... Un comportamento assolutamente conforme alla cultura dei due paesi nei confronti delle malattie mentali, più aperto nei paesi anglosassoni, molto più travagliato in quelli mediterranei, in questo caso Greco, ove la persona che si reca da uno psicologo viene ancora vista con sospetto ed è oggetto di chiacchiere e pettegolezzi.Come affermano gli autori, c'è ancora molto lavoro da fare per sensibilizzare l'opinione pubblica sulla normalità del chiedere un supporto psicologico, soprattutto se si considera che negli ultimi dieci anni c'è stato un aumento significativo dei problemi di natura psichiatrica, anche tra il personale sanitario, come segnalato più volte dall'OMS.Pertanto, è necessario che la popolazione sia più consapevole del carico emotivo a cui è sottoposto un operatore sanitario e cominci a guardare con meno sospetto chi si reca da uno psicologo per farsi aiutare.. E' fondamentale che gli operatori sanitari, oltre a assistere e prendersi cura dei pazienti, si prendano cura anche di se stessi, al fine di non piombare in uno stato ansioso o nell'esaurimento nervoso con i gravi sintomi che depersonalizzazione e problemi di auto-stima, da non confondersi con i sintomi della depressione vera e propria che sono il pianto facile, la disperazione, il senso di colpa, i disturbi del sonno, i sintomi psico-somatici, i pensieri suicidi, il grave affaticamento e l'irritabilità. A questo punto sorge spontanea la domanda: ma in che modo lo stress incide sulla salute dell'individuo?Questo è ciò a cui la School of Experimental Psychology dell'Università di Bristol (Inghilterra)(Thomson, 2014) ha cercato di rispondere, mediante uno studio a cui hanno partecipato 1413 persone, di cui 785 avevano sofferto di depressione ( 480 endogeni e 205 reattivi), con età media tra i 44 e i 58 anni, e di cui il 67,7% erano donne. Come gruppo di controllo, sono stati utilizzati i dati del Registro del National Health Service (in Inghilterra), da cui sono statei attinti i dati riguardanti il numero di infarti e il tasso di sopravvivenza delle persone della stessa età. ...
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In seguito al successo del libro intitolato "Aspetti psicologici nei tempi della pandemia", in cui vengono affrontati temi relativi all’impatto del virus COVID-19 sulla vita dei cittadini dal punto di vista psicologico, e sulla base dell’espressa richiesta da parte dei lettori di un testo incentrato sul personale sanitario, ho deciso di scrivere questo libro. L'obiettivo è quello di offrire informazioni aggiornate sugli aspetti psicologici di quello che è stato descritto come il primo fronte di battaglia contro l'avanzata del COVID-19 dal punto di vista della psicologia scientifica, con precisi riferimenti alle ultime pubblicazioni a riguardo alla fine del libro. Una visione rigorosa e aggiornata sui contributi della scienza della psicologia espressa in modo accessibile a tutti, con l'obiettivo di aiutare a comprendere l'impatto emotivo di questa situazione nell’ambito del personale sanitario, nonché le sue conseguenze presenti e future.
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Os processos cognitivos são aqueles que permitem tratar a informação sensorial, tanto externa, como interna, percebê-la e analisá-la, para dar uma resposta adequada, processo que se complica, quando se incorporam outros como a memória, a atenção, a emoção ou a aprendizagem. Cada um destes processos vai ser objeto de estudo por parte da neuropsicologia, dependendo do trauma ou doença que se está analisando, assim existem transtornos que vão ter uma maior incidência sobre a atenção como o Transtorno do Deficit de Atenção com ou sem Hiperatividade ou outros que afetam principalmente a memória (Doença de Alzheimer), daí a importância de explorá-los para acompanhar a evolução do processo ou processos afetados, o que informará sobre a evolução da doença ou trauma. Os processos cognitivos são os que "dão sentido" ao cérebro e o permite desenvolver, especializando-se em diferentes áreas de processamento, em função da tarefa que realizam, tudo sustentado em um cérebro único e irrepetível, moldado pela relação entre a genética e o ambiente. As bases disto são conhecidas, tanto dos sentidos, como das vias que estas seguem ao transmitir a informação até o cérebro, e dentro do mesmo as estruturas que intervem na sua análise em função do significado que vem. Informação que é processada e elaborada ao passar no filtro de atenção e se tornar consciente, podendo ser reelaborada na memória de trabalho, juntando a informação já registrada nos traços de memória existente, tudo isso para completar o processo de aprendizagem. Embora este mecanismo seja comum para todos, ele pode variar em função do nível de desenvolvimento intelectual, desde a infância, quando estão sendo desenvolvidas estas habilidades, pode-se começar a observar...
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In light of the very positive reception to the article entitled “Cual es el papel del psicólogo ante el nuevo Coronavirus (COVID-19)?” (“What is the role of psychology in the face of the new Coronavirus (COVID-19)?”) published in La Cátedra Abierta de Psicología y Neurosciencias on 12th February 2020, and the general interest evoked amongst fellow psychologists and other people with an interest in psychology, I have decided to produce this book, which addresses the subject of the psychological perspective in times of a pandemic. Despite the fact that information concerning health crises such as COVID-19 is very recent and in some cases quite changeable, I am going to present a work based on current data sourced principally from scientific publications, and which will include, from the same sources, statements from various experts. A book accessible to all who wish to delve into the psychological aspects of a mass phenomenon in times of a health crisis, as in the case of COVID-19.
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Embora o confinamento possa ser uma das medidas mais midiáticas e até impopulares, especialmente quando pela primeira vez na história o governo chinês fechou uma de suas províncias, impedindo a livre circulação de seus habitantes e ordenando que eles se trancassem em suas casas, permitindo que saíssem apenas para conseguir comida. Situação sem precedentes até o momento, mas justificada pelas autoridades de saúde como forma de combater a expansão da COVID-19 e, assim, reduzir a possibilidade de infectar outros cidadãos. Além disso, dessa forma, o restante do país é "protegido" da expansão da doença. Medida adotada pela Itália quando o número de afetados cresceu incontrolavelmente e, depois, por muitos outros países, com mais ou menos restrições. Se nos colocarmos no lugar de um cidadão comum dessa localidade, perceberemos o que significa, noite para o dia, ficar limitado em seus deslocamentos, trancado em sua própria casa por dias, sem saber quanto a situação vai durar ou se essa medida é eficaz. Além disso, somente quem tem recursos financeiros e até quem trabalha on-line não enfrenta o dilema de como pagar as contas depois de ficar sem o pouco dinheiro que tem, já que de nenhuma maneira será possível ir trabalhar, porque está tudo fechado. Pelo menos essa é a situação que milhões de habitantes viveram por meses, com a incerteza adicional de não saber como o vírus é transmitido e se eles próprios estão infectados ou não. Uma situação de estresse mantida ao longo do tempo, que marcará cada um de maneira diferente em virtude de suas próprias características psicológicas, que em alguns casos trará consequências de médio e longo
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Sicuramente il confinamento a casa è stata una delle misure più mediatiche e persino impopolari, soprattutto se si considera che per la prima volta nella storia il governo Cinese ha chiuso una delle sue province, impedendo la libera circolazione dei suoi abitanti e imponendo che rimanessero chiusi a casa con la possibilità di uscirne solo per fare la spesa. Situazione senza precedenti fino ad oggi, ma giustificata dalle autorità sanitarie come un modo per combattere il contagio da COVID-19 e quindi ridurre la possibilità di infettare la popolazione, una misura che è stata adottata in misura più o meno totale da molti Stati da quando il numero della popolazone mondiale infetta è cresciuto in modo incontrollato, passando da pochi casi a centinaia o migliaia. Il confinamento in casa era stato già preceduto dalla chiusura dei centri educativi e da un'altra misura, quello dello smart working, che ha fatto sì che ove possibile le persone lavoprassero da casa in modo da ridurre ulteriormente le occasioni di uscire ma nel contempo non abbattendo del tutto l'economia del paese. All'opposto, mentre la maggioranza della poplazione veniva confinata in casa, il personale sanitario non solo continuava a lavorare ma anzi ne veniva reclutato di nuovo, per far fronte al numero crescente di contagiati e per evitare il collasso del sistema sanitario nazionale. Nonostante il fatto che gli operatori non abbiano subito gli effetti della reclusione forzata, tutto il personale era ben consapevole della situazione, in quanto la vivevano quotidinamante i propri parenti e amici che non solo non potevano uscire di casa, ma addirittura in alcuni casi non potevano approbigionarsi di materie prime o sopravvivere, se non erano di quelli che
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Il confinamento è stato una delle misure più mediatiche e persino impopolari, soprattutto quando per la prima volta nella storia il governo cinese ha chiuso una delle sue province, impedendo la libera circolazione dei suoi abitanti e imponendo che si chiudessero nelle loro case e permettendo loro di uscire solo per procurarsi da mangiare. Situazione senza precedenti fino ad oggi, ma che è giustificata dalle autorità sanitarie come un modo per combattere l'espansione del COVID-19 e quindi ridurre la possibilità di infettare altri cittadini, inoltre, in questo modo, il resto del paese è "protetto" dall'espansione dello stesso. Una misura adottata dall'Italia quando il numero delle persone colpite è cresciuto in modo incontrollato, e a seguire da molti altri paesi con più o meno restrizioni. Se ci mettiamo nei panni di un comune cittadino di quella città, realizzeremo cosa significa che dal giorno alla notte uno si trovi limitato nei suoi viaggi, chiuso in casa per giorni e giorni, senza sapere quanto la situazione durerà e nemmeno se sarà efficace. Inoltre, solo coloro che hanno risorse finanziarie e chi lavora online possono sentirsi sollevati dalla situazione di dover affrontare il dilemma su come pagare una volta esauriti i pochi soldi messi via, poiché in nessun modo saranno in grado di andare al lavoro, dal momento che è tutto chiuso. Almeno questa è la situazione che milioni di abitanti hanno vissuto per mesi, con l'ulteriore incertezza di non sapere come viene trasmesso il virus e se essi stessi sono infetti o meno. Una situazione di stress mantenuta nel tempo, che segnerà ognuno in modo diverso in virtù delle proprie caratteristiche psicologiche, che in alcuni
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Dopo la grande accoglienza dell`articolo intitolato ”Qual è il ruolo dello psicologo di fronte al nuovo virus?” che ho pubblicato su Cátedra Abierta de Psicología y Neurociencias lo scorso 12 febbraio 2020, e dato l`interesse suscitato tra colleghi psicologi e altre persone interessate alla psicologia, ho deciso di scrivere questo libro in cui viene affrontato l`argomento della prospettiva psicologica in tempi di pandemia. Nonostante le informazioni sulle crisi sanitarie siano molto recenti, e in alcuni casi ”mutevoli”, presenterò il lavoro basato su dati attuali e soprattutto su pubblicazioni di natura scientifica, che includeranno anche dichiarazioni di diversi esperti raccolti attraverso i mezzi di comunicazione debitamente citati. Un libro accessibile a tutti coloro che vogliano approfondire gli aspetti psicologici di un fenomeno di massa in tempi di crisi sanitaria e di pandemia.
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Afterward the successful on reception of the book “Psychological Aspects in Times of Pandemic” where a number of issues from the perspective of psychological science are addressed, related to the impact of the appearance COVID-19 on the lives of citizens, and afore readers insistent request for a text focused on healthcare personnel, from there came this book The purpose of it is to offer updated information on the psychological aspects of whom have been described as the battlefront against the advance of COVID-19 from a perspective of scientific psychology, for which reference will be made to the latest publications in this regard. A rigorous and up-to-date vision on the contributions of the science of psychology told in a way accessible to everyone, with the aim of helping to understand the emotional impact of this situation on health personnel, as well as the present and future consequences of the same.
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Untersuchungen am Gehirn waren schon immer ein fester Bestandteil der Wissenschaft. Hinweise darauf reichen bis in die Zeit der Ägypter zurück, die Spuren von Trepanationen im Schädel hinterließen, die sie durchführten, um den Patienten von seinen Problemen zu "befreien", eine Praxis, die bis zur Entwicklung der Medizin als Wissenschaft beibehalten wurde (Collado-Vazquez & Carrillo, 2014). Die ersten anatomisch-deskriptiven Studien an postmortalen Gehirnen erlaubten die Differenzierung von Hirnlappen, Furchen und Spalten auf der Ebene der Hirnrinde und die Identifizierung subkortikaler Strukturen, die trotz der geringen Größe einiger Gehirne sichtbar waren. Die Entwicklung des Mikroskops ermöglichte die Entdeckung der Histologie, auch als mikroskopische Anatomie bekannt, wodurch man schließlich beginnt, die Zellen des Gehirns zu studieren, um sie später zu klassifizieren und die Regionen zu bestimmen, in denen sie am häufigsten auftreten. Dank von Verfärbungen und Kontrasten, wie z.B. mit Goldchlorid oder Silberchromat ist es gelungen, die Struktur der Schichten sowie die Formen der sich in den Schichten befindenden Neuronen zu skizzieren. Mit elektronischen Mikroskopen, die eine fünftausendmal höhere Auflösung als optische Mikroskope haben, ist es heute möglich, Mitochondrien, den Golgi-Apparat und andere innere Strukturen von Neuronen sowie Proteinen zu beobachten (@rafaelsolana2, 2020) (siehe Abbildung 1).
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Depression is reported to be associated with increased mortality, although underlying mechanisms are uncertain. Associations between anxiety and mortality are also uncertain. To investigate associations between individual and combined anxiety/depression symptom loads (using the Hospital Anxiety and Depression Scale (HADS)) and mortality over a 3-6 year period. We utilised a unique link between a large population survey (HUNT-2, n = 61 349) and a comprehensive mortality database. Case-level depression was associated with increased mortality (hazard ratio (HR) = 1.52, 95% CI 1.35-1.72) comparable with that of smoking (HR = 1.59, 95% CI 1.44-1.75), and which was only partly explained by somatic symptoms/conditions. Anxiety comorbid with depression lowered mortality compared with depression alone (anxiety depression interaction P = 0.017). The association between anxiety symptom load and mortality was U-shaped. Depression as a risk factor for mortality was comparable in strength to smoking. Comorbid anxiety reduced mortality compared with depression alone. The relationship between anxiety symptoms and mortality was more complex with a U-shape and highest mortality in those with the lowest anxiety symptom loads.
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• A 16-year prospective study of a general population sample indicates that those who had reported a depression and/or anxiety disorder at baseline experienced 1.5 times the number of deaths expected on the basis of rates for a large reference population. As part of the Stirling County Study (Canada), the information was gathered from 1003 adults through structured interviews and was analyzed by means of a diagnostic computer program. The risk for mortality was assessed using external and internal standards, controlling for the effects of age and sex as well as for the presence of self-reported physical disorders at baseline. Increased risk was found to be significantly associated with affective but not physical disorders and with depression but not generalized anxiety. When this evidence about mortality was combined with information about subsequent psychiatric morbidity among survivors, 82% of those who were depressed at baseline had a poor outcome.
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• We located 113 former inpatients with panic disorder 35 years after index admission. According to age-and sex-specific Iowa population figures, patients with panic disorder had significant excess mortality due to death by unnatural causes. Other studies suggest that secondary depression and alcoholism may have had a role in these deaths. Men with panic disorder also exhibited excess mortality due to circulatory system disease. In an age-and sex-matched patient group with primary unipolar depression, both men and women showed excess mortality. Suicide accounted for 20.0% and 16.2% of deaths in the panic disorder and primary depression groups, respectively. We conclude that panic disorder accounted for much of the excess mortality formerly noted in the "neuroses."
Article
The object of this study was to discover if a mortality study could distinguish between reactive/neurotic and endogenous depression; a reoccurring concern. Research has so far been inconclusive and psychiatrists still use the two diagnoses; reactive and endogenous depression. A method was designed using a cohort selected 24 years previously and that followed the strict criteria of a Medical Research Unit in the U.K. Each patient was given the diagnosis of either reactive or neurotic at that time. The cohorts were followed prospectively for 24 years. The results were computed to test the statistical significance of premature mortality for both diagnosis and to compare the results with a control group. The results showed endogenous depression was associated with premature mortality, from both natural and unnatural death, particulary in the years immediately after discharge. The results give some support to the distinction between endogenous and reactive depression, and demonstrate that a diagnosis of endogenous depression is related to a higher risk of premature mortality in some patients.
Article
Numerous studies have shown higher rates of death from natural causes in the years immediately following an episode of clinical depression. The longer term relationship of depression to excess mortality is less clear because relatively few studies have followed the same cohort of patients for more than 10 years. The present paper reports on the findings following the same cohort of patients 49 years after discharge. Patients who were diagnosed with depression in the Chichester/Salisbury Catchment Area Study were followed for 49 years. The incidence of death from natural causes in the clinical population was compared with population rates adjusted for age and sex. The results suggest that clinical depression may have enduring effects on physical health that emerge later in life, the significance of which have so far remained undetected. Further analyses of death rates by age and sex suggest that: a.) Depression has a stronger impact on mortality among women. b.) Excess mortality starts to emerge at an earlier age among women. Because prior studies of depression and mortality have typically followed patients for fewer than 25 years, the long-term impact of major depression has remained undetected. The results are consistent with the view that depression has a negative impact on health that spans multiple decades. The association between mortality and depression could arise if prolonged treatment with antidepressant medication increases mortality. The association found between depression and mortality might also reflect differences in the quality of medical care that is provided to clinically depressed individuals. The present study does not control for factors that are confounded with depression (e.g., diet, exercise), nor does it utilize a matched control group. The pathways linking depression and mortality are likely to be complex and multifactorial in nature. The major implication of the present work is to suggest that such pathways link depression with long-term, as well as short-term differences in mortality.
Article
The mortality of all patients seen at the Department of Psychiatry, the General Hospital in Lund, Sweden during 1962 was studied for the years 1962–1968. The number of deaths was 260. The expected number of deaths in a corresponding sample of the general population was 159. The mortality was significantly increased in both men and women. The ratio between observed and expected mortality was highest in the younger age groups. The overmortality was due mainly to an increased number of suicides, accidents and nervous and circulatory diseases in the men and suicide and cancer in women. The patients who died were compared with a randomized subsample of psychiatric patients sill alive at the end of the observation time. The items chosen for comparison were social and medical factors previously found to be related to mortality. The purpose was to try to recognize high risk groups within the psychiatric population. Divorced persons were more common among those who died than among controls, and more males who died were living along, unemployed or invalid pensioners. Mortality seemed to be independent of type of care in 1962 in terms of hospitalization and out-patient contact. Differences found in psychiatric services by those who had died and controls before and after 1962 were of low significance. The one outstanding psychiatric diagnosis among those who died was the organic brain syndrome. Alcoholism was more common among men who died accidental deaths compared with controls. More than 50% of the patients who committed suicide had previously attempted suicide. A high proportion of those who died were hospitalized in somatic wards and sent to the psychiatric out-patient department for psychiatric assessment. Common reasons for referral were recently attempted suicide and pain, often of unknown origin.