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Social Support, Depression, and Mortality During the First Year After Myocardial Infarction
Abstract
We previously reported that depression after myocardial infarction (MI) increases the long-term risk of cardiac mortality. Other research suggests that social support may also influence prognosis. This article examines the interrelationships between baseline depression and social support in terms of cardiac prognosis and changes in depression symptoms over the first post-MI year.
For this study, 887 patients completed the Beck Depression Inventory (BDI) and the Perceived Social Support Scale (PSSS) at about 7 days after MI. Some 32% had BDIs > or =10, indicating mild to moderate depression. One-year survival status was determined for all patients. Follow-up interviews, including the BDI, were conducted with 89% of survivors. There were 39 deaths (35 cardiac). Elevated BDI scores were related to cardiac mortality (P=0.0006), but PSSS scores and other measures of social support were not. There was a significant interaction between depression and the PSSS (P=0. 016). The relationship between depression and cardiac mortality decreased with increasing support. Furthermore, residual change score analysis revealed that among 1-year survivors who had been depressed at baseline, higher baseline social support was related to more improvement in depression symptoms than expected.
Post-MI depression is a predictor of 1-year cardiac mortality, but social support is not directly related to survival. However, very high levels of support appear to buffer the impact of depression on mortality. Furthermore, high levels of support predict improvements in depression symptoms over the first post-MI year in depressed patients. High levels of support may protect patients from the negative prognostic consequences of depression because of improvements in depression symptoms.
... They reported that over 40% of patients with stable CHD have elevated anxiety symptoms. This same study reports a 2.3 fold increase in the risk of cardiac events 2 months after discharge for generalized anxiety disorder (GAD) patients [16]. ...
... The keyword here is "perceived". Depressed patients who have social support did not always see it as such and were less likely to have close friends, which can possibly explain why the overall rate of depression remained high [16]. ...
... The absence [16,22] or presence [14] of social support plays a large role in how severe the different stressors will be on the affected individual. ...
Objective: Whenever the subject of coronary artery disease (CAD) and myocardial infarctions is discussed, the focus is usually shifted towards biological factors such as smoking, diabetes, or obesity; consequently, the management aims at addressing these factors. This paper approaches the subject from a psychosocial perspective and highlights the importance of these risk factors and their inclusion in CAD screening. Background: CAD is one of the most common diseases worldwide and also one of the leading causes of death in multiple countries. Although we have a proper understanding of its pathogenesis and risk factors, we sometimes tend to overlook the psychological factors that affect the patient both pre- and post-diagnosis. The purpose of this paper is to present these underestimated factors and convey their importance. Methods: To accomplish this, an extensive review of the literature was done using PubMed and Google Scholar, and articles were chosen based on the specified keywords. The references of these articles were also screened to identify more related studies and clinical trials. Discussion: This paper is composed of multiple subsections that go over the epidemiology of the disease as well as its pathogenesis and known biological risk factors, before delving into the psychosocial aspects associated with CAD including the effects of depression, anxiety, social support, and sex differences on a patient’s prognosis. Conclusion: CAD is a disease for which the management is through multifactorial interventions. Although the pathogenesis is well understood, there is a clear gap when it comes to appreciating the patients’ mental health when living with this diagnosis. Additionally, it has been shown that there is an increase in morbidity and mortality in the patients struggling on a psychosocial level, thus these factors should be included in the screening process.
... The networks in this study were based on Spearman partial correlations. The graphical LASSO technique was employed to regularize the partial correlations within the represented network [22]. By penalizing very small partial correlation coe cients to zero, this technique aids in removing spurious edges, resulting in a more stable and sparse network [22]. ...
... The graphical LASSO technique was employed to regularize the partial correlations within the represented network [22]. By penalizing very small partial correlation coe cients to zero, this technique aids in removing spurious edges, resulting in a more stable and sparse network [22]. The Extended Bayesian Information Criterion (EBIC) hyperparameter γ was set to 0.5 to balance sensitivity and speci city [23]. ...
Background
Previous research has suggested that transitioning from the level of impairment to the level of symptoms may provide a more nuanced understanding in psychopathology. This study aims to explore the relationships between the three dimensions of perceived social support (i.e., family support, friend support, and other support) and individual symptoms of anxiety among college students.
Methods
We conducted a network analysis of anxiety symptoms and perceived social support in a sample of 4105 college students. Two networks were constructed in this study, namely the Perceived Social Support-Anxiety network. Bridge centrality indices were calculated for variables within both networks.
Results
In this sample, perceived social support showed a significant association with anxiety symptoms. Bridge centrality analysis revealed that, in both networks, family support had negative bridge expected influence values, while friend support and other support had positive bridge expected influence values.
Conclusions
The results unveil specific roles of perceived social support in relation to anxiety at the symptom level.
... 18 The questions are using a scale of 0 to 3: null (0), a lot of days (1), more than half the days (2), and approximately every day (3). The PHQ-9 scores classify depression as mild (score: 5-9), moderate (10-14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27) The Patient Health Questionnaire-9 VHD Valvular heart disease Statistical Analysis Data collected were entered and stored in a personal computer. Statistical Package for the Social Sciences, Version 22 (IBM Corp., Armonk, NY, USA), was used to analyze the data through both descriptive and inferential statistical methods. ...
... Because of rising CVDs and depression has been identified as a major contributor to CVDs morbidity and mortality, early detection and improving mental health care services and programs will reflect positively on cardiac outcomes. [19][20][21][22] In our study, we found that 59.3% of our patients had depression, which is more than what had been found in other studies as in Australia (15%). 23 In another study, it was found that the prevalence of depression was 20%-45% in Caucasian populations with cardiac disease. ...
Objective:
This study sought to assess the prevalence and identify factors associated with depression among patients with cardiovascular diseases and followed-up in a public teaching hospital.
Methods:
A cross-sectional study was conducted with a systematic random sample of 302 out-patients with cardiovascular diseases and followed-up in the cardiology outpatient department at Tripoli University Hospital. Stable adults (>18 years of age) were eligible to be included in this study. Face-to-face interviews were conducted to complete a questionnaire comprising questions on demographic, medical, and lifestyle issues besides the Patient Health Questionnaire-9 tool. Statistical Package for the Social Sciences, Version 22, was used to analyze the data.
Results:
Age ranged between 29 and 84 years with a mean age of 60.6 ± 10.4 years; 60.6% were females and 75.8% were married. The highest prevalent morbidity was hypertension (76.2%) followed by diabetes mellitus (48%), ischemic heart disease (39%), and different types of arrhythmias (22.8%). About 59.3% of screened patients had different degrees of depression from mild to severe. The participants with a positive history of psychological problems, those complicated with cardiomyopathy, those who were females, patients with a history of cerebrovascular accident, and patients who were living alone were more likely to be depressed.
Conclusion:
Prevalence of depression is found to be higher among patients with cardiovascular diseases and a family history of psychological illnesses, and cardiomyopathy had the highest contribution as independent predictor for depression. Screening of all patients with cardiovas-cular diseases is essential to identify and treat the patients at greater risk of depression.
... [5][6][7]17,18,21,[23][24][25] However, not all individuals will engage in adaptive behaviours or experience positive health outcomes when exposed to a perceived threat. [18][19][20][26][27][28][29][30][31][32][33][34][35][36][37] Individuals who do not have the emotional and/or mental capacity to process a stressful situation may be susceptible to psychological harm when exposed to a perceived threat. [18][19][20][28][29][30][31][32][33][34][35][36][37][38] Receiving positive screening test results related to a major medical condition can lead to elevated fear, concerns related to personal health, psychological distress (e.g. ...
... [18][19][20][26][27][28][29][30][31][32][33][34][35][36][37] Individuals who do not have the emotional and/or mental capacity to process a stressful situation may be susceptible to psychological harm when exposed to a perceived threat. [18][19][20][28][29][30][31][32][33][34][35][36][37][38] Receiving positive screening test results related to a major medical condition can lead to elevated fear, concerns related to personal health, psychological distress (e.g. high rates of anxiety and depression), and changes in health-related quality of life (HRQoL). ...
Aims: Psychological distress and changes in health-related quality of life (HRQoL) may occur after screening for disease. Reporting outcomes related to potential benefits and harms of screening is a key recommendation in the guidelines for reporting high-quality trials or interventions. However, no reviews have directly investigated outcomes related to psychological distress and/or changes in HRQoL following imaging assessment of cardiovascular risk and communication of cardiovascular findings to asymptomatic adults. A scoping review was conducted to map research on psychological distress and/or HRQoL following screening.
Methods and results: Six electronic databases (MEDLINE, PsychINFO, Social Work Abstracts, Psychology and Behavioural Sciences Collection, CINAHL, and EMBASE) were searched for articles that assessed psychological distress and/or HRQoL following screening. Two investigators independently screened titles and abstracts for all records retrieved using predefined criteria. Studies were conducted among active smokers, military personnel, athletes, post-menopausal women, and high-risk individuals. Seven constructs related to psychological distress and HRQoL appeared across 11 articles (randomized controlled trials, n = 4 and non-randomized studies, n = 7). Worry, depression, perceived stress, anxiety, and quality of life were most prominent. Multiple-item measures of psychological distress (e.g. Taylor Anxiety Score and Beck Depression Inventory) were used in 5/9 (56%) studies. Key findings on psychological distress and/or changes in HRQoL following screening were mixed.
Conclusions : Findings support the need for multiple-item measures with better psychometric properties to examine the psychological responses to screening results in future studies. Strategies to support individuals during and following vascular screening to maximise potential benefits of screening and minimize harms are discussed.
... Our findings also demonstrated a significant association between social support-seeking beliefs and depressive symptoms in this sample. This finding is consistent with previous research that demonstrates a relationship between perceptions of social support and depression across diverse samples and across different years (Bosworth et al., 2008;Brummett et al., 2000;Frasure-Smith et al., 2000;Steffens et al., 2005). Whereas previous research has largely examined the role of social support beliefs in the link between physical health conditions (e.g., cardiovascular disease) and depression (Bronder et al., 2014), the present study extended this work by examining social support-seeking beliefs within the context of a cultural construct (i.e., SBW schema) and depressive symptoms. ...
Objectives: The Strong Black Woman (SBW) schema, a multidimensional construct that promotes self-reliance, self-silencing, self-sacrificial caregiving, and resilience, has been linked to depressive symptoms in Black women. Yet, additional research is needed to examine the mechanisms through which this association exists. The present study examines the indirect effect of social support beliefs on the relationship between the SBW schema and depressive symptoms. Method: Data from a sample of 194 Black women (Mage = 37.53, SD = 19.88) were collected using an online survey assessing internalization of the SBW schema, depressive symptoms, and social support-seeking beliefs. Results: A primary dimension of the SBW schema, the expectation to manifest strength, was significantly positively correlated with depressive symptoms and negatively correlated with social support seeking. Depressive symptoms were also significantly negatively correlated with social support beliefs. In addition, an indirect effect of support-seeking beliefs was observed between the expectation to manifest strength and depressive symptoms (ab = .12, 95% CI [.02, .24]). Conclusions: Findings from this study suggest that Black women experience impairing depressive symptoms, which can be explained by race and gender-specific stress-coping ideologies and behaviors, specifically, the SBW schema. Furthermore, the SBW schema is a factor that may contribute to adverse mental health outcomes among Black women vis-à-vis decreased support-seeking beliefs. We discuss the implications of these findings and how these results can help facilitate culturally competent care for Black women.
... In people with depression, increased C-reactive protein levels indicating increased inflammatory response and altered platelet aggregation due to changes in serotonergic pathways may induce atherosclerosis. [21] Besides, Frasure-Smith et al. [24] defined diabetes as a risk factor for depression. The higher prevalence of depression in the diabetic population may explain the relationship between CAD severity and depression. ...
Objectives: The SYNergy between percutaneous coronary interventions with TAXUS and Cardiac Surgery (SYNTAX) score is a quantitative scoring system used to evaluate the severity and extent of the disease in patients with coronary artery disease. Hospital Anxiety and Depression Scale (HADS) is a scale that measures the anxiety and depression levels of patients. The relationship between psychosocial stress and atherosclerosis is well known. In this study, we aimed to examine the relationship between SYNTAX score and HADS in patients who performed percutaneous coronary intervention due to acute coronary syndrome (ACS).
Methods: A total of 130 subjects with ACS were included in our study. The SYNTAX score, which was calculated by two independent interventional cardiologists, was divided into three groups: 0–22, low; 23–32, moderate; 33 and above, high. In our study, patients’ anxiety and depression levels were evaluated with HADS 1 month after ACS.
Results: Of the total subjects, 68, 39, and 23 patients were determined in SYNTAX scores of 0–22, 23–32, and >33 groups, respectively. A significant relationship was observed between the high SYNTAX score and the HADS-depression and anxiety scale (p<0.001, p<0.001, respectively). In the correlation analysis found that, a moderate positive correlation between the SYNTAX score and depression level, and a weak positive correlation between the SYNTAX and anxiety level (r=0.642, r=0.538, respectively).
Conclusion: In our study, we found that HADS and SYNTAX scores were significantly correlated in ACS patients who performed percutaneous coronary intervention.
... A systematic review by Rashidi et al. (2020) demonstrated that social support contributes significantly to the adherence to treatment plans in chronic diseases. Conversely, the lack of social support has been linked to a higher likelihood of high-risk factors, such as atherosclerosis, myocardial infarction, slower recovery from CVD events, and increased mortality (Frasure-Smith et al., 2000;Lett et al., 2009;Rosengren et al., 2004;Rozanski et al., 1999). ...
Cardiovascular diseases stand out as the foremost cause of mortality on a global scale and encompass conditions that require long term self-care. Coronary heart disease and heart failure are two cardiovascular conditions that require significant lifestyle modifications. Adherence to self-care is a multifaceted phenomenon, and is influenced by various factors that include social, economic, disease-related and healthcare system-related factors. A key factor in adherence to self-care in chronic illnesses is social support. To explore this relationship between social support and adherence to self-care, a systematic review was carried out across Scopus, EBSCO host and ProQuest from October 2022 to February 2023 using predefined search criteria. Studies from inception to February 2023 were considered for the review, ultimately incorporating a total of 11 studies. Six studies had an adult population with coronary heart disease while the remaining five had adults with heart failure. All the studies reported a significant positive correlation between social support and adherence to self-care. Our findings revealed that social support plays a significant role in promoting self-care, emphasizing the need for a holistic understanding of self-care to develop effective interventions. Along with self-report measures, objective measures should be used to assess adherence accurately. There is a need for scales that assess all aspects of self-care, as well as the development of new interventions and teaching strategies to facilitate the individual’s self-care journey. In addition, family members and trusted resources should be involved in encouraging self-care, and interventions should target both patients and their family members.
... It is particularly evident in adaptation and recovery from physical illness and for the prognosis and status of chronic diseases [10][11][12][13]. Especially for depressed patients, social support plays an important role in adaptation and coping with an illness [14,15]. There is also empirical evidence that the lack of social support contributes to new onset or recurrence of depressive symptoms [16][17][18]. ...
Background
Mental resources such as optimism and social support are important to face different stressors. The aim of this study is to identify groups in the population that are similar in terms of their mental resources.
Methods
For this purpose, a randomly selected general population community sample was used, representative for the city of Leipzig, Germany. In a two-stage process, three clusters were identified using hierarchical cluster analysis and the K-means method and then tested with a multinomial logistic regression analysis for differences in sociodemographic characteristics.
Results
Three clusters were identified which vary in their extent of social support and optimism. In distinguishing between those with higher and lower (medium or poor) mental resources, male gender, unemployment, being born abroad and low household income are risk factors for having fewer mental resources. Internal migrants from West Germany and persons with children at home have a higher chance of being in the type with good mental resources. The groups with medium and lower mental resources differ significantly only by variables living with a partner and employment.
Conclusion
Our results indicate that good mental resources are associated with good mental health. Special mental health care programs, focusing in particular on the needs of vulnerable groups with poor mental resources within a society, should be implemented.
... El aislamiento también ha sido señalado como un factor importante de la mortalidad, la percepción de bajo apoyo social y realizar pocas actividades sociales aumenta la mortalidad por enfermedades coronarias en varones adultos (Orth-Gomér et al., 1988). Asimismo, existe evidencia de que el apoyo social funge como amortiguador del impacto de la depresión sobre la mortalidad después de un ataque al corazón, como en el estudio de Frasure- Smith et al. (2000) en donde 887 pacientes contestaron el inventario de depresión de Beck (BDI). Otros estudios, han proporcinado evidencia en donde el apoyo social tiene un fuerte impacto tanto en la autoestima como en la capacidad de la persona para afrontar adecuadamente situaciones difíciles y estresantes (Cava, 1995;Herrero, 1994;Lin y Ensel, 1989;Musitu et al., 2001). ...
La epidemia del VIH trajo consigo grandes necesidades
para nuestro país y para el resto del mundo.
En la presente obra, un grupo de investigadores de
diversas disciplinas ofrecemos evidencia actualizada
y sustentada en evidencia científica para hacer
un abordaje multidisciplinario con un profundo sentido
de responsabilidad social que pueda cubrir el
perfil multifacético de las personas con VIH. El
objetivo es contribuir a que se busquen estrategias
para mejorar las condiciones humanas y de salud
de las personas que viven y padecen la infección
por el VIH en nuestra comunidad. Se consideran
factores de vulnerabilidad asociados al VIH, tales
como: adicciones, problemas de salud mental, etc.
Así como temas de prevención, evaluación integral,
apoyo social, cuidado de la salud mental y uso
de tecnologías de la información. Se agradece el
apoyo y financiamiento del Consejo Nacional para
la Enseñanza e Investigación en Psicología A. C.
(CNEIP) para la presente obra.
... Psychosocial and socioeconomic factors like socioeconomic status, occupation, education, and social support have not by themselves been shown to have a direct impact on mortality, but rather play a part in the context of developing depression and other risk factors. However, the feeling of low control has also by itself been associated with CVD [7][8][9]. ...
Background
Despite improvements in the treatment and prevention of cardiovascular disease since the 1960s, the incidence of cardiovascular diseases among young people has remained the same for many years. This study aimed to compare the clinical and psychosocial attributes of young persons affected by myocardial infarction under the age of 50 years compared to middle-aged myocardial infarction patients 51–65 years old.
Methods
Data from patients with a documented STEMI or NSTEMI elevated acute myocardial infarction in the age groups up to 65 years, were collected from cardiology clinics at three hospitals in southeast Sweden. The Stressheart study comprised a total of 213 acute myocardial infarction patients, of which n = 33 (15.5%) were under 50 years of age and n = 180 (84.5%) were middle-aged, (51–65 years). These acute myocardial infarction patients filled in a questionnaire at discharge from the hospital and further information through documentation of data in their medical records.
Results
Blood pressure was significantly higher in young compared to middle-aged patients. For diastolic blood pressure (p = 0.003), systolic blood pressure (p = 0.028), and mean arterial pressure (p = 0.005). Young AMI patients had a higher (p = 0.030) body mass index (BMI) than the middle-aged. Young AMI patients were reported to be more stressed (p = 0.042), had more frequently experienced a serious life event the previous year (p = 0.029), and felt less energetic (p = 0.044) than middle-aged AMI patients.
Conclusions
This study revealed that persons under the age of 50 affected by acute myocardial infarction exhibit traditional cardiovascular risk factors like high blood pressure, and higher BMI, and were more exposed to some psychosocial risk factors. The risk profile of young persons under age 50 affected by AMI was in these respects more exaugurated than for middle-aged persons with AMI. This study underlines the importance of the early discovery of those at increased risk and encourages preventative actions to focus on both clinical and psychosocial risk factors.
... Sociodemographic features, stable (trait-like, pre-existing) personality features and incidental (state-like, time-related) emotional symptoms could be associated with depression in ACS, such as younger age [19], female gender [20,21], widowhood [6], low education [22] and social isolation [19,23]. In addition, depression is more frequent among those with Type D personalities [24][25][26], higher levels of neuroticism [6,27,28], novelty-seeking behavior, harm avoidance [6], narcissistic traits [6], lower self-directedness [29] and, possibly, alexithymia [30][31][32]. ...
Several biopsychosocial factors are associated with the onset of a Major Depressive Episode (MDE) after cardiovascular events. However, little is known of the interaction between trait- and state-like symptoms and characteristics and their role in predisposing cardiac patients to MDEs. Three hundred and four subjects were selected among patients admitted for the first time at a Coronary Intensive Care Unit. Assessment comprised personality features, psychiatric symptoms and general psychological distress; the occurrences of MDEs and Major Adverse Cardiovascular Events (MACE) were recorded during a two-year follow-up period. Network analyses of state-like symptoms and trait-like features were compared between patients with and without MDEs and MACE during follow-up. Individuals with and without MDEs differed in sociodemographic characteristics and baseline depressive symptoms. Network comparison revealed significant differences in personality features, not state-like symptoms: the group with MDEs displayed greater Type D personality traits and alexithymia as well as stronger associations between alexithymia and negative affectivity (edge differences between negative affectivity and difficulty identifying feelings was 0.303, and difficulty describing feelings was 0.439). The vulnerability to depression in cardiac patients is associated with personality features but not with state-like symptoms. Personality evaluation at the first cardiac event may help identify individuals more vulnerable to development of an MDE, and they could be referred to specialist care in order to reduce their risk.
... Данные последних систематических обзоров показали, что люди, которые изолированы или обособлены от других, имеют повышенный риск преждевременной смерти от ССЗ. В то же время было показано, что у пациентов с ишемической болезнью сердца (ИБС) низкий уровень социальной поддержки, определенный по шкале MSPSS, был связан с прогрессированием заболевания, что ведет к снижению выживаемости и более неблагоприятному прогнозу у этих пациентов [Frasure-Smith et al., 2000;Lett et al., 2005]. ...
Представлены результаты оценки факторной, конструктной валидности, а также надежности русскоязычной версии опросника MSPSS у кардиологических больных. В исследование включено 1018 пациентов с ИБС, которым было выполнено коронарное стентирование. Всем пациентам предлагалось пройти анкетирование для выявления психосоциальных факторов риска, в том числе определения уровня социальной поддержки шкалой MSPSS. Полученные результаты свидетельствуют о том, что русскоязычная версия опросника MSPSS полностью соответствует англоязычной версии в отношении надежности-согласованности и внутренней структуры шкалы, характеризуется высокой ретестовой надежностью, а конструктная валидность опросника полностью подтверждается результатами корреляционного анализа. В целом методика может применяться для определения уровня социальной поддержки у больных с кардиологической патологией.
... Psychosocial and socioeconomic factors like socioeconomic status, occupation, education, and social support have not by themselves been shown to have a direct impact on mortality, but rather play a part in the context of developing depression and other risk factors. However, the feeling of low control has also by itself been associated with CVD [7,8,9]. ...
Background: Despite improvements in the treatment and prevention of cardiovascular disease since the 1960s, the incidence of cardiovascular diseases among young people has remained the same for many years. This study aimed to compare the clinical and psychosocial attributes of young persons affected by myocardial infarction under the age of 50 years compared to middle-aged myocardial infarction patients 51-65 years old.
Methods: Data from patients with a documented STEMI or NSTEMI elevated acute myocardial infarction in the age groups up to 65 years, were collected from cardiology clinics at three hospitals in southeast Sweden. The Stressheart study comprised a total of 213 acute myocardial infarction patients, of which n=33 (15.5%) were under 50 years of age and n=180 (84.5%) were middle-aged, (51-65 years). These acute myocardial infarction patients filled in a questionnaire at discharge from the hospital and further information through documentation of data in their medical records.
Results: Blood pressure was significantly higher in young compared to middle-aged patients. For diastolic blood pressure (p=0.003), systolic blood pressure (p=0.028), and mean arterial pressure (p=0.005). Young AMI patients had a higher (p=0.030) body mass index (BMI) than the middle-aged. Young AMI patients were reported to be more stressed (p=0.042), had more frequently experienced a serious life event the previous year (p=0.029), and felt less energetic (p=0.044) than middle-aged AMI patients.
Conclusions: This study revealed, that persons under the age of 50 affected by acute myocardial infarction exhibit traditional cardiovascular risk factors like high blood pressure, and higher BMI, and were more exposed to some psychosocial risk factors. The risk profile of these young persons affected by AMI was in some respects more exaugurated than for middle-aged persons with AMI. This study underlines the importance of the early discovery of those at increased risk and encourages preventative actions to focus on both clinical and psychosocial risk factors.
... 20 Patients who lack emotional support do poorly after being diagnosed with cardiovascular diseases, mainly mediated by depression. 21,22 Moreover, spouses of married patients may supervise medication or promote medical advice seeking, which may also account for the protective effect. 23,24 Wu et al reported worse cardiac event-free survival in unmarried patients with heart failure than in married counterparts, and the worse adherence to medications mediates this disparity. ...
Background
Acute myocardial infarction (AMI) is one of the leading causes of mortality worldwide, whereas social support is a known predictor of the prognosis after AMI. As a common factor influencing social support, the impact of marital status on care quality, in‐hospital mortality, and long‐term prognosis of patients with AMI remains largely unknown.
Methods and Results
The present study analyzed data from the CAMI (China Acute Myocardial Infarction) registry involving 19 912 patients with AMI admitted at 108 hospitals in China between January 2013 and September 2014 and aimed to evaluate marital status–based differences in acute management, medical therapies, and short‐term and long‐term outcomes. The primary end point was 2‐year all‐cause death. The secondary end points included in‐hospital death and 2‐year major adverse cardiac and cerebrovascular events (a composite of all‐cause death, myocardial infarction, or stroke). After multivariable adjustment, 1210 (6.1%) unmarried patients received less reperfusion treatment in patients with both ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction (adjusted odds ratio [OR], 0.520 [95% CI, 0.437–0.618]; P <0.0001; adjusted OR, 0.489 [95% CI, 0.364–0.656]; P <0.0001). Being unmarried was not associated with poorer in‐hospital outcome but with long‐term all‐cause mortality and major adverse cardiac and cerebrovascular events in both ST‐segment–elevation myocardial infarction (adjusted hazard ratio [HR], 1.225 [95% CI, 1.031–1.456]; P =0.0209; adjusted HR, 1.277 [95% CI, 1.089–1.498]; P =0.0027) and non–ST‐segment–elevation myocardial infarction (adjusted HR, 1.302 [95% CI, 1.036–1.638]; P =0.0239; adjusted HR, 1.368 [95% CI, 1.105–1.694]; P =0.0040) populations.
Conclusions
The present study suggests that being unmarried is independently related to less reperfusion received, but could not explain the higher in‐hospital mortality rate after covariate adjustment. Being unmarried is associated with a substantially increased risk of adverse events over at least the first 24 months after AMI.
Registration
URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01874691.
... после перенесенного ИМ. Также в результате полученных данных из метаанализов более 20 исследований установлено, что депрессия, сопровождающая ИМ, увеличивает риск смерти после коронарного события более чем в 2 раза [15,16]. ...
In the conditions of the existing pandemic, that affects both the physical and psychological health of people, it can be predicted with a high degree of probability an outbreak in mental disorders and stress-associated mental illnesses, including depression. The problem of the relationship between depression and cardiac diseases, in particular coronary heart disease (CHD), has been studied by native and foreign scientists for several decades. Various mechanisms have been found and continue to be studied, indicating that the presence of depression can affect more or less on the course of coronary heart disease and even become a predictor of new cardiac events. Dysfunction of the autonomic nervous system with changes in heart rate variability, hyperactivity of the hypothalamic-pituitary-adrenal axis and associated hypercortisolemia, disorders of serotonergic signal transmission pathways, high aggregation response and increased platelet activity, continuous increase of proinflammatory cytokines ((IL17A, IL6, TNFa and IL12p70) in patients’ plasma – such mechanisms probably underlie the correlation between depression and an increased risk of cardiovascular complications and cardiac death. The review includes some features of depression and its influence on various forms of coronary heart disease, particularly in different age and gender groups. In view of the ongoing COVID-19 pandemic, this theme seems to be relevant and requires targeted study. Probably it is necessary to conduct clinical researches, to create registers for a detailed assessment of the mutual influence of depression and coronary heart disease in existing conditions. Perhaps, the results of such work will contribute not only to the early detection and treatment of depression, but also to the development of new ways in primary and secondary prevention of coronary heart disease and its acute forms.
... The number of social networks in the past month were assessed and used as an indicator for social isolation. Social isolation was indicated by a low network size, 0-4 persons/month in this study [24]. Psychosocial risk was a combination of the depression and social network scores; high risk was defined by the presence of both depression and social isolation (having ≤ 9 social networks) and low risk by having neither. ...
We examined the long-term relationship of psychosocial risk and health behaviors on clinical events in patients awaiting heart transplantation (HTx). Psychosocial characteristics (e.g., depression), health behaviors (e.g., dietary habits, smoking), medical factors (e.g., creatinine), and demographics (e.g., age, sex) were collected at the time of listing in 318 patients (82% male, mean age = 53 years) enrolled in the Waiting for a New Heart Study. Clinical events were death/delisting due to deterioration, high-urgency status transplantation (HU-HTx), elective transplantation, and delisting due to clinical improvement. Within 7 years of follow-up, 92 patients died or were delisted due to deterioration, 121 received HU-HTx, 43 received elective transplantation, and 39 were delisted due to improvement. Adjusting for demographic and medical characteristics, the results indicated that frequent consumption of healthy foods (i.e., foods high in unsaturated fats) and being physically active increased the likelihood of delisting due improvement, while smoking and depressive symptoms were related to death/delisting due to clinical deterioration while awaiting HTx. In conclusion, psychosocial and behavioral characteristics are clearly associated with clinical outcomes in this population. Interventions that target psychosocial risk, smoking, dietary habits, and physical activity may be beneficial for patients with advanced heart failure waiting for a cardiac transplant.
... 5. Social support: Low levels of social support were significantly associated with depression among fathers [29]. However, high levels of social support seemingly buffer the effect of depression on negative life events and diseases [30,31]. Perceived social support for caring and kindness was evaluated using seven items. ...
The mental health of fathers influences the development of children and the functioning of families significantly. However, there is no useful scale for the mental health screening of childrearing fathers. This study developed a Mental Health Scale for Childrearing Fathers (MSCF) and determined its reliability and validity. Childrearing fathers are working fathers who co-parent with their spouses. This survey was conducted in two stages: a pilot study and a main survey. Data were obtained from 98 fathers raising preschoolers in the pilot study and 306 fathers in the main survey. The collected data were used to confirm the construct validity, criterion-related validity, convergent validity, and internal consistency reliability. The final MSCF consisted of 25 items comprising four factors: peaceful familial connection, healthy mind and body, satisfying paternal alliances, and leading a meaningful life as a parent. The internal consistency reliability estimated using Cronbach’s alpha coefficient for the total scale was 0.918. The validity of the MSCF was logically secured using a confirmatory factor analysis. The MSCF can be an effective tool for mental health screening among fathers in relation to the burden of childrearing during regular infant health checks.
... Such misdiagnosis and subsequent inappropriate treatment (e.g., antidepressantinduced manic switch) can lead to detrimental outcomes such as increased suicide risk and mood instability [19,21]. These outcomes mirror symptoms of depressive disorder, as depression often also entails great personal suffering, increased risk of suicide, and social dysfunction [14,[34][35][36][37][38][39]. ...
(1) Background: The MMPI-2-RF is the most widely used and most researched test among the tools for assessing psychopathology, and previous studies have established its validity. Mood disorders are the most common mental disorders worldwide; they present difficulties in early detection, go undiagnosed in many cases, and have a poor prognosis. (2) Methods: We analyzed a total of 8645 participants. We used the PHQ-9 to evaluate depressive symptoms and the MDQ to evaluate hypomanic symptoms. We used the 10 MMPI-2 Restructured Form scales and 23 Specific Problems scales for the MMPI-2-RF as predictors. We performed machine learning analysis using the k-nearest neighbor classification, linear discriminant analysis, and random forest classification. (3) Results: Through the machine learning technique, depressive symptoms were predicted with an AUC of 0.634–0.767, and the corresponding value range for hypomanic symptoms was 0.770–0.840. When using RCd to predict depressive symptoms, the AUC was 0.807, but this value was 0.840 when using linear discriminant classification. When predicting hypomanic symptoms with RC9, the AUC was 0.704, but this value was 0.767 when using the linear discriminant method. (4) Conclusions: Using machine learning analysis, we defined that participants’ mood symptoms could be classified and predicted better than when using the Restructured Clinical scales.
... The interventions did not differ in mediational effects for ICD-specific self-management behavior or ICD knowledge on either physical function or psychological adjustment. Social support has been linked to successful recovery from a cardiac event, maintenance of an exercise program and weight loss, better prognosis for depressed patients, and ultimately to longevity (Frasure-Smith et al., 2000;Greco et al., 2014). Social support from significant others plays a central role in coping with illness, building self-efficacy, and contributing to a positive recovery trajectory (Greco et al., 2014). ...
This study examined mechanisms by which social cognitive theory (SCT) interventions influence health outcomes and the importance of involving partners in recovery following the patients' receipt of an initial implantable cardioverter defibrillator (ICD). We compared direct and indirect intervention effects on patient health outcomes with data from a randomized clinical trial involving two telephone-based interventions delivered during the first 3 months post-ICD implant by experienced trained nurses: P-only conducted only with patients, and P + P conducted with patients and their intimate partners. Each intervention included the patient-focused component. P + P also included a partner-focused intervention component. ICD-specific SCT-derived mediators included self-efficacy expectations, outcome expectations, self-management behavior, and ICD knowledge. Outcomes were assessed at discharge, 3- and 12-months post ICD implant. Patients (N = 301) were primarily Caucasian, male, 64 (± 11.9) years of age with a mean ejection fraction of 34.08 (± 14.3). Intervention effects, mediated through ICD-specific self-efficacy and outcome expectations, were stronger for P + P compared to P-only for physical function (β = 0.04, p = 0.04; β = 0.02, p = 0.04, respectively) and for psychological adjustment (β = 0.06, p = 0.04; β = 0.03, p = 0.04, respectively). SCT interventions show promise for improving ICD patient physical and psychological health outcomes through self-efficacy and outcome expectations. Including partners in post-ICD interventions may potentiate positive outcomes for patients.
Trial registration number (TRN): NCT01252615 (Registration date: 12/02/2010)
... We found that higher levels of social support were associated with longer HFST and with better mental health at six months; the association with better mental health persisted after adjustment for all covariates. Aligned with this hypothesis, Frasure-Smith, et al., reported that high levels of social support buffered the impact of depression on mortality one-year after AMI (Frasure-Smith et al., 2000). These findings are also consistent with existing literature describing that social support improves mental health directly and indirectly, through stress-buffering mechanisms (Kawachi and Berkman, 2001;Thoits, 2011). ...
Physical activity and social support are associated with better outcomes after surviving acute myocardial infarction (AMI), and greater walkability has been associated with activity and support. We used data from the SILVER-AMI study (November 2014 – June 2017), a longitudinal cohort of community-living adults ≥75 years hospitalized for AMI to assess associations of neighborhood walkability with health outcomes, and to assess whether physical activity and social support mediate this relationship, if it exists. We included data from 1345 participants who were not bedbound, were discharged home, and for whom we successfully linked walkability scores (from Walk Score®) for their home census block. Our primary outcome was hospital-free survival time (HFST) at six months after discharge; secondary outcomes included physical and mental health at six months, assessed using SF-12. Physical activity and social support were measured at baseline. Covariates included cognition, functioning, comorbidities, participation in rehabilitation or physical therapy, and demographics. We employed survival analysis to examine associations between walkability and HFST, before and after adjustment for covariates; we repeated analyses using linear regression with physical and mental health as outcomes. In adjusted models, walkability was not associated with physical health (ß = 0.010; 95% CI: -0.027, 0.047), mental health (ß = -0.08; 95% CI: -0.175, -0.013), or HFST (ß = 0.008; 95% CI: -0.023, 0.009). Social support was associated with mental health in adjusted models. Neighborhood walkability was not predictive of outcomes among older adults with existing coronary disease, suggesting that among older adults, mobility limitations may supercede neighborhood walkability.
... This is essential in order to arrange for salutogenic health processes. Even so, depression in older adults may be unrecognized, untreated, and thus reducing the health outcome [36]. This may obstruct health promotion in terms of developing resilience, experiencing coherence, hope, and finding meaning-in-life. ...
The population of older adults (≥60 years) is currently growing. Thus, in the years to come it is expected that a high proportion of patients hospitalized will be in the older age range. In western countries, the proportion of older inpatients is about 40% in the medical and surgical hospitals units. Older people with illness is vulnerable to both physical and cognitive impairments as well as depression. Therefore, a health-promoting perspective and approach are highly warranted in clinical nursing care of older adults in medical hospitals. This chapter focuses on health promotion related to depressive symptoms, impairment in activities of daily living, and cognitive impairment in older hospitalized adults.
... These factors showed no significance in Cox regression analysis; however, there was still a certain correlation between patients' clinical outcomes. One study 23 found that patients with CHD who had good social support were less likely to be emotional and less likely to focus on their own disease within 4 months of discharge, in comparison with those who did not have social support. Additionally, patients with initial onset of heart disease are more urgently in need of social support than those with a previous hospitalization history. ...
Objectives:
The deleterious effects of psychological problems on coronary heart disease (CHD) are not satisfactorily explained. We explored influential factors associated with mortality in psycho-cardiological disease in a Chinese sample.
Methods:
Of 7460 cardiac patients, we selected 132 patients with CHD and mental illness. Follow-up was conducted via telephone. We analyzed clinical characteristics, clinical outcomes, and survival.
Results:
The clinical detection rate of psycho-cardiological disease in the overall patient population was 1.8%. Of these, 113 patients completed follow-up; 18 died owing to cardiovascular diseases during follow-up. Kaplan-Meier analysis showed dysphagia, limb function, self-care ability, percutaneous coronary intervention, low-density lipoprotein, total cholesterol, pro-brain natriuretic peptide and high-sensitivity (hs) troponin T had significant associations with cumulative survival. Cox regression analysis showed total cholesterol (hazard ratio [HR]: 2.765, 95% confidence interval [CI]: 1.001-7.641), hs troponin T (HR: 4.668, 95% CI: 1.293-16.854), and percutaneous coronary intervention (HR: 3.619, 95% CI: 1.383-9.474) were independently associated with cumulative survival.
Conclusions:
The clinical detection rate of psycho-cardiological disease was far lower than expected. Normal total cholesterol and hs troponin T were associated with reduced cardiovascular disease mortality over 2 years. Percutaneous coronary intervention is a prognostic risk factor in patients with psycho-cardiological disease.
... Researchers have reported a connection between job strain, for example, and depressive symptoms as regularly co-occurring with hypertension and cardiovascular risk (Cervilla, Prince, & Rabe-Hesketh, 2004). Depression itself has been linked to a broad range of clinical vascular and cardiac outcomes with major consequences on physical health, work, and productivity (Frasure-Smith et al., 2000;L'esperance, Frasure-Smith, Talajic, & Bourassa, 2002;Penninx, et al., 2001). Thus, any mitigation of depression may have far-reaching mental and somatic benefits. ...
Over the past few decades, evidence has accumulated that psychological consequences of work behavior can mount to affect physical health. Still, the connection between leadership behaviors of supervisors and their impact on subordinate mental and physical health remains understudied despite managers being able to mitigate the assignment and impact of difficult and stressful tasks. This study reports correlational findings in a sample of 71 nurses and their work relationship with their supervisor. Participants self-reported supervisory relationship quality measured by the Leader-Member Exchange (LMX) construct and physiological and psychological variables. Nurses with lower supervisory relationship quality reported significantly higher levels of depression, cardiac risk and blood pressure than nurses reporting higher relationship quality. The current research suggests that workplace supervisory relationships may have broader health implications and notes that additional research is needed to understand the impact of the supervisory-subordinate relationship on physical and psychological health.
... Επίσης, στη µελέτη των Frasure-Smith και συν. σε δείγµα 887 ασθενών που είχαν υποστεί έµφραγµα του µυοκαρδίου, βρέθηκε πως τα υψηλά επίπεδα υποστήριξης προς αυτούς φάνηκαν να βελτιώνουν τα συµπτώµατα της κατάθλιψης και να προστατεύουν από την αρνητική έκβαση (Frasure-Smith et al 2000). Επιπλέον, σε µελέτη των Hughes και συν. ...
Introduction: Religious faith and spirituality often seem to affect physical and psychological functioning of patients with chronic diseases. Aim: To investigate the relationship between religiosity/spirituality of coronary patients with anxiety and depression which may be experienced during their hospitalization. Methods: A cross-sectional study was conducted involving 172 patients (23 female and 149 male) with coronary artery disease, who were hospitalized in a general hospital of Attica region with an acute coronary syndrome diagnosis. HADS scale was used for the investigation of hospital anxiety and depression and the Belief and Values Scale was used to evaluate the patients’ religious faith and spirituality. Results: Moderate levels of religiosity/spirituality and no to moderate levels of anxiety and depression were found in coronary patients. No statistically significant correlations were found between the HADS subscales and the Beliefs and Values Scale (p> 0.001), although individuals who have experienced strong spiritual experiences, experienced less anxiety and depression in hospital. There were found statistically significant correlations (p <0.001) with gender, religious beliefs, patients’ age with Belief and Values Scale. There were also statistically significant correlations (p<0.001) of HADS subscales with family status, age, smoking habits, stress and medication. Conclusion: Highly religious coronary patients are less likely to experience anxiety and depression during hospitalization, though confounders seem to interfere and make it difficult to interpret this relationship. Further research is required in order to explore the impact of religiosity on psychological distress of hospitalized coronary patients.
... Social support is often considered an adaptive form of emotion regulation, which promotes emotional and physical health (e.g. Demaray and Malecki 2002;Frasure-Smith et al. 2000;Turner 1981). However, some research suggests that social support-seeking in the form of co-rumination (i.e. ...
Background
Despite increasing interest in positive psychological states, we know little about how regulatory responses to positive (savoring) compared to negative events (e.g. acceptance, cognitive reappraisal) influence emotional functioning. Savoring may be particularly helpful for athletes who are often trained to attend more to negative (e.g. rectifying weaknesses) compared to positive stimuli (e.g. enjoying progress).
Methods
Sixty-seven college athletes completed a two-week daily diary study. Using multi-level modeling, we first explored whether various regulatory responses to daily negative events predicted unique variance in daily emotions (i.e. happy, content, grateful, sad, angry, annoyed). Next, we tested whether savoring positive events strengthened the association between event intensity and positive daily emotions. Finally, we tested whether regulatory responses to positive compared to negative events had stronger moderating (buffering) effects on the association between daily negative event intensity and daily emotions.
Results
Based on 836 daily observations, reappraising and accepting negative events were the only strategies that predicted unique variance in daily emotions. Savoring enhanced positive emotions related to positive events. Reappraising negative events buffered associations between negative event intensity and decreased daily gratitude, while savoring positive events buffered associations between negative event intensity and increased anger, annoyance, and average negative emotions. Accepting negative events had similar effects.
Conclusions
Savoring positive events may be an underappreciated strategy for helping athletes regulate emotions related to negative events. Since our sample predominantly identified as white and female, further research is needed to understand savoring use and effectiveness among the full, diverse spectrum of college athletes.
... Those who perceive that they have support are at a decreased risk for mortality, and this association has been found even when controlling for demographic factors (Berkman et al., 1992;Brummett et al., 2001). Those who do not perceive social support to be available are at an increased risk for the development and progression of cardiovascular disease (André-Petersson et al., 2006;Coyne et al., 2001;Frasure-Smith et al., 2000), cognitive deterioration (Cacioppo & Hawkley, 2009), and cancer (Lehto et al., 2006), as well as all-cause mortality (Holt-Lunstad et al., 2010). ...
Using cluster analysis, we investigated whether perceived social support and individual differences in preferences to use support combined to form dis- tinct profiles. Self-report data were collected from U.S. adults (N = 454; aged 40–90, Mage = 55.37, SD = 9.73). Four profiles were identified: disengaged, interpersonally connected, isolated independent, and connected indepen- dent. Profiles characterized by high perceived support were associated with better overall health, even among those who preferred not to use support; men and those not married or cohabiting were less likely to be in these profiles. Implications for understanding associations between social support and health and the identification of at-risk groups are discussed.
... A study investigating the role of social factors in recovery of patients post MI within 4 months after discharge showed that coping style, social network and social support caused these patients to be less fixated on their illness and feel less threatened or worried in comparison with those who lacked social support. 21 These patients were also less excited and had faster recovery rate. Moreover, patients with first MI sought more social support than those having past history of hospitalization due to ischemic heart disease. ...
Myocardial infarction (MI) is a major cause of mortality in the developing world. Modifiable risk factors of MI such as obesity, diabetes, smoking, high blood pressure and dyslipidemia are well known but besides these, there are many psychosocial factors that are independently related to MI. There is a striking dearth of reviews in the literature that examine, collate and summarize the impact of psychological contributors to MI. Present work was done to cover such gaps in knowledge and emphasize the need for psychological risk factors of MI to be considered while devising prevention guidelines and policies. Original research studies, meta-analyses and systematic reviews focusing on psychological factors in the development of MI were retrieved from databases including PubMed, Google Scholar, ProQuest, Elsevier, and Ovid Medline. Psychological factors like depression, anxiety, type A personality, stress, anger, hostility, social isolation and occupational stress were shown to feature consistently as risk factors for MI. Mitigating lifetime psychological distress may help decrease the disease burden of MI.
Sex and gender have wide sweeping effects on many aspects of cardiovascular health, and special considerations should be taken when determining the cardiovascular risk in men. Compared to women, men have different clinical presentations, present earlier with major adverse cardiovascular events, and have higher cardiovascular mortality rates. Some of these sex differences can be influenced by the role of testosterone due to its role in foam cell formation in atherosclerosis. Other risk factors that are unique to men are associated with and may contribute to this disparity, such as higher rates of tobacco and alcohol abuse, erectile dysfunction, testosterone replacement therapy, and anabolic steroid abuse. Cardiovascular risk assessment should be individualized to men and risk factors unique to men should be considered.
CL psychiatry is one of the newer sub-specialties of adult psychiatry and is concerned with the practice of psychiatry in non-psychiatric settings. Typically, this means in general hospital wards and outpatient clinics, although in some countries, it also includes liaison with primary care. In recent years, there have been important changes in general medicine relevant to CL psychiatry. There is now a much wider recognition of the high prevalence of psychiatric and physical comorbidity and how this influences consultation frequency, service utilisation, treatment adherence, the physical prognosis and probably the overall cost as well. The relationship between physical disease and mental disorder is influenced by biological factors contributing to psychological change in physical disease, psychological factors in physical disease, social factors and comorbidity. There has also been recognition of the high prevalence of non-organic complaints among general medical patients as well as an awareness of the high costs of investigating these patients, which has led to a search for better ways to manage this group of patients.
Collaboration between general medical and psychiatric staff is essential. Psychological treatment and psychotropic medication can be effective. Mental capacity is an important and sometimes complex issue.
vorliegende Arbeit beschäftigt sich mit der Psychotherapie bei chronisch körperlich kranken, nämlich herzkranken Menschen. Nach einer kurzen Beschreibung des medizinischen Krankheitsbildes der Koronaren Herzkrankheit folgt ein Überblick über den Stand der Theoriebildung und Forschung aus psychosomatischer Sicht. Mögliche Ansatzpunkte für Psychotherapie unter besonderer Berücksichtigung des Klientenzentrierten Ansatzes werden formuliert. Eine Analyse der Behandlungsverläufe von Herzpatienten in der ambulanten Rehabilitation mit psychotherapeutischem Versorgungsauftrag soll die Besonderheiten und Schwierigkeiten des Zuganges von Herzpatienten zur Psychotherapie aufzeigen und mögliche Ursachen der häufigen Psychotherapieabbrüche dieser Patientengruppe im Beziehungsgeschehen identifizieren.
This study assessed the prevalence of Adverse Childhood Experiences (ACEs) among Home Care Aides (HCAs) and explored the relationship between ACEs and mental health. A 2017 survey of 424 HCAs assessed childhood trauma using the CDC-BRFSS ACE module. Approximately 27% of HCAs had a high ACE score (between 4 and 10). There were no associations found between ACE score and respondent demographic characteristics. HCAs with high ACE scores reported lower rates of social and emotional support and higher rates of past-month hopelessness compared with those with no or limited experience of adverse childhood events. This research suggests that HCAs have higher than average rates of ACEs, known to be linked to various negative physical and mental health outcomes.
This study examined the impact of perceived social support on quality of life and death anxiety in individuals with coronary heart disease. For this purpose, a sample of 100 patients (Male=55, Female=45) with coronary heart disease were selected. Data was gathered through the purposive sampling technique from different hospitals in Islamabad and Rawalpindi.
Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. However, the connection between MI and depression has remained under-appreciated. This review examines the potential connection between depression and MI by overviewing the possible pathophysiologic mechanisms including dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, coagulation system dysfunction, inflammation, environmental factors, as well as, genetic factors. Furthermore, depression can be an adverse event of medications used for MI treatment including beta-blockers, statins, or anti-platelet agents. The need for early detection and management of depression in patients with MI is, therefore, crucial for improving their overall prognosis. Adherence to treatments and regular follow-up visits can ensure the best response to treatment.
Consenso de Prevención Cardiovascular
Cardiovascular diseases (CVDs) pose a serious threat to global public health due to its high prevalence and mortality. Meanwhile, psychosocial rehabilitation (PSR) has gained popularity due to its beneficial effects on the cardiovascular system. There is substantial evidence that PSR is effective in lessening cardiovascular morbidity and mortality in CVD patients. To learn more about the development of PSR, 3,759 publications about PSR and related research were retrieved from the Web of Science (WoS) Core Collection from 1989 to 2022. Then, these publications were analysed using CiteSpace 6.1.R3 (64-bit) W version software in terms of country and institution-based analysis, author co-citation analysis (ACA), keyword analysis, and document co-citation analysis (DCA). The outcomes were elaborated in four aspects. First, the number of annual publications related to PSR has consistently increased in last three decades. Second, country and institution-based analysis showed that a few developed countries such as the United States, England and Canada, and institutions such as the Harvard University, the University of California, and the University of Toronto were the most active countries and institutions in carrying out PSR-related studies. Third, author co-citation analysis (ACA) revealed that Sherry L. Grace from York University had the highest number of publications (35). Her research majorly focused on optimizing post-acute cardiovascular care and its outcomes that contribute to the field of PSR. Frasure-Smith had the highest burst count of 41.39. His research mainly emphasized on the impact of psychological stress in acute myocardial infarction which is related to CVD. Document co-citation analysis (DCA) revealed that epidemiologic evidence was the predominant cluster in the domain of PSR. Fourth, Keyword based analysis showed that keywords such as coronary heart disease, cardiovascular disease, acute myocardial infarction and major depression made outstanding contribution to the PSR field. In conclusion, this study has provided useful information for gaining knowledge about PSR such as identifying potential contributors for researchers interested in the field of PSR, and discovering research trends in PSR, which can provide guidance for more extensive studies related to PSR in the future.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
Exercise is well known to be beneficial to physical health; however, increasing research indicates that physical exercise is also beneficial to brain health and may alleviate symptoms of mental disorders. This book, written by international experts, describes and explores the theory and practice of exercise intervention for different mental disorders across the life span. Drawing on evidence from basic neuroscience research, and enriched with findings from the latest clinical trials, the work provides clear descriptions of current practice and highlights ways to translate this knowledge into pragmatic advice for use in daily practice. The chapters cover a broad range of conditions including neurodevelopmental disorders, depression, anxiety, psychosis and late life neurocognitive disorders. This book is for mental health clinicians including psychiatrists, psychologists, social workers, nurses, as well as internists, paediatricians and geriatricians seeking a comprehensive and individualized approach to treatment.
The ability to recognize, challenge, and change self-defeating automatic thoughts and silent assumptions and long-standing health risking behaviors can be challenging and frustrating. With the careful choice of techniques, honest and thoughtful feedback, and continued support, however, nurses can help patients cope more effectively with the myriad stresses they encounter. Cognitive therapy provides a framework for patients to acquire critical skills to cope more effectively with stress and become autonomous in self-managing and challenging negative distorted thoughts. From this awareness the patient is able to challenge and change perception, decrease stress and reactivity, increase self-management skills, and mitigate the negative, harmful consequences of stress. The process of cognitive restructuring positively influences health, disease prevention, and disease management.
Background & Objective: Social support is generally accepted to act as a protective factor against stressful situations. However, the extent of its effect on the depression and lifestyle of myocardial infarction (MI) patients is not known. Therefore, the present study aimed to examine the role of perceived social support in predicting major depressive disorder and lifestyle components in MI patients. Materials & Methods: This quasi-experimental study was conducted in 2019 on 176 MI patients chosen through the purposive and convenience sampling methods from the Heart Center Hospital of Mazandaran, Iran. The required information was collected by three standard questionnaires, including the social support appraisals (SS-A) scale by Phillips, the Beck Depression Inventory (BDI-II), and Health-Promoting Lifestyle Profile (HPLP-II). Pearson correlation coefficient and canonical correlation coefficient were performed. The significance level in this study was considered as P- value<0.05. Results: The findings of the present study indicated that social support could predict depression by 48% and a significant negative correlation was found between social support and depression (r=-0.47, P=0.01). Moreover, social support had a significant impact on lifestyle components and was shown to predict health accountability (R²=0.691, β=0.289), spiritual growth (R²=0.672, β=0.256), stress management (R²=0.285, β=0.122), and interpersonal behavior (R²=0.586, β=0.175). In addition, it affected these factors significantly. Conclusion: Providing opportunities for further social support for MI patients paves the way for enhancing health-promoting behaviors and reducing depression in this group of patients.
Physical activity/exercise has consistently been shown to improve objective measures of functional capacity, enhance quality of life, improve coronary risk profile, and reduce mortality for individuals with coronary heart disease. Despite the gains achieved by those who attend cardiac rehabilitation (CR) many individuals fail to maintain lifestyle changes.
The aims of this study were to evaluate the effectiveness of motivational interviewing as a strategy for promoting maintenance of cardiac risk factor modification in patients who had participated in standard, 6-week outpatient CR programs.
In a randomized controlled trail, participants in usual care and intervention group (Motivational interviewing supplemental to a standard 6-week CR program) were followed up at 6-weeks and 12-months. The primary outcome was distance walked on the six-minute walk test (6MWT), used as both an indicator of functional capacity and habitual physical activity. Secondary outcomes included modifiable coronary risk factors (smoking, self-reported physical activity, waist circumference, body mass index and medication adherence), psychological status (depression, anxiety, stress, perceived cardiac control, perceived social support, exercise self-efficacy) and quality of life.
Total 110 patients, usual care (n=58) and intervention (n=52), consented to participate in the study. Overall, demographic and clinical characteristics did not differ between groups at baseline. Motivational interviewing was no more likely to promote maintenance of cardiac risk factor modification (both primary and secondary outcomes) than a standard CR program alone. Both intervention and control groups maintained the gains achieved during CR at the 12-month follow-up except for weight loss.
Although both groups maintained the gains achieved during CR for physical activity, there was no effect of the intervention on maintenance of cardiac risk factor modification on both primary and secondary outcomes.
Health is primordial importance for all the living beings.The pandemic like calamitiestime and againhas been creating distressing situations globally irrespective of gender. This disturbing state of affairs has psychological influence on the individuals. Stress in the individuals not only deviate from their routine but also levy health burden. The researchers tried to study the psychological challenges faced during COVID-19 pandemic in gender perspective. The pandemic not only imposed health burden but also heavy workload and psychosocial and economic anguish.
Examines procedures previously recommended by various authors for the estimation of "change" scores, "residual," or "basefree" measures of change, and other kinds of difference scores. A procedure proposed by F. M. Lord is extended to obtain more precise estimates, and an alternative to the L. R. Tucker, F. Damarin, and S. A. Messick (see 41:3) procedure is offered. A consideration of the purposes for which change measures have been sought in the past leads to a series of recommended procedures which solve research and personnel-decision problems without estimation of change scores for individuals. (22 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The initial study describing the development of the Multidimensional Scale of Perceived Social Support (MSPSS) indicated that it was a psychometrically sound instrument (Zimet, Dahlem, Zimet, & Farley, 1988). The current study attempted to extend the initial findings by demonstrating the internal reliability, factorial validity, and subscale validity of the MSPSS using three different subject groups: (a) 265 pregnant women, (b) 74 adolescents living in Europe with their families, and (c) 55 pediatric residents. The MSPSS was found to have good internal reliability across subject groups. In addition, strong factorial validity was demonstrated, confirming the three-subscale structure of the MSPSS: Family, Friends, and Significant Other. Finally, strong support was also found for the validity of the Family and Significant Other subscales.
In this article we attempt to distinguish empirically between psychosocial variables that are concomitants of depression, and variables that may serve as antecedents or sequelae of this disorder. We review studies that investigated the relationship between depression and any of six psychosocial variables after controlling for the effects of concurrent depression. The six variables examined are attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The review suggests that whereas there is little evidence in adults of a cognitive vulnerability to clinical depression, disturbances in interpersonal functioning may be antecedents or sequelae of this disorder. Specifically, marital distress and low social integration appear to be involved in the etiology of depression, and introversion and interpersonal dependency are identified as enduring abnormalities in the functioning of remitted depressives. We attempt to integrate what is known about the relationships among these latter variables, suggest ways in which they may influence the development of depression, and outline specific issues to be addressed in future research.
This study examine the importance of major depression symptoms, history of major depression, anxiety, anger-in, anger-out, and perceived social support, measured in the hospital after a myocardial infarction (MI), in predicting cardiac events over the subsequent 12 months in a sample of 222 patients. Cardiac events included both recurrences of acute coronary syndromes (unstable angina admissions and survived and nonsurvived MI recurrences) and probable arrhythmic events (survived cardiac arrests and arrhythmic deaths). Major depression, depressive symptoms, anxiety, and history of major depression all significantly predicted cardiac events. Multivariate analyses showed that depressive symptoms, anxiety, and history of major depression each had an impact independent of each other, as well as of measures of cardiac disease severity.
We followed a cohort of subjects (predominantly inpatients) suffering a major depressive episode in midlife and late life for 1 year (N = 118). In this follow-up study, we examined three hypotheses, a) Elder subjects suffering major depression, compared with middle-aged subjects, will more likely report endogenous symptoms and less likely report decreased life satisfaction symptoms at 1-year follow-up. b) Impaired social support during the index episode will predict poor life satisfaction, but not endogenous symptoms at 1-year follow-up, regardless of age. c) Impaired social support during the index episode will be more predictive of decreased life satisfaction symptoms in midlife, compared with late life, at 12-month follow-up. The first two hypotheses were not supported, but the third hypothesis was. Both decreased life satisfaction and endogenous symptoms at outcome were significantly predicted by impaired social support during the index episode. Impaired social support predicted a poor outcome from an episode of major depression in both middle life and late life in controlled analyses. However, the effect of impaired subjective social support was conditional on age. Subjective social support appears to have a decreasing influence on the report of both endogenous and decreased life satisfaction symptoms for older individuals. (C) Williams & Wilkins 1992. All Rights Reserved.
• Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.
(Arch Intern Med 1988;148:1929-1936)
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Objective.
—To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (Ml) would have an independent impact on cardiac mortality over the first 6 months after discharge.Design.
—Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.Setting.
—A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec.Patients.
—All consenting patients (N=222) who met established criteria for Ml between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male.Primary Outcome Measure.
—Survival status at 6 months.Results.
—By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P=.0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous Ml, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P=.013).Conclusion.
—Major depression in patients hospitalized following an Ml is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous Ml. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.(JAMA. 1993;270:1819-1825)
Background:
Clinical characteristics of depression, age at illness onset, medical burden, disability, cognitive impairment, lack of social support, and poor living conditions may influence the course of depression. This study investigates the timetable of recovery and the role of the above factors in predicting recovery in elderly patients with major depression.
Methods:
Recovery was studied in 63 elderly (age >63 years) and 23 younger patients with depression who were followed up for an average of 18.2 months (SD, 13.1 months) under naturalistic treatment conditions. Diagnosis was assigned according to Research Diagnostic Criteria after administration of the Schedule for Affective Disorders and Schizophrenia. The Longitudinal Follow-up Interval Examination was used to identify recovery.
Results:
The recovery rate of depressed elderly patients was similar to that of younger depressed patients. In the elderly patients, age, antidepressant treatment, age at onset, and chronicity of episode were significantly as sociated with time to recovery since entry. Among these parameters, late age at onset was the strongest predictor of slow recovery. In younger patients, long time to recovery was predicted by weak social support, younger age, cognitive impairment, and low intensity of antidepressant treatment. In the elderly, the intensity of antidepressant treatment began to decline within 16 weeks from entry and approximately 10 weeks prior to recovery.
Conclusions:
These findings challenge the view that geriatric depression has a worse outcome than depression in younger adults. However, depressed patients with onset of first episode in late life may be at higher risk for chronicity. Antidepressant treatment prescribed by clinicians may decline prior to recovery despite evidence that high treatment intensity is effective in preventing relapse.
Objective.
—To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction.
Design.
—Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database.
Setting.
—Multicenter trial in a mixture of community and academic hospitals in the United States and Canada.
Patients.
—All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years.
Primary Outcome Measure.
—Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death).
Results.
—Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P<.03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P=.001). A disrupted marriage was not an independent risk factor.
Conclusion.
—Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.(JAMA. 1992;267:515-519)
this chapter will describe Interpersonal Psychotherapy (IPT) for depression, including the theoretical and empirical bases, efficacy studies, and derivative forms, and will also make recommendations for its use in clinical practice
Interpersonal Psychotherapy (IPT) is based on the observation that major depression—regardless of symptom patterns, severity, presumed biological or genetic vulnerability, or the patients' personality traits—usually occurs in an interpersonal context, often an interpersonal loss or dispute / IPT is a brief, weekly psychotherapy that is usually conducted for 12 to 16 weeks, although it has been used for longer periods of time with less frequency as maintenance treatment for recovered depressed patients with major depression / the focus is on improving the quality of the depressed patients' current interpersonal functioning and the problems associated with the onset of depression (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Kubler and Stotland (1964) have argued, 'emotional disturbance, even the most severe, cannot be understood unless the field in which it develops and exists is examined. The manifestations of the difficulty in the disturbed individual have meaning depending on aspects of the field. The significant aspects of the field are usually interpersonal'. Yet the study of depression has focused on the individual and his behavior out of his interactional context. To a large degree, the depressed person's monotonously reiterated complaints and self accusations, and his provocative and often annoying behavior have distracted investigators from considerations of his environment and the role it may play in the maintenance of his behavior. The possibility that the characteristic pattern of depressed behavior might be interwoven and concatenated with a corresponding pattern in the response of others has seldom been explored. This paper addresses itself to that possibility.
To compare the survival of elderly patients hospitalized for acute myocardial infarction who have emotional support with that of patients who lack such support, while controlling for severity of disease, comorbidity, and functional status.
A prospective, community-based cohort study.
Two hospitals in New Haven, Connecticut.
Men (n = 100) and women (n = 94) 65 years of age or more hospitalized for acute myocardial infarction between 1982 and 1988.
Social support, age, gender, race, education, marital status, living arrangements, presence of depression, smoking history, weight, and physical function were assessed prospectively using questionnaires. The presence of congestive heart failure, pulmonary edema, and cardiogenic shock; the position of infarction; in-hospital complications; and history of myocardial infarction were assessed using medical records. Comorbidity was defined using an index based on the presence of eight conditions.
Of 194 patients, 76 (39%) died in the first 6 months after myocardial infarction. In multiple logistic regression analyses, lack of emotional support was significantly associated with 6-month mortality (odds ratio, 2.9; 95% CI, 1.2 to 6.9) after controlling for severity of myocardial infarction, comorbidity, risk factors such as smoking and hypertension, and sociodemographic factors.
When emotional support was assessed before myocardial infarction, it was independently related to risk for death in the subsequent 6 months.
We followed a cohort of subjects (predominantly inpatients) suffering a major depressive episode in midlife and late-life for 1 year (N = 118). In this follow-up study, we examined three hypotheses. a) Elder subjects suffering major depression, compared with middle-aged subjects, will more likely report endogenous symptoms and less likely report decreased life satisfaction symptoms at 1-year follow-up. b) Impaired social support during the index episode will predict poor life satisfaction, but not endogenous symptoms at 1-year follow-up, regardless of age. c) Impaired social support during the index episode will be more predictive of decreased life satisfaction symptoms in midlife, compared with late life, at 12-month follow-up. The first two hypotheses were not supported, but the third hypothesis was. Both decreased life satisfaction and endogenous symptoms at outcome were significantly predicted by impaired social support during the index episode. Impaired social support predicted a poor outcome from an episode of major depression in both middle life and late life in controlled analyses. However, the effect of impaired subjective social support was conditional on age. Subjective social support appears to have a decreasing influence on the report of both endogenous and decreased life satisfaction symptoms for older individuals.
To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction.
Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database.
Multicenter trial in a mixture of community and academic hospitals in the United States and Canada.
All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years.
Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death).
Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P less than .03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P = .001). A disrupted marriage was not an independent risk factor.
Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.
One hundred and fifty middle-aged and elderly adults with a diagnosis of major depression were assessed initially as in-patients, and were reinterviewed 6-32 months later. Both size of social network and subjective social support were significant predictors of depressive symptoms at follow-up, with baseline depression scores and other predictors of outcome status statistically controlled. Subjective social support was most strongly associated with major depression; this effect was significantly stronger for middle-aged than older adults, and for men than women. Differences in the effects of marital status, size of social network, and subjective social support also suggest the importance of distinguishing between involvement in and quality of interpersonal relationships.
Depressive symptoms and disorders were identified by structured psychiatric interview in 130 consecutively admitted male inpatients aged 70 years and over. Major depression was found in 11.5% and other depressive syndromes in 23%. While depressive symptoms and syndromes are common among the medically ill, this study demonstrated the need for careful diagnostic assessment of older patients with depressive symptoms before initiating treatment that may itself convey significant risk. Sociodemographic and health characteristics of older men at higher risk for depression were also identified. Patients more likely to be depressed were over age 75 years, had less formal education, experienced cognitive dysfunction, suffered from more severe medical illness (particularly recent myocardial infarction), and had a history of psychiatric illness. Depressive symptoms were also common among patients with renal or neurologic diseases, those having a family history of psychiatric illness, the unmarried, and the more severely disabled. Given the impact of depression on recovery from medical illness, compliance with medical therapy, and costs of extended hospital stays, detection and treatment of this disorder are imperative.
Synopsis
A prospective study of 400 largely working-class women with children living at home has used measures of self-esteem and ‘social support’ to predict the risk of depression in the following year once a stressor had occurred. Actual support received at the time of any crisis in the follow-up year was also measured. Self-esteem was correlated quite highly with some of the measures of support.
A core tie was defined as a husband, lover or someone named as very close at first contact. Negative evaluation of self (i.e. low self-esteem), and various indices of lack of support from a core tie at the first interview, were associated with a greatly increased risk of subsequent depression once stressor occurred. Lack of support from a core tie at the time of the crisis was particularly highly associated with an increased risk. There was also a high risk among those who were ‘let down’ - that is, for those who did not receive the support which they might have expected in terms of the first interview material. It is concluded that it is essential for prospective enquiries to take account of the actual mobilization of support in the follow-up period.
The results of treatment of 250 patients with established acute myocardial infarction in a coronary care unit in a university hospital are described. The criteria for diagnosis have been carefully defined. In 62 per cent of patients admitted with a tentative diagnosis of acute infarction, the initial impression was confirmed. Fifteen per cent of patients admitted to the unit were classified as having possible infarction; in this group, the mortality rate was 3 per cent. A classification of functional severity based on clinical evidence of heart failure or shock is presented.Morbidity and mortality in acute myocardial infarction are related to the functional severity of the illness. Although arrhythmia is common, the overriding importance of five life-threatening arrhythmias is emphasized. Mortality of patients in the coronary care unit was not improved in comparison to those treated under regular care until strong central direction of therapeutic programs, immediate treatment of arrhythmia in cardiac arrest, and delegation of some medical authority to trained nurses was accomplished. The change in concept of the purposes and practices of special coronary care from resuscitation to prevention of arrhythmia is emphasized.The mortality in myocardial infarction complicated by shock remains high. In the absence of shock, aggressive medical treatment in the coronary care unit reduced mortality from 26 to 7 per cent. The implications of these data in the management of patients admitted to a hospital with a diagnosis of acute myocardial infarction are discussed.
Psychosocial interviews with 2320 male survivors of acute myocardial infarction, participants in the beta-Blocker Heart Attack Trial, permitted the definition of two variables strongly associated with an increased three-year mortality risk. With other important prognostic factors controlled for, the patients classified as being socially isolated and having a high degree of life stress had more than four times the risk of death of the men with low levels of both stress and isolation. An inverse association of education with mortality in this population reflected the gradient in the prevalence of the defined psychosocial characteristics. High levels of stress and social isolation were most prevalent among the least-educated men and least prevalent among the best-educated. The increase in risk associated with stress and social isolation applied both to total deaths and to sudden cardiac deaths and was noted among men with both high and low levels of ventricular ectopy during hospitalization for the acute infarction.
A standardized study of the point prevalence of non-psychotic disorder was carried out on a systematic sample of Canberra residents (N = 756). Rates were estimated for PSE CATEGO diagnoses and the Index of Definition. The association between neurosis and deficiencies in social relationships was examined, using the Interview Schedule for Social Interaction (ISSI). An objective measure of exposure to adversity was also obtained at interview. Both attachment and social integration (affectionally close and more diffuse relationships) were found to be negatively associated with neurosis. This association holds in its own right, in addition to an interaction with the load of adversity. The associations are weaker for men.
The significance of this work lies in its demonstration of an association between neurosis and the lack of social ties, and in its attempt to obtain a specification of those elements in social relationships which, when deficient, may be associated with neurosis. The direction of causality has now to be investigated.
We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality.
Two-hundred twenty-two patients responded to a modified version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) for a major depressive episode at approximately 7 days after MI. The Beck Depression Inventory (BDI), which measures depressive symptomatology, was also completed by 218 of the patients. All patients and/or families were contacted at 18 months to determine survival status. Thirty-five patients met the modified DIS criteria for major in-hospital depression after the MI. Sixty-eight had BDI scores > or = 10, indicative of mild to moderate symptoms of depression. There were 21 deaths during the follow-up period, including 19 from cardiac causes. Seven of these deaths occurred among patients who met DIS criteria for depression, and 12 occurred among patients with elevated BDI scores. Multiple logistic regression analyses showed that both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32 to 10.05; P = .012) and elevated BDI scores (odds ratio, 7.82; 95% CI, 2.42 to 25.26; P = .0002) were significantly related to 18-month cardiac mortality. After we controlled for the other significant multivariate predictors of mortality in the data set (previous MI, Killip class, premature ventricular contractions [PVCs] of > or = 10 per hour), the impact of the BDI score remained significant (adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09; P = .0026). In addition, the interaction of PVCs and BDI score marginally improved the model (P = .094). The interaction showed that deaths were concentrated among depressed patients with PVCs of > or = 10 per hour (odds ratio, 29.1; 95% CI, 6.97 to 122.07; P < .00001).
Depression while in the hospital after an MI is a significant predictor of 18-month post-MI cardiac mortality. Depression also significantly improves a risk-stratification model based on traditional post-MI risks, including previous MI, Killip class, and PVCs. Furthermore, the risk associated with depression is greatest among patients with > or = 10 PVCs per hour. This result is compatible with the literature suggesting an arrhythmic mechanism as the link between psychological factors and sudden cardiac death and underscores the importance of developing screening and treatment programs for post-MI depression.
To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (MI) would have an independent impact on cardiac mortality over the first 6 months after discharge.
Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.
A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec.
All consenting patients (N = 222) who met established criteria for MI between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male.
Survival status at 6 months.
By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P = .0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous MI, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P = .013).
Major depression in patients hospitalized following an MI is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous MI. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.
Clinical characteristics of depression, age at illness onset, medical burden, disability, cognitive impairment, lack of social support, and poor living conditions may influence the course of depression. This study investigates the timetable of recovery and the role of the above factors in predicting recovery in elderly patients with major depression.
Recovery was studied in 63 elderly (age >63 years) and 23 younger patients with depression who were followed up for an average of 18.2 months (SD, 13.1 months) under naturalistic treatment conditions. Diagnosis was assigned according to Research Diagnostic Criteria after administration of the Schedule for Affective Disorders and Schizophrenia. The Longitudinal Follow-up Interval Examination was used to identify recovery.
The recovery rate of depressed elderly patients was similar to that of younger depressed patients. In the elderly patients, age, antidepressant treatment, age at onset, and chronicity of episode were significantly associated with time to recovery since entry. Among these parameters, late age at onset was the strongest predictor of slow recovery. In younger patients, long time to recovery was predicted by weak social support, younger age, cognitive impairment, and low intensity of antidepressant treatment. In the elderly, the intensity of antidepressant treatment began to decline within 16 weeks from entry and approximately 10 weeks prior to recovery.
These findings challenge the view that geriatric depression has a worse outcome than depression in younger adults. However, depressed patients with onset of first episode in late life may be at higher risk for chronicity. Antidepressant treatment prescribed by clinicians may decline prior to recovery despite evidence that high treatment intensity is effective in preventing relapse.
Little is known about the course and outcome of depression in patients with coronary heart disease, despite its prevalence and effect on medical prognosis. A series of 200 patients undergoing diagnostic cardiac catheterization and coronary angiography were administered a psychiatric diagnostic interview. Seventeen percent were diagnosed with a current major depressive episode, and another 17% with a current minor depressive episode. Ninety percent of those patients who consented to follow-up completed the study. Half of the patients with major depression either remained depressed or relapsed within 12 months. Nearly half of the patients with minor depression remitted, but 42% subsequently developed major depression. These results suggest that major depression, if left untreated, is persistent in patients with coronary heart disease. Furthermore, minor depression is nearly as likely to progress to major depression as to remit over the course of the 12 months following diagnostic angiography.
We report the outcome of depressive states after 3-4 years in a community sample of the elderly.
A sample of 1045 persons aged 70+ years in 1990-1 was re-interviewed after 3.6 years.
Mortality (21.7%) and refusal or non-availability (10.4%) were higher in those who initially had had a diagnosis or symptoms of depression. Of those with an ICD-10 depressive episode in 1990-1, 13% retained that diagnosis. Of those who were not depressed initially only 2.5% had become cases. Depression was unrelated to age or apolipoprotein E genotype. The best predictors of the number of depressive symptoms at follow-up was the number at Wave 1, followed by deterioration in health and in activities of daily living, high neuroticism, poor current health, poor social support, low current activity levels and high service use. Depressive symptoms at Wave 1 did not predict subsequent cognitive decline or dementia.
Non-random sample attrition is unavoidable. ICD-10 criteria yield more cases than other systems, while continuous measures of symptoms confer analytical advantages. Risk factors for depressive states in the elderly have been further identified. The prognosis for these states is favourable. At the community level, depressive symptoms do not seem to predict cognitive decline, as they do in referred series.
Increases in life stress have been linked to poor prognosis, after myocardial infarction (MI). Previous research suggested that a programme of monthly screening for psychological distress, combined with supportive and educational home nursing interventions for distressed patients, may improve post-MI survival among men. Our study assessed this approach for both men and women. We aimed to find out whether the programme would reduce 1-year cardiac mortality for women and men.
We carried out a randomised, controlled trial of 1376 post-MI patients (903 men, 473 women) assigned to the intervention programme (n = 692) or usual care (n = 684) for 1 year. All patients completed a baseline interview that included assessment of depression and anxiety. Survivors were also interviewed at 1 year.
The programme had no overall survival impact. Preplanned analyses showed higher cardiac (9.4 vs 5.0%, p = 0.064) and all-cause mortality (10.3 vs 5.4%, p = 0.051) among women in the intervention group. There was no evidence of either benefit or harm among men (cardiac mortality 2.4 vs 2.5%, p = 0.94; all-cause mortality 3.1 vs 3.1%, p = 0.93). The programme's impact on depression and anxiety among survivors was small.
Our results do not warrant the routine implementation of programmes that involve psychological-distress screening and home nursing intervention for patients recovering from MI. The poorer overall outcome for women, and the possible harmful impact of the intervention on women, underline the need for further research and the inclusion of adequate numbers of women in future post-MI trials.
Depression is common among patients with cardiac disease. A number of psychosocial factors may affect the relationship between physical health and depression. There is evidence from the psychiatric literature suggesting that negative life events and social support are important factors in the development and outcome of depression. It is unknown if these factors are important in the context of depression in medically ill patients. Thus it is important to examine the relationship among social support, negative life events, and the presence of depression in elderly patients with cardiac disease.
Patients with coronary artery disease were assessed with the Duke Depression Evaluation Schedule for the Elderly. This includes the mood and anxiety disorder section of the Diagnostic Interview Schedule modified for Diagnostic and Statistical Manual of Mental Disorders diagnoses, life events, and multidimensional assessment of social support. Two hypotheses were tested: (1) the number of concurrent negative life events will be higher in patients with coronary artery disease with major depression than those without depression, and (2) social support will be less in patients with major depression than in those without.
Presence of major depression was associated with increased negative life events and lowered subjective social support after accounting for age, sex, and race.
The finding that subjective social support and negative life events are related to major depression suggests that even in the context of medical illness, social factors are still important in the development of major depression.
Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients.
A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age.
Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age.
Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.
The purpose of this study was to assess gender differences in the impact of depression on 1-year cardiac mortality in patients hospitalized for an acute myocardial infarction (MI).
Secondary analysis was performed on data from two studies that used the Beck Depression Inventory (BDI) to assess depression symptoms during hospitalization: a prospective study of post-MI risk and a randomized trial of psychosocial intervention (control group only). The sample included 896 patients (283 women) who survived to discharge and received usual posthospital care. Multivariate logistic regression analysis was used to assess the risk of 1-year cardiac mortality associated with baseline BDI scores.
There were 290 patients (133 women) with BDI scores > or =10 (at least mild to moderate symptoms of depression); 8.3% of the depressed women died of cardiac causes in contrast to 2.7% of the nondepressed. For depressed men, the rate of cardiac death was 7.0% in contrast to 2.4% of the nondepressed. Increased BDI scores were significantly related to cardiac mortality for both genders [the odds ratio for women was 3.29 (95% confidence interval (CI) = 1.02-10.59); for men, the odds ratio was 3.05 (95% CI = 1.29-7.17)]. Control for other multivariate predictors of mortality in the data set (age, Killip class, the interactions of gender by non-Q wave MI, gender by left ventricular ejection fraction, and gender by smoking) did not change the impact of the BDI for either gender.
Depression in hospital after MI is a significant predictor of 1-year cardiac mortality for women as well as for men, and its impact is largely independent of other post-MI risks.
Recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Pathophysiological mechanisms underlying the relationship between these entities and CAD can be divided into behavioral mechanisms, whereby psychosocial conditions contribute to a higher frequency of adverse health behaviors, such as poor diet and smoking, and direct pathophysiological mechanisms, such as neuroendocrine and platelet activation. An extensive body of evidence from animal models (especially the cynomolgus monkey, Macaca fascicularis) reveals that chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis. Evidence from monkeys also indicates that psychosocial stress reliably induces ovarian dysfunction, hypercortisolemia, and excessive adrenergic activation in premenopausal females, leading to accelerated atherosclerosis. Also reviewed are data relating CAD to acute stress and individual differences in sympathetic nervous system responsivity. New technologies and research from animal models demonstrate that acute stress triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity through hemoconcentration. In the presence of underlying atherosclerosis (eg, in CAD patients), acute stress also causes coronary vasoconstriction. Recent data indicate that the foregoing effects result, at least in part, from the endothelial dysfunction and injury induced by acute stress. Hyperresponsivity of the sympathetic nervous system, manifested by exaggerated heart rate and blood pressure responses to psychological stimuli, is an intrinsic characteristic among some individuals. Current data link sympathetic nervous system hyperresponsivity to accelerated development of carotid atherosclerosis in human subjects and to exacerbated coronary and carotid atherosclerosis in monkeys. Thus far, intervention trials designed to reduce psychosocial stress have been limited in size and number. Specific suggestions to improve the assessment of behavioral interventions include more complete delineation of the physiological mechanisms by which such interventions might work; increased use of new, more convenient "alternative" end points for behavioral intervention trials; development of specifically targeted behavioral interventions (based on profiling of patient factors); and evaluation of previously developed models of predicting behavioral change. The importance of maximizing the efficacy of behavioral interventions is underscored by the recognition that psychosocial stresses tend to cluster together. When they do so, the resultant risk for cardiac events is often substantially elevated, equaling that associated with previously established risk factors for CAD, such as hypertension and hypercholesterolemia.
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Social support and the outcome of major depression
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Social support and the outcome of major depression
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- D C Hughes
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George LK, Blazer DG, Hughes DC, Fowler N. Social support and the
outcome of major depression. Br J Psychiatry. 1989;154:478 -485.
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