Long-term follow-up of psychosocial distress after early onset preeclampsia:The Preeclampsia Risk EValuation in FEMales cohort study

Contains fulltext : 170899.pdf (Publisher’s version ) (Open Access)OBJECTIVE: To examine long-term psychosocial distress in women with a history of early onset preeclampsia (PE) compared to a comparison group. METHODS: Women with and without a history of early onset PE participating in the 'Preeclampsia Risk EValuation in FEMales' (PREVFEM) study were sent questionnaires, on average 14.1 years (SD = 3.2, range 5-23 years) after the index pregnancy. In total 265 (77%) women with PE and 268 (78%) age-matched women without PE returned questionnaires (mean age 43.5, SD =4.6 years). Group differences were examined on indicators of psychosocial distress, depressive symptoms, anxiety, fatigue, loneliness, marital quality, trait optimism and Type D personality, and unadjusted and adjusted for a priori chosen and study-specific covariates. In secondary analyses, the effect of previously detected hypertension was examined, as well as pregnancy-related events within the PE group. RESULTS: Women with a history of PE reported more subsequent depressive symptoms (B = 0.70, 95% CI 0.09-1.32, p = 0.026) and more fatigue (B = 1.12, 95% CI 0.07-2.18, p = 0.037) compared to the non-PE group, but the differences explained less than 1% of the variance. The differences remained after adjustment for age, BMI and education level, and additional adjustment for partner, being unemployed and physical activity. No significant differences were observed for anxiety, loneliness, marital quality, optimism, or Type D personality. These differences were not explained by four-year previously measured elevated blood pressure in the PE group. Having had a stillborn child or early neonatal death during the index pregnancy was associated with higher depressive symptoms, anxiety, fatigue, and loneliness in the PE group, but these factors explained only a small proportion of the variance in these psychosocial distress factors. CONCLUSION: A history of early PE is associated with slightly higher levels of depressive symptoms and fatigue on average 14 years later, but this is unlikely to be of clinical relevance

Psychosocial distress and health status as risk factors for ten-year major adverse cardiac events and mortality in patients with non-obstructive coronary artery disease

BackgroundWe examined the risk of psychosocial distress, including Type D personality, depressive symptoms, anxiety, positive mood, hostility, and health status fatigue and disease specific and generic quality of life for MACE in patients with non-obstructive coronary artery disease (NOCAD).MethodsIn the Tweesteden mild stenosis (TWIST) study, 546 patients with NOCAD were followed for 10 years to examine the occurrence of cardiac mortality, a major cardiac event, or non-cardiac mortality in the absence of a cardiac event. Cox proportional hazard models were used to examine the impact of psychosocial distress and health status on the occurrence of MACE while adjusting for age, sex, disease severity, and lifestyle covariates.ResultsIn total 19% of the patients (mean age baseline = 61, SD 9 years; 52% women) experienced MACE, with a lower risk for women compared to men. Positive mood (HR 0.97, 95%CI 0.95–1.00), fatigue (HR 1.03, 95%CI 1.00–1.06), and physical limitation (HR 0.99, 95%CI 0.98–1.00) were associated with MACE in adjusted models. No significant interactions between sex and psychosocial factors were present. Depressive symptoms were predictive of MACE, but no longer after adjustment.ConclusionsIn patients with NOCAD fatigue, low positive mood, and a lower physical limitation score were associated with MACE, without marked sex differences. Type D personality, psychosocial factors, and health status were not predictive of adverse outcomes. Reducing psychosocial distress is a valid intervention goal by itself, though it is less likely to affect MACE in patients with NOCAD

Anxiety and hemodynamic reactivity during cardiac stress testing:The role of gender and age in myocardial ischemia

Background The prevalence of myocardial ischemia is associated with anxiety. State and trait anxiety are more common in younger women compared to men, and high anxiety levels could affect hemodynamic reactivity during cardiac stress testing. The aim is to examine whether anxiety plays a role in gender differences in patients ≤ 65 and > 65 years in hemodynamic reactivity and ischemia during cardiac stress testing. Methods and results Included were 291 patients (66.8 ± 8.7 years, 45% women) with suspect ischemia undergoing myocardial perfusion single-photon emission computed tomography (MPI-SPECT). Primary outcomes were semi-quantitative summed difference score (SDS) and summed stress score (SSS), as continuous indicators of myocardial ischemia. Analyses were stratified by age. Trait anxiety was measured using a validated questionnaire (GAD-7) and state anxiety using facial expression analyses software. Overall, trait and state anxiety were not associated with the prevalence of ischemia (N = 107, 36%). A significant interaction was found between gender and trait anxiety in women ≤ 65 years for SDS (F(1,4) = 5.73, P = .019) and SSS (F(1,10) = 6.50, P = .012). This was not found for state anxiety. Conclusion SDS and SSS were significantly higher in women younger than 65 years with high trait anxiety. This interaction was not found in men and women over 65 years

Higher levels of psychological distress are associated with a higher risk of incident diabetes during 18 year follow-up:Results from the British Household Panel Survey

BACKGROUND: Reviews have shown that depression is a risk factor for the development of type 2 diabetes. However, there is limited evidence for general psychological distress to be associated with incident diabetes. The aim of the present study was to test whether persons who report higher levels of psychological distress are at increased risk to develop type 2 diabetes during 18 years follow up, adjusted for confounders. METHODS: A prospective analysis using data from 9,514 participants (41 years, SD=14; 44% men) of the British Household Panel Survey. The General Health Questionnaire 12 item version was used to assess general psychological distress, diabetes was measured by means of self-report. Cox proportional hazards regression models were used to calculate the multivariate-adjusted hazard ratio (HR) of incident diabetes during 18 years follow up, comparing participants with low versus high psychological distress at baseline (1991). RESULTS: A total of 472 participants developed diabetes 18 year follow up. Those with a high level of psychological distress had a 33% higher hazard of developing diabetes (HR=1.33, 95% CI 1.10–1.61), relative to those with a low level of psychological distress, adjusted for age, sex, education level and household income. After further adjustment for differences in level of energy, health status, health problems and activity level, higher psychological distress was no longer associated with incident diabetes (HR=1.10, 95% CI 0.91-1.34). CONCLUSIONS: Higher levels of psychological distress are a risk factor for the development of diabetes during an 18 year follow up period. This association may be potentially mediated by low energy level and impaired health status

The Psychophysiology of the burnout syndrome: cortisol sampling in burned out subjects.

Burnout symptoms of emotional exhaustion, depersonalisation and reduced personal accomplishment are the result of chronic stress. Specifically the hypothalamus pituitary adrenal (HPA)-axis is involved in long-term stress adaptation. Upon stimulation the HPA-axis releases cortisol from the adrenal medulla. Cortisol maintains the stress response and at the same time prevents overshoot of the stress response. The HPA-axis is interconnected with other regulatory systems involved in maintaining the energy balance, mood states, cognition, immunity, feeding and reproduction. A disrupted HPA-axis, with either hypo- or hyperfunctioning, could therefore act upon these systems, causing a whole array of different symptoms found in burnout individuals. The main goal of our study is to establish the occurrence of HPA-axis disregulation in burned out subjects. Burned out subjects are included before receiving treatment in a Dutch private health clinic. To date 40 burnout subjects (30 M) and 25 controls (18 M) have been included. The HPA-axis and burnout related questionnaires are sampled at the onset of treatment (T1), immediately after treatment (T2) and at follow up (T3) 6 months later. At each time point basic cortisol levels are measured non-invasively via cotton role saliva sampling. Daily sampling on two consecutive days includes the early morning rise (acute increase after awakening) and 3 further samples across the day. The dexamethason suppression test (0,5 mg o.d.) provides information on the negative feedback efficiency of the HPA-axis. A preceding pilot study on 22 burnout subjects (7 M, age 45 SD 8) and 21 controls (7 M, age 50 SD 7) has shown that the cortisol EMR level is lower for burnout subjects compared with the control group. The Early Morning Rise, and the day curve are not different. The burnout subjects also score sign. higher on the following questionnaires: SCl-90; general complaints, MBI; burnout, CIS-20; fatigue, BDI; depression, GSKS; sleep, CFQ; cognitive functioning. However a correlation between the cortisol data and the psychological complaints was not found. The first data of T1 sampling in the ongoing study will be shown

Psychosocial factors may serve as additional eligibility criteria for cardiovascular risk screening in women and men in a multi-ethnic population:The HELIUS study

Cardiovascular disease (CVD) prevention strategies include identifying and managing high risk individuals. Identification primarily occurs through screening or case finding. Guidelines indicate that psychosocial factors increase CVD risk, but their use for screening is not yet recommended. We studied whether psychosocial factors may serve as additional eligibility criteria in a multi-ethnic population without prior CVD. We performed a cross-sectional analysis using baseline data of 10,226 participants of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged 40-70 years, living in Amsterdam, the Netherlands. Using logistic regressions and Akaike Information Criteria, we analyzed whether psychosocial factors (educational level, employment status, occupational level, financial stress, primary earner status, mental health, stress, depression, and social isolation) improved prediction of high CVD risk (SCORE-estimated fatal and non-fatal CVD risk ≥5%) beyond eligibility criteria from history taking (smoking, obesity, family history of CVD). Next, we compared the additional predictive value of psychosocial eligibility criteria in women and men across ethnic groups, using the area under the curve (AUC). Of our sample, 32.7% had a high CVD risk. Only socioeconomic eligibility criteria (employment status and educational level) improved high CVD risk prediction (p &lt; .001 for likelihood-ratio tests). These increased AUCs in women (from 0.563 to 0.682) and men (from 0.610 to 0.664), particularly in Dutch, South-Asian Surinamese, African Surinamese and Moroccan women, and Dutch and Moroccan men. Concluding, socioeconomic eligibility criteria may be considered as additional eligibility criteria for CVD risk screening, as they improve detection of women and men at high CVD risk.</p

The psychophysiology of burnout

Burnout is characterized by emotional exhaustion, feelings of depersonalisation and reduced professional competence. It is an adverse health outcome to chronic work-related stress and insufficient recovery. The main aim of this thesis was to search for physiological disturbances in persons with severe burnout. HPA-axis function, salivary DHEAS, and in vitro immune function were investigated in clinically diagnosed burnout participants. Diagnosis was based on ICD-10 criteria for 'work-related neurasthenia' in combination with a semi-structured DSM-IV interview. Contrary to initial findings in a pilot-study, the cortisol awakening response (CAR), the cortisol decline during the day and cortisol suppression after a low-dose dexamethasone (DST) intake were not different in a burnout group compared to a healthy control group. The burnout related complaints; fatigue, depressive symptoms, sleep quality, and general psychopathology were significantly reduced after a treatment period, remained stable at follow-up but did not show complete recovery. There were no longitudinal changes in the CAR or DST and a small decline in the day-curve. A decrease in exhaustion and depression after treatment were related to a decrease and an increase respectively of the CAR after treatment and at follow-up, however this finding explained little variance of the changes between and within the burnout group. There were no other correlations with the complaints. The burnout group showed significantly higher DHEAS levels. Stimulated monocytes produced more of the anti-inflammatory cytokine IL-10 in burnout, but no change was observed in the pro- and anti-inflammatory cytokine (IFN-γ and IL-10 resp.) release by PHA-stimulated T-cells, nor in pro-inflammatory cytokine (TNF-α) release of LPS stimulated monocytes. No changes were observed in circulating T-cells, B-cells or NK-cells. In addition, the capacity of dexamethasone to regulate cytokine release in vitro was not different between the burnout and the control group. We conclude that there is no predictive or diagnostic value for cortisol in severe burnout. There may be a role for DHEAS. The increased IL-10 release by monocytes may be the basis of an increased sensitivity for common cold- or flu-like symptoms in burnout, however the HPA-axis does not appear to be involved