Socio- Demographic, Clinical and Lifestyle Determinants of Low Response Rate on a Self- Reported Psychological Multi-Item Instrument Assessing the Adults’ Hostility and its Direction: ATTICA Epidemiological Study (2002-2012)

Background: Missing data constitutes a common phenomenon, especially, in questionnaire-based, population surveys or epidemiological studies, with the statistical power, the efficiency and the validity of the conducted analyses being significantly affected by the missing information. The aim of the present work was to investigate the socio-demographic, lifestyle and clinical determinants of low response rate in a self- rating multi-item scale, estimating the individuals’ hostility and direction of hostility.Methods: 3042 apparently healthy volunteers residing in the Athens metropolitan area participated in the ATTICA epidemiological study [1514 (49.8%) were men [46 years old (SD= 13 years)] and 1528 (50.2%) were women [45 years old (SD= 14 years)]]. Hostility and Direction of Hostility was assessed with the Hostility and Direction of Hostility (HDHQ) scale. Binary logistic regression with backward model selection was used in order to identify the key demographic, clinical and lifestyle determinants of higher non-response rate in the HDHQ scale.Results: The vast majority of the participants (87.0%) had missing information in the HDHQ scale. Older age, lower educational level, poorer health status and unhealthy dietary habits, were found to be significant determinants of high nonresponse rate, while female participants were found to be more likely to have missing data in the items of the HDHQ scale.Conclusions: The present work augments prior evidence that higher non-response to health surveys is significantly affected by responders’ background characteristics, while it gives rise to research towards unrevealed paths behind this claim

H εκδήλωση του μεταβολικού συνδρόμου σε σχέση με το γνωσιακό-συμπεριφορικό μοντέλο: ο ρόλος του τρόπου ζωής και ψυχολογικών διαταραχών

Background/Aim: Cardio-metabolic conditions (i.e., metabolic syndrome (MetS) and cardiovascular diseases (CVDs) are the primary cause of death around the world even though they are often preventable. This thesis proposes that psychological theories, derived from the Cognitive-Behavioural Therapy and the Rational-Emotive Behavioural Therapy (CBT/REBT) models can explain the onset of MetS and CVD, taking into consideration the primary role of their core construct, namely irrational beliefs, directly through neurochemical and biochemical dysregulation, and/or through dysfunctional emotions and behaviours. Therefore, given that cardio-metabolic disorders are extremely complex, the purpose of this thesis is to better explain their development taking irrational beliefs into consideration and specifically, to examine whether MetS could play a mediating role in the potential relationship between irrational beliefs and CVDs. Another goal is to fill current gaps in knowledge and inform future directions for public health, which could eventually include bio-psychosocial interventions for individuals at high risk for cardio-metabolic diseases in first-choice interventions. Material and Methods: 853 participants without a history of CVD [453 men (aged 45±13 years) and 400 women (aged 44±18 years)] from the ATTICA study (2002-2012) underwent psychological evaluations. Detailed biochemical, clinical, and lifestyle evaluations were performed, while participants’ irrational beliefs, anxiety, depression and hostility were assessed using the Irrational Beliefs Inventory (IBI, range 0-88), the Spielberger State-Trait Anxiety Inventory (STAI, score 20-80), the Zung Self-Rating Depression Scale (ZDRS, score 20-80) and the Hostility and Direction of Hostility Questionnaire (HDHQ, score 0-55), respectively. Incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria. Univariable and multivariable logistic regression was applied to estimate the risk of developing MetS and CVDs and to control for confounders, as well as stratified logistic regression to detect moderator effects. Results: Mean IBI score was 53±2 in men and 53±3 in women (p=0.88). High IBI was associated with 1.5-times higher odds of developing MetS than low IBI. Additionally, participants with high IBI and high STAI were 96% more likely to develop MetS, compared with those with low IBI and low or high STAI (OR 1.96; 95% CI 1.01, 3.80). IBI score was also positively associated with 10-year CVD risk (HR 1.07, 95%CI 1.04, 1.13), in both men and women. Also, participants with high irrational beliefs and anxiety symptoms had a 138% greater risk of developing CVD during the 10-year follow-up (2.38; 95%CI 1.75, 3.23) as compared to those without anxiety. Preliminary findings from the recent 20-year follow-up revealed that participants with high levels of IBI were at higher risk of developing CVD during a 20-year follow-up period, compared to participants with low endorsement (HR 1.10, 95%CI 1.05 1.14). Lastly, lower education status, MetS, anxiety and depression moderated the relationship between irrational beliefs and CVD risk, whereas dietary habits away from the Mediterranean diet, smoking, hypertension, hypercholesterolemia, T2DM, MetS, C-reactive protein (CRP), interleukin-6 (IL-6) and total antioxidant capacity (TAC) were mediators in the tested relationships. Conclusions: Findings from this thesis advance psychological research in the area of primary and secondary prevention of mental health and cardio-metabolic conditions since they underline the important role of irrational beliefs for the first time in the literature and the need to build new, holistic approaches in order to better understand the inter-relationships between psychological, lifestyle, and biological determinants in CVD risk.Εισαγωγή/Σκοπός: Τα καρδιο-μεταβολικά νοσήματα (δηλαδή, το μεταβολικό σύνδρομο (ΜετΣ) και τα καρδιαγγειακά νοσήματα (ΚΑΝ) είναι η κύρια αιτία θανάτου σε όλο τον κόσμο, παρόλο που συχνά μπορούν να προληφθούν. Η παρούσα διατριβή προτείνει ότι οι ψυχολογικές θεωρίες που προέρχονται από τα μοντέλα της Γνωσιακής-Συμπεριφορικής Θεραπείας και της Λογικό-θυμικής Συμπεριφορικής Θεραπείας μπορούν να εξηγήσουν την εμφάνιση του ΜετΣ και των ΚΑΝ, λαμβάνοντας υπόψη τον πρωταρχικό ρόλο της βασικής τους δομής, δηλαδή των παράλογων πεποιθήσεων, είτε απευθείας μέσω νευροχημικής και βιοχημικής δυσλειτουργίας είτε μέσω δυσλειτουργικών συναισθημάτων και συμπεριφορών. Δεδομένου ότι οι παραπάνω καρδιο-μεταβολικές καταστάσεις είναι εξαιρετικά περίπλοκες, σκοπός αυτής της διατριβής είναι να διερευνήσει την ανάπτυξή τους, λαμβάνοντας υπόψη τις παράλογες πεποιθήσεις, και συγκεκριμένα, να εξετάσει εάν το ΜΣ θα μπορούσε να διαδραματίσει μεσολαβητικό ρόλο στην πιθανή σχέση μεταξύ παράλογων πεποιθήσεων και ΚΑΝ. Ένας άλλος στόχος είναι να καλυφθούν τα τρέχοντα κενά στη γνώση και να γνωστοποιηθούν μελλοντικές κατευθύνσεις για τη δημόσια υγεία, οι οποίες θα μπορούσαν τελικά να περιλαμβάνουν βιο-ψυχοκοινωνικές παρεμβάσεις για άτομα υψηλού κινδύνου για καρδιο-μεταβολικά νοσήματα σε παρεμβάσεις εκλογής. Υλικό και Μέθοδοι: 853 συμμετέχοντες χωρίς ιστορικό ΚΑΝ [453 άνδρες (ηλικίας 45±13ετών) και 400 γυναίκες (ηλικίας 44±18 ετών)] που συμμετείχαν στη μελέτη ΑΤΤΙΚΗ, υποβλήθηκαν σε ψυχολογικές αξιολογήσεις και παρακολουθήθηκαν για 10έτη (2002-2012), αποτελούν το δείγμα της παρούσας μελέτης. Πραγματοποιήθηκαν βιοχημικές, κλινικές αξιολογήσεις και καταγραφή του τρόπου ζωής, ενώ οι παράλογες πεποιθήσεις, το άγχος, η κατάθλιψη και η εχθρότητα αξιολογήθηκαν χρησιμοποιώντας το ερωτηματολόγιο αυτό-αναφοράς για τις παράλογες πεποιθήσεις (IBI, εύρος βαθμολογίας 0-88), το ερωτηματολόγιο άγχους του Spielberger (STAI, εύρος βαθμολογίας 20-80), την κλίμακα αυτό-αξιολόγησης της κατάθλιψης τους Zung (ZDRS, εύρος βαθμολογίας 20-80) και το ερωτηματολόγιο εχθρότητας και κατεύθυνσης της εχθρότητας (HDHQ, εύρος βαθμολογίας 0-55), αντίστοιχα. Η επίπτωση των ΚΑΝ ορίστηκε σύμφωνα με τα κριτήρια της Διεθνούς Στατιστικής Ταξινόμησης Νόσων και Συναφών Προβλημάτων Υγείας ICD-10. Εφαρμόστηκε μονομεταβλητή και πολυμεταβλητή λογιστική παλινδρόμηση για την εκτίμηση του κινδύνου ανάπτυξης ΜΣ και ΚΑΝ, και για τον έλεγχο συγχυτικών παραγόντων, καθώς και στρωματοποιημένη λογιστική παλινδρόμηση για την ανίχνευση πιθανών τροποποιητών. Αποτελέσματα: Η μέση τιμή IBI ήταν 53±2 για τους άνδρες και 53±3 για τις γυναίκες (p=0,88). Τα υψηλά επίπεδα IBI συσχετίστηκαν με 1,5 φορές περισσότερες πιθανότητες εμφάνισης ΜΣ, συγκριτικά με τα χαμηλά επίπεδα IBI. Επιπλέον, οι συμμετέχοντες με υψηλό IBI και υψηλό STAI είχαν 96% περισσότερες πιθανότητες να αναπτύξουν ΜΣ, σε σύγκριση με εκείνους με χαμηλό IBI και χαμηλό ή υψηλό STAI [Σχετικός Λόγος (ΣΛ)= 1,96;95%Διάστημα Εμπιστοσύνης (ΔΕ):(1,01,3,80)]. Η υψηλή βαθμολογία IBI συσχετίστηκε, επίσης, θετικά με το 10-ετή κίνδυνο ΚΑΝ [Σχετικός Κίνδυνος (ΣΚ)=1,07,95%ΔΕ 1,04,1,13)], τόσο στους άνδρες όσο και στις γυναίκες. Επίσης, οι συμμετέχοντες με υψηλές παράλογες πεποιθήσεις και συμπτώματα άγχους είχαν 138% μεγαλύτερο κίνδυνο εμφάνισης ΚΑΝ κατά τη διάρκεια της 10-ετούς παρακολούθησης (ΣΚ 2,38, 95%ΔΕ 1,75,3,23) σε σύγκριση με εκείνους χωρίς άγχος. Επιπρόσθετα, προκαταρκτικά ευρήματα από την πρόσφατη 20-ετή παρακολούθηση αποκάλυψαν ότι οι συμμετέχοντες με υψηλά επίπεδα IBI διέτρεχαν επίσης υψηλότερο κίνδυνο να αναπτύξουν ΚΑΝ κατά τη διάρκεια περιόδου παρακολούθησης 20ετών (2002-2022), σε σύγκριση με τους συμμετέχοντες με χαμηλά επίπεδα (ΣΚ 1,10, 95%ΔΕ 1,05 1.14). Το χαμηλό μορφωτικό επίπεδο, το άγχος και η κατάθλιψη, και το ΜετΣ, έχουν τροποποιητική επίδραση στη σχέση μεταξύ των παράλογων πεποιθήσεων και ΚΑΝ, ενώ οι διατροφικές συνήθειες μακριά από τη μεσογειακή διατροφή, το κάπνισμα, η υπέρταση, οι τροχιές άγχους και κατάθλιψης, η υπερχοληστερολαιμία, το ΜΣ, ο σακχαρώδης διαβήτης τύπου ΙΙ, η C-αντιδρώσα πρωτεΐνη (CRP),η ιντερλευκίνη- 6 (IL-6) και η ολική αντιοξειδωτική ικανότητα (TAC) ήταν μεσολαβητές στις υπό μελέτη συσχετίσεις. Συμπεράσματα: Τα ευρήματα αυτής της διατριβής προάγουν την ψυχολογική έρευνα στον τομέα της πρωτογενούς πρόληψης της ψυχικής υγείας και των καρδιο- μεταβολικών παθήσεων, καθώς υπογραμμίζουν τον σημαντικό ρόλο των παράλογων πεποιθήσεων, για πρώτη φορά στη βιβλιογραφία, και την ανάγκη οικοδόμησης νέων, ολιστικών προσεγγίσεων για την καλύτερη κατανόηση των αλληλεπιδράσεων μεταξύ των ψυχολογικών, συμπεριφορικών και βιολογικών καθοριστικών παραγόντων στον κίνδυνο ΚΑΝ, αλλά και την εφαρμογή αντίστοιχων παρεμβάσεων

Hostile personality as a risk factor for hyperglycemia and obesity in adult populations:a systematic review

PURPOSE: Several studies have already provided valuable insights into the physiological and genetic causes of hyperglycemia and obesity. Concurrently, personality traits, such as hostility, have been suggested to have an impact on health and illness (i.e., self-reported general health, coronary artery disease, and overall mortality). The present systematic review investigated possible effects of hostility upon metabolic markers, such as high plasma glucose level and obesity among adults. We also attempted to reveal current gaps in knowledge and provide insights for future directions. METHODS: This systematic review was performed following the PRISMA 2009 guidelines to examine current evidence arising from observational studies regarding the potential impact of hostile behavior on hyperglycemia and obesity among adults. Of the initial 139 articles, 13 studies were included. RESULTS: The evidence supports an association between pre-diabetes and obesity with a hostile temperament in certain populations. The relationship between hostility and hyperglycemia was most common in African American women, in women with a family history of diabetes, in unmarried individuals, in White men, as well as in middle-aged and older people. Regarding obesity, high body mass index (BMI) was associated with a hostile personality, particularly among men. However, the paths by which hostile temperament affects glucose levels and BMI, as well as potential mediating and moderating mechanisms, are not entirely understood. CONCLUSIONS: There is a need for research to enhance the understanding of biological, psychological and social factors related to hostility with a view to prevention and effective intervention

Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers and 10-year diabetes mellitus risk: the ATTICA epidemiological study

Objectives: To investigate the combined role of irrational beliefs and anxiety, depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors. Methods: Within the context of the ATTICA cohort study (2002-2012), 853 participants without evidence of CVD [453 men (45±13 years) and 400 women (44±18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI, range 0-88), the Zung Self-Rating-Depression-Scale and the State-Trait-Anxiety-Inventory. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association. Results: Mean IBI score was 5310 in men and 5111 in women (p=0.68). Participants with high irrational beliefs who also had anxiety symptoms had 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with increased levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations. Conclusions: Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions

Irrational beliefs, dietary habits and 10-year incidence of type 2 diabetes; the ATTICA epidemiological study (2002-2012) Corresponding author

Objectives: The aim of this study was to evaluate the dietary habits of apparently healthy individuals in relation to their irrational beliefs’ status, as well as 10-year diabetes incidence.Methods: The ATTICA study (2002–2012) is a prospective population-based cohort study, in which 853 participants without a history of cardiovascular disease (CVD) [453 men (aged 45±13 years) and 400 women (aged 44±18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a brief, self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary and other lifestyle habits were also evaluated. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association.Results: Mean IBI score was 5310 in men and 5111 in women (p=0.68). IBI was positively associated with 10-year type 2 diabetes incidence (Hazard Ratio 1.14; 95%CI 1.04, 1.25) in both men and women, and more prominently among those with lower education status, married, overweight, smokers, with anxiety and depressive symptomatology and unhealthy dietary habits. Especially, participants with increased irrational beliefs and low adherence to the Mediterranean diet were 37% more likely to develop type 2 diabetes compared to those with a reverse status (HR 3.70; 95%CI 2.32, 5.88).Conclusions: These data support the need to promote a shift towards healthier eating by educating people to recognize false and unhelpful thoughts in order to prevent negative psychological and clinical outcomes, such as mental health disorders and type 2 diabetes

Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers in the 10-year diabetes mellitus risk:the ATTICA epidemiological study

PURPOSE: To investigate the combined role of irrational beliefs, anxiety and depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors. METHODS: Within the context of the ATTICA cohort study (2002–2012), 853 participants without evidence of CVD [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI) (range 0–88), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI). Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association (ADA). RESULTS: Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). Participants with high irrational beliefs who also had anxiety symptoms had a 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with high levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations. CONCLUSION: Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions

Association between family history of diabetes, irrational beliefs, and health anxiety with 10-year risk of Type 2 Diabetes Mellitus: the ATTICA epidemiological study (2002-2012)

Background This study aimed to examine the relationship between family history of diabetes, irrational beliefs, and health anxiety in the development of type 2 diabetes mellitus (T2DM). Method ATTICA is a prospective, cohort study (2002–2012). The working sample included 845 participants (18–89 years), free of diabetes at baseline. Α detailed biochemical, clinical, and lifestyle evaluation was performed, while participants’ irrational beliefs and health anxiety were assessed through the Irrational Beliefs Inventory and the Whiteley index scale, respectively. We evaluated the association between the participants’ family history of diabetes mellitus with the 10-year risk of diabetes mellitus, both in the total study’s sample and separately according to their levels of health anxiety and irrational beliefs. Results The crude 10-year risk of T2DM was 12.9% (95%CI: 10.4, 15.4), with 191 cases of T2DM. Family history of diabetes was associated with 2.5 times higher odds (2.53, 95%CI 1.71, 3.75) of T2DM compared to those without family history. Among participants with family history of diabetes, the highest likelihood of developing T2DM, regarding their tested psychological features (i.e., low/high irrational beliefs in the entire group, low/high health anxiety in the entire group, and low/high irrational beliefs, low/high healthy anxiety), had people with high irrational beliefs, low health anxiety (OR 3.70, 95%CI 1.83, 7.48). Conclusions The findings underline the important moderating role of irrational beliefs and health anxiety in the prevention of T2DM, among participants at increased risk of T2DM

Cognitive vulnerability, anxiety, and physical well-being in relation to 10-year cardiovascular disease risk: The ATTICA epidemiological study

This study aimed to evaluate the association between irrational beliefs and the 10-year cardiovascular disease (CVD) incidence among apparently healthy adults. The ATTICA study is a population-based, prospective cohort (2002-2012) consisting of 853 participants without evidence of CVD (453 men and 400 women) who underwent psychological evaluations. Participants completed the Irrational Beliefs Inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. We conducted a factor analysis to develop irrational beliefs factors to evaluate the association between subcategories of irrational beliefs and CVD incidence. Demographic characteristics, detailed medical history, other psychological factors, and dietary and other lifestyle habits were also evaluated. The incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria. The identified dominant irrational beliefs factor, cognitive vulnerability to anxiety, consisted of demandingness, perfectionism, emotional irresponsibility, anxious overconcern, dependence on others, and overconcern for the welfare of others, was strongly associated with an increased 10-year CVD risk. Nested multi-adjusted regression analysis revealed that anxiety, as well as negative physical well-being, mediated this relationship, and subset of irrational beliefs predicted CVD risk directly and indirectly through anxiety and negative physical well-being. These findings further map the path through which irrational beliefs can contribute to CVDs and provide insights in favor of preventive healthcar

Irrational beliefs, dietary habits and 10-year incidence of type 2 diabetes; the ATTICA epidemiological study (2002-2012)

OBJECTIVE: The aim of this study was to evaluate the dietary habits and irrational beliefs of apparently healthy individuals in relation to their 10-year diabetes incidence. METHODS: The ATTICA study (2002-2012) is a prospective population based cohort study, in which 853 participants (453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)) without a history of cardiovascular disease (CVD) underwent psychological evaluations. Among other things, participants completed the Irrational Beliefs Inventory (IBI, range 0-88), a brief, self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, and dietary and other lifestyle habits were evaluated as well. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association. RESULTS: Mean IBI score was 53 ± 10 in men and 51± 11 in women (p = 0.68). IBI was positively associated with the 10-year type 2 diabetes incidence (hazard ratio: 1.14; 95% CI: 1.04-1.25) in both men and women, and even more distinctly associated with participants with the following characteristics: lower education status, married, overweight, smokers, anxiety and depressive symptomatology, and unhealthy dietary habits. Especially, participants with increased irrational beliefs and low adherence to the Mediterranean diet were 37% more likely to develop type 2 diabetes than those with the reverse status (hazard ratio: 3.70; 95% CI: 2.32-5.88). CONCLUSIONS: These data support the need for lifestyle changes towards healthier nutrition which can be achieved by educating people so that they are equipped to recognize false and unhelpful thoughts and thus to prevent negative psychological and clinical outcomes such as mental health disorders and type 2 diabetes