Graphical Models of Psychosocial Factors in Chronic Somatic Diseases

AbstractIn this paper we describe a graph, tree and forest model of psychosocial factors dependencies of chronically ill patients, called graphical models. Foundation of the study was the theory of meaningfulness of suffering by V. E. Frankl. 181 patients with either arterial hypertension or neoplasms with bad prognosis were examined thrice: 0-10 days from the time of diagnosis (stage I), about 5 weeks from the diagnosis (stage II) and at a follow-up about 5 months since stage II (stage III). 75 factors were available for consideration: 17 in stage I, 28 in stage II, 27 in stage III and 4 sets of data that describe populations: age, gender, education, number of stages executed. For both diseases graphs and trees are built under assumption that factors are vertices and significant correlations are edges, leading to model of dependencies between factors. Usefulness of this approach to analysis of difference between diseases is discussed

Graphical Models of Psychosocial Factors in Chronic Somatic Diseases

AbstractIn this paper we describe a graph, tree and forest model of psychosocial factors dependencies of chronically ill patients, called graphical models. Foundation of the study was the theory of meaningfulness of suffering by V. E. Frankl. 181 patients with either arterial hypertension or neoplasms with bad prognosis were examined thrice: 0-10 days from the time of diagnosis (stage I), about 5 weeks from the diagnosis (stage II) and at a follow-up about 5 months since stage II (stage III). 75 factors were available for consideration: 17 in stage I, 28 in stage II, 27 in stage III and 4 sets of data that describe populations: age, gender, education, number of stages executed. For both diseases graphs and trees are built under assumption that factors are vertices and significant correlations are edges, leading to model of dependencies between factors. Usefulness of this approach to analysis of difference between diseases is discussed

Comorbidities in the diseasome are more apparent than real: What Bayesian filtering reveals about the comorbidities of depression

Comorbidity patterns have become a major source of information to explore shared mechanisms of pathogenesis between disorders. In hypothesis-free exploration of comorbid conditions, disease-disease networks are usually identified by pairwise methods. However, interpretation of the results is hindered by several confounders. In particular a very large number of pairwise associations can arise indirectly through other comorbidity associations and they increase exponentially with the increasing breadth of the investigated diseases. To investigate and filter this effect, we computed and compared pairwise approaches with a systems-based method, which constructs a sparse Bayesian direct multimorbidity map (BDMM) by systematically eliminating disease-mediated comorbidity relations. Additionally, focusing on depression-related parts of the BDMM, we evaluated correspondence with results from logistic regression, text-mining and molecular-level measures for comorbidities such as genetic overlap and the interactome-based association score. We used a subset of the UK Biobank Resource, a cross-sectional dataset including 247 diseases and 117,392 participants who filled out a detailed questionnaire about mental health. The sparse comorbidity map confirmed that depressed patients frequently suffer from both psychiatric and somatic comorbid disorders. Notably, anxiety and obesity show strong and direct relationships with depression. The BDMM identified further directly co-morbid somatic disorders, e.g. irritable bowel syndrome, fibromyalgia, or migraine. Using the subnetwork of depression and metabolic disorders for functional analysis, the interactome-based system-level score showed the best agreement with the sparse disease network. This indicates that these epidemiologically strong disease-disease relations have improved correspondence with expected molecular-level mechanisms. The substantially fewer number of comorbidity relations in the BDMM compared to pairwise methods implies that biologically meaningful comorbid relations may be less frequent than earlier pairwise methods suggested. The computed interactive comprehensive multimorbidity views over the diseasome are available on the web at Co=MorNet: bioinformatics.mit.bme.hu/UKBNetworks

Impact of Multiple Factors on the Degree of Tinnitus Distress

Objective: The primary cause of subjective tinnitus is a dysfunction of the auditory system; however, the degree of distress tinnitus causes depends largely on the psychological status of the patient. Our goal was to attempt to associate the grade of tinnitus-related distress with the psychological distress, physical, or psychological discomfort patients experienced, as well as potentially relevant social parameters, through a simultaneous analysis of these factors. Methods: We determined the level of tinnitus-related distress in 531 tinnitus patients using the German version of the tinnitus questionnaire (TQ). In addition, we used the Perceived Stress Questionnaire (PSQ); General Depression Scale Allgemeine Depression Skala (ADS), Berlin Mood Questionnaire (BSF); somatic symptoms inventory (BI), and SF-8 health survey as well as general information collected through a medical history. Results: The TQ score significantly correlated with a score obtained using PSQ, ADS, BSF, BI, and SF-8 alongside psychosocial factors such as age, gender, and marital status. The level of hearing loss and the auditory properties of the specific tinnitus combined with perceived stress and the degree of depressive mood and somatic discomfort of a patient were identified as medium-strong predictors of chronic tinnitus. Social factors such as gender, age, or marital status also had an impact on the degree of tinnitus distress. The results that were obtained were implemented in a specific cortical distress network model. Conclusions: Using a large representative sample of patients with chronic tinnitus permitted a simultaneous statistical measurement of psychometric and audiological parameters in predicting tinnitus distress. We demonstrate that single factors can be distinguished in a manner that explains their causative association and influence on the induction of tinnitus-related distress

Depression and chronic diseases in old age : understanding their interplay for better health

Late-life depression is intricately linked with somatic diseases. This thesis aimed to systematically explore this complex interplay. Specifically, we investigated: 1) the symptom-level interconnectedness between depression and somatic diseases, 2) the association of depression with somatic multimorbidity accumulation, 3) the role of somatic disease burden in depression development, and 4) the association of somatic burden with transitions across depressive states in older adults. Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), a populationbased study comprising 3,363 individuals aged 60+ years who underwent clinical assessments over a 15-year follow-up. Study I. Using a network approach, we aimed to describe the interconnectedness between depressive symptoms and somatic disease burden in older people. We found that sadness, pessimism, anxiety, and suicidal thoughts were central to the network, whereas somatic symptoms of depression appeared peripherally with fewer interconnections. When examining the association between depressive symptoms and measures of somatic disease burden, we found that suicidal thoughts, reduced appetite, and cognitive difficulties were bridge symptoms, linking late-life depression with somatic health. Study II. We investigated the impact of depression severity and phenotypes (i.e., affective, anxiety, cognitive, and psychomotor) on the progression of somatic multimorbidity over 15 years. Compared to those without depression, individuals with major (β*year: 0.33, 95%CI: 0.06-0.61) and subsyndromal depression (β*year: 0.21, 95%CI: 0.12-0.30) presented an accelerated accumulation of somatic multimorbidity. An increase in the cognitive phenotype burden (and not in the other three) was associated with faster accumulation of somatic diseases in old age (β*year: 0.07, 95%CI: 0.03-0.10). Study III. We aimed to examine the association between quantitative and qualitative measures of somatic disease burden and the incidence of depression in older adults. Each additional somatic disease was associated with an increased hazard of depression over a 15-year follow-up (HR 1.16, 95%CI: 1.08-1.24). Individuals presenting with disease patterns of sensory/anemia (HR 1.91, 95%CI: 1.03-3.53), thyroid/musculoskeletal (HR 1.90, 95%CI: 1.06-3.39), and cardiometabolic patterns (HR 2.77, 95%CI: 1.40-5.46) had higher depression hazards compared to those without multimorbidity. In the subsample of multimorbid participants, the cardiometabolic pattern remained associated with a higher depression risk (HR 1.71, 95%CI: 1.02-2.84) compared to the unspecific pattern. Study IV. We examined the course of old-age depression by investigating 15-year transitions along the depressive continuum and exploring time-varying factors associated with specific transition patterns. Over the follow-up, 19.1% had ≥1 transitions across depressive states (no depression, subsyndromal depression [SSD], depression), while 6.5% had ≥2 transitions. A higher number of somatic diseases was associated with progression from no depression to both SSD (HR 1.09, 95%CI: 1.07-1.10) and depression (HR 1.06, 95%CI: 1.04-1.08), and with lower recovery rates from SSD (HR 0.95, 95%CI: 0.93- 0.97) and depression (HR 0.96, 95%CI: 0.93-0.99). A richer social network was linked to lower transition rates to depressive states (HRNoDep-SSD 0.81, 95%CI: 0.70-0.94; HRNoDep-Dep 0.58, 95%CI: 0.46-0.73; HRSSD-Dep 0.66, 95%CI: 0.44-0.98), and higher recovery rates (HRSSD-NoDep 1.44, 95%CI: 1.26-1.66; HRDep-NoDep 1.51, 95%CI: 1.34-1.71). Being physically active was associated with higher recovery rates (HRSSD-NoDep 1.49, 95%CI: 1.28-1.73; HRDep-NoDep 1.20, 95%CI: 1.00-1.44). Conclusions. Our findings suggest that several dimensions of complexity characterize the interconnection of depression and somatic disease burden in old age. A symptomlevel characterisation of depression, along with a consideration of subsyndromal severity, may help clarify the comorbidity of depression and somatic diseases, as well as predict health decline in people with depressive symptoms. Similarly, recognizing disease patterns may help improve risk stratification for depression development in clinically complex older adults. Last, the natural course of depression in late life is dynamic and involves complex patterns of transitions through symptom severities, which can be influenced by the time-varying burden of somatic diseases. Developing person-centered care that integrates these complexities could enhance resilience and contribute to better health in old age

Machine learning algorithms distinguish discrete digital emotional fingerprints for web pages related to back pain

Back pain is the leading cause of disability worldwide. Its emergence relates not only to the musculoskeletal degeneration biological substrate but also to psychosocial factors; emotional components play a pivotal role. In modern society, people are significantly informed by the Internet; in turn, they contribute social validation to a “successful” digital information subset in a dynamic interplay. The Affective component of medical pages has not been previously investigated, a significant gap in knowledge since they represent a critical biopsychosocial feature. We tested the hypothesis that successful pages related to spine pathology embed a consistent emotional pattern, allowing discrimination from a control group. The pool of web pages related to spine or hip/knee pathology was automatically selected by relevance and popularity and submitted to automated sentiment analysis to generate emotional patterns. Machine Learning (ML) algorithms were trained to predict page original topics from patterns with binary classification. ML showed high discrimination accuracy; disgust emerged as a discriminating emotion. The findings suggest that the digital affective “successful content” (collective consciousness) integrates patients’ biopsychosocial ecosystem, with potential implications for the emergence of chronic pain, and the endorsement of health-relevant specific behaviors. Awareness of such effects raises practical and ethical issues for health information providers

Determinants of female sexual function in inflammatory bowel disease: a survey based cross-sectional analysis

<p>Abstract</p> <p>Background</p> <p>Sexual function is impaired in women with inflammatory bowel disease (IBD) as compared to normal controls. We examined disease specific determinants of different aspects of low sexual function.</p> <p>Methods</p> <p>Women with IBD aged 18 to 65 presenting to the university departments of internal medicine and surgery were included. In addition, a random sample from the national patients organization was used (separate analyses). Sexual function was assessed by the Brief Index of Sexual Function in Women, comprising seven different domains of sexuality. Function was considered impaired if subscores were < -1 on a z-normalized scale. Results are presented as age adjusted odds ratios with 95% CI based on multiple logistic regression.</p> <p>Results</p> <p>336 questionnaires were included (219 Crohn's disease, 117 ulcerative colitis). Most women reported low sexual activity (63%; 17% none at all, 20% moderate or high activity). Partnership satisfaction was high in spite of low sexual interest in this group. Depressed mood was the strongest predictor of low sexual function scores in all domains. Urban residency and higher socioecomic status had a protective effect. Disease activity was moderately associated with low desire (OR 1.8, 95% CI 1.0 to 3.2). Severity of the disease course impacted most on intercourse frequency (OR 2.3, 95% CI 1.4 to 4.7). Lubrication problems were more common in smokers (OR 2.5, 95% CI 1.3 to 5.1).</p> <p>Conclusion</p> <p>Mood disturbances and social environment impacted more on sexual function in women with IBD than disease specific factors. Smoking is associated with lubrication problems.</p

Using network analysis to examine links between individual depressive symptoms, inflammatory markers, and covariates

Background   Studies investigating the link between depressive symptoms and inflammation have yielded inconsistent results, which may be due to two factors. First, studies differed regarding the specific inflammatory markers studied and covariates accounted for. Second, specific depressive symptoms may be differentially related to inflammation. We address both challenges using network psychometrics.   Methods   We estimated seven regularized Mixed Graphical Models in the Netherlands Study of Depression and Anxiety (NESDA) data (N = 2321) to explore shared variances among (1) depression severity, modeled via depression sum-score, nine DSM-5 symptoms, or 28 individual depressive symptoms; (2) inflammatory markers C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); (3) before and after adjusting for sex, age, body mass index (BMI), exercise, smoking, alcohol, and chronic diseases.   Results   The depression sum-score was related to both IL-6 and CRP before, and only to IL-6 after covariate adjustment. When modeling the DSM-5 symptoms and CRP in a conceptual replication of Jokela et al., CRP was associated with ‘sleep problems’, ‘energy level’, and ‘weight/appetite changes’; only the first two links survived covariate adjustment. In a conservative model with all 38 variables, symptoms and markers were unrelated. Following recent psychometric work, we re-estimated the full model without regularization: the depressive symptoms ‘insomnia’, ‘hypersomnia’, and ‘aches and pain’ showed unique positive relations to all inflammatory markers.   Conclusions   We found evidence for differential relations between markers, depressive symptoms, and covariates. Associations between symptoms and markers were attenuated after covariate adjustment; BMI and sex consistently showed strong relations with inflammatory markers

Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

Contains fulltext : 80758.pdf (publisher's version ) (Open Access)BACKGROUND: Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. METHODS: A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. RESULTS: GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. CONCLUSION: GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions