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Is Worrying Bad for Your Heart?: A Prospective Study of Worry and Coronary Heart Disease in the Normative Aging Study
Abstract
Worry is an important component of anxiety, which recent work suggests is related to increased incidence of coronary heart disease (CHD). Chronic worry has also been associated with decreased heart rate variability. We hypothesized that high levels of worry may increase CHD risk.
We examined prospectively the relationship of worry with CHD incidence in the Normative Aging Study, an ongoing cohort of older men. In 1975, 1759 men free of diagnosed CHD completed a Worries Scale, indicating the extent to which they worried about each of five worry domains: social conditions, health, financial, self-definition, and aging. During 20 years of follow-up, 323 cases of incident CHD occurred: 113 cases of nonfatal myocardial infarction (MI); 86 cases of fatal CHD; and 124 cases of angina pectoris. Worry about social conditions was the domain most strongly associated with incident CHD. Compared with men reporting the lowest levels of social conditions worry, men reporting the highest levels had multivariate adjusted relative risks of 2.41 (95% CI, 1.40 to 4.13) for nonfatal MI and 1.48 (95% CI, 0.99 to 2.20) for total CHD (nonfatal MI and fatal CHD). A dose-response relation was found between level of worry and both nonfatal MI (P for trend, .002) and total CHD (P for trend, .04).
These results suggest that high levels of worry in specific domains may increase the risk of CHD in older men.
... 23,[115][116][117] These cognitive tendencies function as adaptive mechanisms in response to short-term stress-evoking situations arising from the social environment. 23,115,118,119 For example, one may attempt to manage future stressors and broader social threats (i.e., experiences of racial discrimination) through the cognitive tendency of vigilance, often conceptualized in terms of an anticipatory orientation toward threat. 119 In contrast, the cognitive tendency of coping via suppression and avoidance (e.g., doing chores to think about a stressor less or saying "this isn't real") is a strategy that orients away from threat through cognitive and emotional disengagement. ...
... 23,115,118,119 For example, one may attempt to manage future stressors and broader social threats (i.e., experiences of racial discrimination) through the cognitive tendency of vigilance, often conceptualized in terms of an anticipatory orientation toward threat. 119 In contrast, the cognitive tendency of coping via suppression and avoidance (e.g., doing chores to think about a stressor less or saying "this isn't real") is a strategy that orients away from threat through cognitive and emotional disengagement. 120 Such stress-related cognitive tendencies may be effective for protecting health short-term and in certain situations (i.e., job-related vigilance), but over time and applied to a wide range of situations, these cognitions may become maladaptive and even harmful. ...
... Our null findings regarding vigilance are at odds with a previous longitudinal study that showed positive association between worrying and the risk of nonfatal myocardial infarction and total coronary heart disease. 119 This might have been due in part to the challenges around ascertainment of the construct of vigilance through self-report. Following GUTS, vigilance may be hypothesized as a symptom of internalized threat due to past trauma and may be normalized or suppressed and unavailable for conscious recall, especially in the setting of a research study. ...
There is growing recognition that chronic psychosocial stress may accelerate aging, increase risk of diseases, and contribute to health disparities. Variability across findings and methodological challenges limit our ability to examine chronic stress as a key mechanism driving health disparities at the population scale. In an effort to clarify some of these dimensions and methodological challenges, this dissertation (1) explored definitional and measurement-related issues around the construct of stress, and by employing uniquely positioned epidemiologic sources of data and life course analytical methods, (2) examined the impact of psychosocial stress on cardiometabolic health across structural and socioeconomic differences. Aim 1 relied on quasi-experimental design features of the Richmond Stress and Sugar study (RSASS) to examine whether two common self-report measures of psychosocial stress reflect neurobiological stress response assessed by changes in salivary cortisol before and after an acute stress challenge. Adjusted linear spline mixed-effects models revealed that both perceived stress and domain-specific stress measures were inversely associated with neurobiological stress reactivity. Neighborhood SES, but not race/ethnicity, modified these associations. In Aim 2, we applied a novel stress framework to examine associations between stress-related cognitive tendencies (i.e., vigilance and avoidant/adaptive stress coping) and metabolic risk in a prospective cohort from the Healthy Aging in Neighborhoods of Diversity across the Lifespan Study (HANDLS). Contrary to our expectations, vigilance was not associated with metabolic risk in any of our mixed-effects linear models, while both types of stress coping were negatively associated with metabolic risk. Findings suggest that a higher level of engagement in any form of stress coping may be beneficial and help temper stress impact on metabolic health. Evidence for stress coping varied by race and lifecourse SES, suggesting that activation of a particular coping style may be context-specific and depend on the availability of psychosocial resources. Aim 3 sought to clarify the role of stress as a contributor to type 2 diabetes incidence, with attention to inequities in diabetes risk. Two separate time-to-event analyses using data from RSASS and HANDLS showed that stress was not associated with incident diabetes, but the estimates of association were in the hypothesized direction and comparable across the studies. This was consistent across two distinct measures of stress: perceived stress and acute stress reactivity. Subgroup analyses in HANDLS revealed that compared to White adults with low levels of perceived stress, White adults with high stress and Black adults (both high and low stress) had higher diabetes incidence. Convergent results from two longitudinal samples underscored the importance of replicating evidence across studies with shared features and design, an effort that provides a more robust understanding of the substantive question than what could be obtained from a single cohort. In sum, collective evidence generated from this work contributes toward efforts aimed at improving stress measures in population research and considering stress as a potentially modifiable factor of social health disparities.
... Evidence has suggested that symptomatic clients may be incredibly costly in their own right. For example, people with GAD symptoms demonstrate greater medical illness, medical utilization, disability (Kubzansky et al., 1997;Logue et at, 1993;Roy-Byrne, 1996), and some of the highest health care costs (Roy-Byrne & Katon, 1997). Moreover, some of the same predictors of treatment failure also predict cost. ...
... Such research demonstrates that worrisome thinking, the cardinal feature of GAD, may inhibit any cardiovascular response to repeated phobic image presentations (Borkovec & Hu, 1990;Borkovec, Lyonfields, Wiser, & Diehl, 1993). Worrisome thinking is also associated with general autonomic rigidity, which has been shown to be a risk factor in coronary heart disease and early mortality (Kubzansky et al., 1997). According to modem neobehaviorists (Foa & Kozak, 1986), the absence of a cardiovascular response to phobic images indicates an absence of the type of emotional processing necessary for extinction of the maladaptive fear. ...
As inexpensive interventions gain empirical support, there is an increasing risk that such data may be used by health maintenance organizations to unfairly restrict the number and type of therapy sessions reimbursed for all clients, even those less likely to benefit from economical treatments. As a result, it is important to identify clients who may not respond to specific therapies and to empirically support ways to treat them. Successful treatment of nonresponders is also valuable because predictors of treatment failure tend to predict cost related to medical and disability expenses. Using generalized anxiety disorder as an example, this article suggests a flexible and comprehensive approach to cost-benefit analysis in psychotherapy that includes clients who may not improve in response to current data-based interventions. In addition, suggestions are made for the identification of alternative treatment approaches, and a potential treatment allocation model is recommended.
... 13,14 Worry has been associated with 40% to 134% excess risk of developing CHD and stroke in 2 studies with 15 to 20 years of follow-up. 15,16 The associations of neuroticism and worry with metabolic disease are more mixed and less well investigated. For example, Čukić and Weiss 17 reported an association between higher neuroticism and lower diabetes incidence among a US national sample. ...
... In prior work with this measure, the overall score was associated with increased risk of CHD. 15 Neuroticism and worry were operationalized as both continuous z scores and categorical variables (using terciles for neuroticism and quartiles for worry). In this sample, the correlation of neuroticism and worry was r=0.30 (P<0.0001). ...
Background
Anxiety is linked to elevated risk of cardiometabolic disease onset, but the underlying mechanisms remain unclear. We examined the prospective association of 2 anxiety facets, neuroticism and worry, with cardiometabolic risk (CMR) trajectories for 4 decades.
Methods and Results
The sample comprised 1561 men from an ongoing adult male cohort. In 1975, healthy men (mean age, 53 years [SD, 8.4 years]) completed the Eysenck Personality Inventory‐Short Form neuroticism scale and a Worries Scale. Seven CMR biomarkers were assessed every 3 to 5 years. The CMR score was the number of biomarkers categorized as high‐risk based on established cut points or medication use. Using mixed effects regression, we modeled CMR trajectories over age and evaluated their associations with neuroticism and worry. Using Cox regression, we examined associations of neuroticism and worry with risk of having ≥6 CMR high‐risk biomarkers through 2015. CMR increased at 0.8 markers per decade from age 33 to 65 years, at which point men had an average of 3.8 high‐risk markers, followed by a slower increase of 0.5 markers per decade. Higher neuroticism (B=0.08; 95% CI, 0.02–0.15) and worry levels (B=0.07; 95% CI, 0.001–0.13) were associated with elevated CMR across time, and with 13% (95% CI, 1.03–1.23) and 10% (95% CI, 1.01–1.20) greater risks, respectively, of having ≥6 high‐risk CMR markers, adjusting for potential confounders.
Conclusions
By middle adulthood, higher anxiety levels are associated with stable differences in CMR that are maintained into older ages. Anxious individuals may experience deteriorations in cardiometabolic health earlier in life and remain on a stable trajectory of heightened risk into older ages.
... Events and factors that are perceived as uncontrollable tend to lead to much greater levels of worry (Dugas et al., 2004). Worry can negatively impact both physical and mental health (Borkovec et al., 1998;Kubzansky et al., 1997) as well as affect engagement in preventive behaviors (Renner & Reuter, 2012;Senay et al., 2013). Worries and concerns can range from under-reacting to overreacting in ways that may impair physical functioning and health. ...
... Worry can lead to appropriate behaviors to address a potentially threatening or dangerous factor (Renner & Reuter, 2012). However, they can also reduce quality of life by impeding the ability to focus on important activities, lead to over-reactions or negative coping such as substance use, or result in mental health problems such as depression and anxiety (Borkovec et al., 1998;Kieffer et al., 2006;Kubzansky et al., 1997). ...
We sought to develop a brief Severe Acute Respiratory Syndrome Coronavirus 2‐related worry (CoV‐Wo) scale to understand COVID‐19‐related worry among adults in the United States. We also aimed to model key determinants of worry in the early stage of the COVID‐19 pandemic in the United States. A total of 806 participants completed an online survey in late March 2020. Exploratory and confirmatory factor analyses assessed scale structure. Factor analysis stratified by depression was used to assess measurement invariance. Linear regression models examined COVID‐19‐related worry determinants. The CoV‐Wo scale exhibited good reliability (α = 0.80) and a two‐factor structure: health (α = 0.83) and resources (α = 0.71). The full scale and both subscales were higher among participants who stopped working due to COVID‐19 and those with depression. Perception of quality medical care if infected with COVID‐19 was associated with reduced worry. The CoV‐Wo scale is a low burden assessment of COVID‐19‐related worry, that captures common worries in domains affected by COVID‐19 and can be used to develop psychosocial resources.
... For example, worries in life (e.g. social conditions, finance, aging) show a dose-response relation with incidence of coronary heart disease (Kubzansky et al., 1997). Likewise, general perceived stress as well as fear (e.g. ...
... General perceived stress was measured with the short version of the Cohen Perceived Stress Scale (PSS-4) (Cohen et al., 1983) ranging from 5 to 20 (Cronbachs a ¼ .63). Worries were measured by a generic worry scale comprising of seven items on a five-point Likert scale (Kubzansky et al., 1997) with higher values indicating more worries (items such as: "Some unimportant thought runs through my head and that bothers me.") (Cronbachs a ¼ .75). Stress at work was assessed by the 17-item Effort-Reward-Imbalance (ERI) questionnaire (Siegrist, 1996). ...
Chronic stress at work shows a moderate but robust longitudinal association with cardiovascular disease (CVD). Atherosclerosis is a pathophysiological process of most CVD, for which intima media thickness (IMT) of the carotid artery is used as an early marker. Its relationship with stress at work has remained largely unexplored, and the present study therefore aimed to elucidate the association between stress at work, assessed as effort-reward imbalance (ERI), and IMT. This cross-sectional study comprised of 501 male German employees aged 42 (19–64) years at enrollment into the Mannheim Industrial Cohort Study. Clinical assessments used fasting blood samples and IMT measurement. Self-report questionnaires assessed sources of perceived stress. Analyses adjusted for medical history, life style, and socio-economic status (SES) indicators as well as general perceived stress and worries to determine the specificity of ERI. Linear regression models estimated the association of ERI with IMT, stratifying for age groups and adjusting for potential confounders. ERI ratio increased until the age of 50 years and abated thereafter. In participants younger than 50 years IMT measurements were not associated with ERI ratios. However, despite lower mean ERI ratios in participants older than 50 years, this age group showed a significant relationship with IMT (standardized Beta = .36, p < .01), adjusting for multiple confounders including general perceived stress and worries. These analyses suggest that atherosclerosis in older employees is specifically related to stress at work. Longitudinal studies will help to elucidate the temporal relationship between stress exposure and downstream biological mechanisms.
• Lay summary
• Our study explored the association of job stress and the calcification of the carotid artery in German employees. We found out that this association is stronger in employees older than 50 years. In addition, it is independent of medical risk factors and stress caused by private issues.
... According to the Response Styles Theory, rumination is the focused attention on the symptoms of one's emotional distress and its possible causes and consequences, as opposed to its solutions (Nolen-Hoeksema, 1991;Nolen-Hoeksema et al., 2008). The habitual tendency to ruminate is considered a maladaptive form of emotional regulation and has been associated with a sustained physiological stress response that damages the hormonal, cardiovascular, and nervous systems, ultimately leading to observable physical and mental health problems (Aldao et al., 2010;Brosschot et al., 2006;Kubzansky et al., 1997). Rumination is one of the reasons responsible for incomplete cardiovascular recovery after stress exposure and is therefore associated with cardiovascular indices (Radstaak et al., 2011). ...
The tendency to ruminate (i.e., repetitive, self‐referential, negative thoughts) is a maladaptive form of emotional regulation and represents a transdiagnostic vulnerability factor for stress‐related psychopathology. Vagally‐mediated heart rate variability (vmHRV) provides a non‐invasive, surrogate measure of vagal modulation of the heart, and higher HRV is considered an indicator of susceptibility, or ability to respond to stress. Past research has suggested a link between trait rumination and vmHRV; however, inconsistent results exist in healthy individuals. In this study, we investigated the association between the tendency to ruminate, brooding, and reflection (using the Ruminative Response Scale) with vmHRV measured at baseline in a healthy population using a large cross‐sectional dataset ( N = 1189, 88% female; mean age = 21.55, ranging from 17 to 48 years old), which was obtained by combining samples of healthy individuals from different studies from our laboratory. The results showed no cross‐sectional correlation between vmHRV and trait rumination (confirmed by Bayesian analysis), even after controlling for important confounders such as gender, age, and depressive symptoms. Also, a non‐linear relationship was rejected. In summary, based on our results in a large sample of healthy individuals, vmHRV is not a marker of trait rumination (as measured by the Ruminative Response Scale).
... Indeed, several longitudinal studies have linked perseverative cognition with the maintenance and recurrence of psychopathological conditions (Spinhoven et al., 2018) as well as with an increased likelihood of developing cardiovascular disease (e.g., Kubzansky et al., 1997). Hence, research investigating ways to reduce perseverative cognition is pivotal. ...
Perseverative cognitions can provoke psychophysiological stress in the absence of an actual stressor and are considered important transdiagnostic vulnerability factors for several (mental) health issues. These stress-related cognitive processes are reflected by both cognitive (assessed by self-reports) and autonomic inflexibility (assessed by heart rate variability; HRV), with a key role attributed to the vagus nerve. Interestingly, modulation of the afferent branches of the vagus can be achieved with transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive technique that employs a low-intensity electrical current applied to the ear. In a sample of healthy individuals, we investigated the effects of taVNS of the left concha, compared to sham (earlobe) stimulation, on the cognitive and autonomic correlates of perseverative cognition following a psychosocial stress task. Interestingly, taVNS significantly reduced cognitive rigidity, reflected by reduced subjective perseverative thinking after psychosocial stress. Although there were no direct effects on autonomic correlates of perseverative cognition, individual differences in perseverative thinking after the stressor significantly affected the effects of taVNS on HRV. Specifically, more autonomic inflexibility during the stress task (i.e., reduced HRV) was associated with increases in perseverative thinking afterward for the sham condition, but not the active taVNS condition. Additional exploratory analyses revealed no significant moderation of stimulation intensity. Overall, the study findings endorse the association between perseverative cognitions and vagus nerve functioning.
... According to the Response Styles Theory, rumination is the focused attention on the symptoms of one's emotional distress and its possible causes and consequences, as opposed to its solutions (Nolen-Hoeksema, 1991;Nolen-Hoeksema et al., 2008). The habitual tendency to ruminate is considered a maladaptive form of emotional regulation and has been associated with a sustained physiological stress response that damages the hormonal, cardiovascular, and nervous systems, ultimately leading to observable physical and mental health problems (Aldao et al., 2010;Brosschot et al., 2006;Kubzansky et al., 1997). Rumination is one of the reasons responsible for incomplete cardiovascular recovery after stress exposure and is therefore associated with cardiovascular indices (Radstaak et al., 2011). ...
The tendency to ruminate (i.e., repetitive, self-referential, negative thoughts) is a maladaptive form of emotional regulation and represents a transdiagnostic vulnerability factor for stress-related psychopathology. Vagally-mediated heart rate variability (HRV), reflecting parasympathetic nervous system activity, is commonly used as a physiological marker of stress regulation. Past research has suggested a link between trait rumination and resting HRV at baseline; however, inconsistent results exist in healthy individuals. In this study, we investigated the association between the tendency to ruminate and resting HRV measured at baseline in a healthy population using a large cross-sectional dataset (N = 1189, 88% women; mean age = 21.55, ranging from 17 to 48 years old), which was obtained by combining samples of healthy individuals from different studies from our laboratory. The results showed no cross-sectional correlation between resting baseline HRV and trait rumination (confirmed by Bayesian analyses), even after controlling for important confounders such as gender, age, and depressive symptoms. Also, a nonlinear relationship was rejected. In summary, based on our results in a large sample of healthy individuals, baseline resting HRV is not a trait marker of the tendency to ruminate.
... Anxiety also is highly prevalent in cardiac populations, with estimates ranging from 25% to 44% [3]. In addition, there is growing evidence that anxiety is an independent predictor of worse outcomes in both healthy adults and in cardiac populations [4][5][6][7][8][9][10][11][12]. For example, Frasure-Smith and colleagues [7] reported that more than 40% of post-myocardial infarction patients had elevated symptoms of anxiety and that anxiety was associated with more than a 50% increased risk for major adverse cardiac events over a 2-year follow-up. ...
Anxiety is common among patients with coronary heart disease (CHD) and is associated with a worse prognosis. UNWIND was a 12-week randomized clinical trial comparing exercise and escitalopram to placebo on measures of anxiety, depression, and CHD biomarkers. Primary results of the trial reported that treatment with escitalopram, but not exercise, was associated with significant reductions in anxiety and depression. At 1-year follow-up, participants completed the Hospital Anxiety-Depression Scale-Anxiety (HADS-A) along with the HADS-Depression (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Godin Leisure Time Exercise survey to assess physical activity. Results showed that those patients randomized to escitalopram had lower scores on the HADS-A compared to those randomized to exercise (P = 0.006) and had less depression compared to exercise on the HADS-D (P = 0.004) and BDI-II (P = 0.004). Participants randomized to exercise reported higher levels of physical activity at 1-year compared to those randomized to Placebo (P = 0.039). However, despite reporting being more physically active, those randomized to exercise did not have less anxiety or depression compared to placebo controls. Escitalopram appears to be a safe and effective treatment for anxiety; exercise has many health benefits, but does not appear to be effective in treating anxiety.
... Moreover, as stress is generally related to weight gain and disordered eating patterns (Tomiyama, 2019), experiencing more stressful life events during the COVID-19 pandemic may (further) worsen adolescents' food intake patterns. Moreover, not just the experience of these 'objective' stressors may be critical, subjective experiences (e.g., adolescents' worries about getting infected by the COVID-19 virus) may be equally important, as more worrying has been previously associated with health behaviours (Kubzansky et al., 1997;Wright et al., 2021). As such, COVID-19 stressful life events and worries may moderate the effect of the pandemic on adolescents' food intake. ...
Although insight in how adolescents’ food intake is affected by the COVID-19 pandemic is critical, knowledge is limited. Hence, this longitudinal study (N = 691, Mage = 14.30, SDage = 0.62; 52.5% female) investigated changes in adolescents’ unhealthy (sugar-sweetened beverages, sweet snacks, savoury snacks) and healthy (fruit and vegetables) food intake (in total, obtained from home, and from outside the home) from pre-pandemic (Spring 2019) to the first lockdown (Spring 2020) and to six months later (Fall 2020). Moreover, several moderating factors were assessed. Results showed that the intake of unhealthy and healthy food in total and obtained from outside the home decreased during the lockdown. Six months later, unhealthy food intake returned to pre-pandemic levels, while healthy food intake remained lower. COVID-19 stressful life events and maternal food intake further qualified these longer-term changes in intake of sugar-sweetened beverages and fruit and vegetables, respectively. Future work is warranted to elucidate longer-term COVID-19 effects on adolescents’ food intake.
... Психоэмоциональные тревожные нарушения могут не только ухудшать течение и прогноз заболевания, но и снижать эффективность антигипертензивной медикаментозной терапии и способствовать прогрессированию гипертонической болезни [16]. В исследовании Framingham Study было показано, что тревога и напряженность являются ФР инфаркта миокарда (ИМ) и ИБС у женщин, а в исследовании Normative Aging study -что хроническая тревога является независимым ФР ИМ у мужчин: при наличии хронического беспокойства, особенно связанного с социальными причинами, отношение рисков (ОР) нефатального ИМ составляет 2,41, фатальных и нефатальных клинических событий, связанных с ИБС -1,48 [17][18][19]. Наличие повышенной тревожности повышает вероятность фатального ИМ в 1,9 раза, внезапной смерти -в 4,5 раза [20]. Многофакторный анализ выявил наиболее тесную связь между тревожно-фобическими расстройствами и фатальными клиническими событиями, связанными с ИБС -ОР 2,45-3,77 и, особенно внезапной сердечной смертью -ОР 6,08 [20]. ...
It has now been established that psychosocial risk factors significantly worsen the course of cardiovascular diseases (CVDs) and reduce patients’ adherence to treatment. Patients with CVDs are characterized by a high prevalence of anxiety comorbidities, which can reach 50-60%. The presence of concomitant anxiety disorders seriously worsens the prognosis of CVDs. The results of studies showed that anxiety increases the risk of fatal myocardial infarction and sudden death by 1,9 times and 4,5 times, respectively. Therefore, the correction of psychosocial factors, in particular anxiety symptoms, should be an important component of the treatment of patients with CVDs. The conducted studies show that the use of fabomotizole in patients with CVD and concomitant anxiety disorders reduces the anxiety manifestations. In addition, a pronounced improvement of somatic status is recorded, which is important for improving the course and prognosis of CVDs. The accumulated experience of fabomotizole use makes it possible to recommend it for the treatment of patients with anxiety and CVDs.
... Maladaptive outcomes, particularly financial threat have close associations with psychological health, personality of the investors and many other attributes i.e. the persons who are too much worried about the finance matters face high level of depression and anxiety in comparison with others who don't have stress (Marjanovic, Greenglass, Fiksenbaum, & Bell,2013b;Westra, Constantino, & Antony, 2016). The deficiency and inability that creates the negative perceptions and thoughts that lead to failure in achieving the personal goals (Kubzansky, Kawachi, Spiro III,Weiss, Vokonas, & Sparrow, 1997). However, the persons who face worry, feel too much insecurity and instability in their lives while making the financial decisions in comparison to persons who don't feel worry in their lives. ...
Abstract
Grounded on “Theory of Planned Behaviour” (TPB), this study analyzes the influence of financial threat and financial literacy on ‘willingness to change’ the financial behavior. The ‘primary data’ collected from the university students by using convenience sampling technique. Multiple regression results shows that financial literacy and financial threat has significant influence on willingness to change the financial behavior of the university students. This implies that increase in the financial threat leads to change in the financial behavior, which supports the fact that investor’s intention to invest is affected by different factors. Employing TPB thus offer researchers to enhance understanding in forecasting an individual financial behaviour. Limited researchers have used TPB to analyze the influence of financial literacy and financial threat on the ‘willingness to change’ the financial behavior of students. Therefore, this study may help the university students to understand the concept of financial threat and those who aid students in coping with emotional or behavior disorders interrelated to the financial issues.
... Although worrying can sometimes aid in identifying ways to avoid or prepare for negative events (Sibrava & Borkovec, 2006), it is typically perceived as aversive. Besides, worries have been shown to be associated with poor physical health such as an increased heart rate (Pieper et al., 2010), an elevated risk for coronary heart disease (Kubzansky et al., 1997), and reductions in heart rate variability (Brosschot et al., 2007;Chalmers et al., 2016; see also Tully et al., 2013;Ottaviani et al., 2016, for a review and meta-analysis). Further studies found worrying to be linked to somatic complaints (Brosschot & van den Doef, 2006; see , for a review) and a dysregulation of the autonomic nervous system (Borkovec & Hu, 1990). ...
Objectives:
This study investigated how COVID-19-related media exposure during the COVID-19 crisis was related to same-day and next-day COVID-19-related worries.
Design:
A 21-day diary study was conducted between late March and late April 2020 in Germany.
Main outcome measures:
Hypotheses were tested in a sample of 561 participants (Mage = 42.79, SDage = 6.12). Every evening, participants indicated their exposure to COVID-19-related media (e.g., TV, print, online) and their COVID-19-related worries.
Results:
Same-day analyses showed that participants reported more COVID-19-related worries on days with higher exposure to COVID-19-related media. Dynamical structural equation models provided evidence for a reciprocal cycle across days: Higher media exposure at one day predicted higher worries the next day, and higher worries at one day also predicted higher media exposure the next day. Individuals with high trait anxiety reported an enhanced general level of media exposure during the 21 days of assessment, and individuals high in neuroticism and anxiety reported an enhanced level of worries.
Conclusion:
These findings suggest a self-reinforcing cycle whereby consuming crisis-related media and worrying reciprocally influence each other across days, possibly amplifying adverse effects of the COVID-19 crisis and other crises alike on mental and physical health.
... According to the perseverative cognition hypothesis , perseverative cognition prolongs the psychophysiological stress response, by prolonging the mental representation of stressful events beyond their actual presence. This prolonged stress response has been suggested to lead to somatic as well as psychological stress related pathology, including health complaints (Brosschot & Van Der Doef, 2006), cardiovascular disease (Kubzansky et al., 1997) and mood and anxiety disorders. A recent meta-analysis showed that perseverative cognition was related to a range of physiological concomitants including increased heart rate, blood pressure, cortisol, and lower heart rate variability (Ottaviani et al., 2016). ...
Worry is a central process in a wide range of psychopathological and somatic conditions. Three studies (N = 856) were used to test whether a subscale composed of five items of the most commonly used trait anxiety questionnaire, Spielberger’s State Trait Anxiety Inventory-Trait version (STAI-T), is appropriate to measure worry. Results showed that the subscale, named the Brief Worry Scale (BWS), had excellent internal consistency and temporal stability. Convergent and divergent validity were supported by correlation analyses using worry questionnaires and measures of anxious arousal and depression. The BWS was a particularly good predictor of the pathogenic aspects of worry, including worry perseveration in daily life (study 1), measures of clinical worry (study 2) and the uncontrollability of experimentally induced worry (study 3). Taken together, these studies demonstrate that the BWS might be a valuable scale for pathological worry, for which many researchers already have data.
... Other sources may include negative life events (McEwen & Stellar, 1993), socioeconomic status (Gruenewald et al., 2012), and psychosocial challenges (Fava et al., 2019;McEwen, 2012). For example, worries in life such as social conditions, health, finance, and aging showed a dose-response relationship with incident coronary heart disease (CHD) (Kubzansky et al., 1997). A more general and widely used psychological instrument to measure perceived stress in life is the perceived stress scale (PSS) . ...
The wear and tear of the body caused by stressful events is subject of extensive research and can be measured by the allostatic load index (ALI). The aim of this cross-sectional study was to replicate an ALI-5 score in a population sample in the USA and to compare these findings with the original ALI-10 score. Data from the Midlife in the United States Study (MIDUS) assessed between 2004 and 2016 were used to calculate different ALI risk scores with 5 and 10 variables, respectively. Examinations included anthropometric data, heart rate variability (HRV), and blood and urine samples. Questionnaires assessed information on perceived stress and medical history. Logistic regression models estimated odds ratios (OR) with corresponding 95% confidence intervals (CIs) for the association between ALI indices and perceived stress, controlling for various confounders. Subgroup analysis explored the difference in gender and in three age clusters. Data of 1421 participants (43% male, 50.4 ± 9.3 years) were included in the analysis. Adjusted logistic regression models showed an odds ratio of 1.37 ± 0.19 (CI 1.05, 1.80; p=.022) for the association of ALI-5 with perceived stress. This association was stronger in females (OR = 1.62 ± 0.28, CI 1.15, 2.28; p = .006) and did not significantly differ between age clusters. Results for the original ALI-10 score did not reach significance. The streamlined ALI-5 score seems to be a reliable risk score and is strongly associated with perceived stress in life. Longitudinal studies should further elaborate this association in different samples.
Lay summary: Stress from different sources can lead to serious diseases. A short composite index comprising of five medical variables is highly associated with perceived stress. This index is able to serve as an early indicator to detect people who are at risk to develop stress-related diseases.
... Some research supports a direct link between rumination and related repetitive thoughts (worry) and clinical disease-related outcomes (e.g., cancer, coronary heart disease). For example, worry-future-oriented repetitive thinking-is associated with coronary heart disease (Kubzansky et al., 1997). In a longitudinal study of over 2000 healthy men, participants reported at the beginning of the study the extent to which they worry. ...
This entry focuses on the relationship between rumination and physical health. Following a review of prominent theoretical models of rumination, we present a conceptual model outlining potential pathways through which rumination may impact health. Specifically, this entry delineates the role of rumination in cardiovascular outcomes, neuroendocrine and immune function, somatic complaints, sleep, health behaviors, and disease progression. Empirical evidence for such rumination–health associations is presented. The entry concludes with a discussion of promising interventions aimed at reducing ruminative thinking, remarks on the current state of the rumination literature, and suggestions for future inquiry.
... Empirical evidence supports this hypothesis. Perseverative cognition is significantly associated with higher blood pressure, higher heart rate, lower heart rate variability, and higher cortisol levels (Ottaviani et al., 2016) and significantly predicts cardiovascular health problems in the long-term (Kubzansky et al., 1997;Holman et al., 2008). One study has also provided initial evidence for a positive association between perseverative cognition and daily sAA activity (Gomez et al., 2018). ...
Psychophysiological research on music performance has focused on musicians’ short-term affective, cognitive, and physiological responses. Much less attention has been devoted to the investigation of musicians’ psychophysiological activity beyond the performance situation. Musicians report having both positive and negative performance-related thoughts (e.g., “My concert was good” and “I made a lot of mistakes”) for days following performances. The potential physiological implications of this post-performance cognitive processing are largely unknown. Salivary cortisol (sC) and salivary alpha-amylase (sAA) are markers of the activity of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal medullary (SAM) system, respectively. The goal of the present study was to investigate whether self-reported positive and negative post performance-related thoughts predict the daily sC output and the daily sAA activity at the between- and within-person levels during a 2-day period following a solo music performance. Seventy-two university music students collected saliva samples six times per day and reported their positive and negative performance-related thoughts for 2 days after a solo performance. We tested between-person and within-person components of positive and negative post performance-related thoughts as predictors of the diurnal area under the curve with respect to ground (AUCg) for sC and sAA while adjusting for relevant person-level and day-level variables. Negative post performance-related thoughts were positively associated with sC AUCg both at the between- and within-person levels, whereas positive post performance-related thoughts were negatively associated with sC AUCg at the between-person level. Post performance-related thoughts did not significantly predict sAA AUCg. These findings provide evidence for a relationship between affectively valenced cognitive processing of a recent music performance and the activity of the HPA axis. Although the directionality of this relationship remains to be established more conclusively, the study makes a significant contribution to the literature on the prolonged psychophysiological effects of music performance situations and more broadly of social-evaluative stressors. Integrating the topic of post-performance cognitive processing and its optimal management into performance training programs would likely have positive effects on music students.
... We also need to examine whether the mental health correlates of altered time perception have implications for physical health. We know that worry and perseverative cognition, both of which are often future focused, are associated with potentially detrimental changes in cardiovascular physiology (Kubzansky et al., 1997;Ottaviani et al., 2016). We also know that depression, anxiety, and posttraumatic stress disorder are risk factors for cardiovascular disease (e.g., Kubzansky, Koenen, Spiro, Vokonas, & Sparrow, 2007;Towfighi et al., 2017). ...
Collective trauma, like the COVID-19 pandemic, can dramatically alter how we perceive time and view our futures. Indeed, the pandemic has challenged us to cope with an ambiguous, invisible threat that has changed our way of life and made our futures, both near and far, less certain. In this commentary, we review existing literature on time perception in the context of stress and trauma and discuss its implications for mental health and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Typically, these age-related declines in worry are beneficial. Worry has been associated with increased risk for cardiovascular disease (Kubzansky et al., 1997), with poorer physical health (Behar, McHugh, & Otto, 2010), and with greater declines in learning and memory over time (Pietzak et al., 2012). However, within the context of preventative health behaviors, worry can also be beneficial, as it is a key determinant of behavior. ...
Objectives:
The case fatality rate of COVID-19 is higher amongst older adults than younger adults and is also higher amongst men than women. However, worry, which is a key motivator of behavioral health changes, occurs less frequently for older than younger adults, and less frequently for men than women. Building on this, we tested whether older adults - and particularly older men -- would report the least amount of COVID-19 worry and also fewer COVID-19 behavior changes.
Methods:
From March 23-31, 2020, we administered an online questionnaire assessing COVID-19 perceptions, worries, and behavior changes. Participants were a convenience sample of United States residents, who were community-dwelling younger adults (18-35) or older adults (65 to 81). Analyses included 146 younger adults (68 men, 78 women) and 156 older adults (82 men, 74 women). Participants was predominately White, living in suburban/urban areas, and had completed some college.
Results:
During the early phase of the outbreak in the United States, older adults perceived the risks of COVID-19 to be higher than did younger adults. Despite this, older men were comparatively less worried about COVID-19 than their younger counterparts. Compared to the other participants, older men had also implemented the fewest behavior changes.
Discussion:
Interventions are needed to increase COVID-19 behavior changes in older men. These results also highlight the importance of understanding emotional-responses to COVID-19, as these are predictive of their behavioral responses.
... It is known that severe chronic worrying and VD are related to stress [36], increasing the risk of coronary heart disease [64] and glaucoma, due to hemodynamic changes in the eye and other organs [23,63]. Surprisingly, in the present study, we found no correlation between the level of chronic stress and the magnitude of vision recovery. ...
PurposeIdentifying factors that affect recovery or restoration of neurological function is a key goal of rehabilitation in neurology and ophthalmology. One such factor can be prolonged mental stress, which may be not only the consequence of nervous system damage but also a major risk factor, or cause, of neural inactivation. Using the visual system as a model of neural injury, we wished to study how patients’ stress and personality profiles correlate with vision recovery as induced by therapy with alternating current stimulation (ACS) in patients with optic nerve damage.Methods
Personality and stress questionnaires were sent retrospectively to a clinical convenience sample of patients who suffer low vision due to optic nerve damage, which had previously been treated with ACS. The questionnaires included the NEO Five-Factor Inventory (NEO-FFI), the Trier Inventory of Chronic Stress (TICS), and the Flammer syndrome (FS) checklist, which probes signs of vascular dysregulation (VD). These scores were then correlated with the extent of ACS-induced vision restoration as recorded 1–3 years earlier by perimetric visual field tests.ResultsTwo NEO-FFI personality factors (lower neuroticism, higher conscientiousness) and the presence of physiological Flammer signs were associated with greater recovery as were individual items of the factors openness and agreeableness. Single NEO-FFI item analysis revealed that recovery relates to greater extraversion (optimistic and happy), openness (less guided by authorities for decisions on moral issues), and agreeableness (argue less, like working with others, thoughtful, considerate) as well as the presence of FS signs (cold hands/feet, hypotension, slim body shapes, tinnitus). This suggests that patients with better recovery were more calm, peaceful and secure, hard-working, and reliable, and with high organizational skills. In contrast, patients with poor recovery had a tendency to be emotionally unstable, anxious, unhappy and prone to negative emotions, impulsive, careless, and unorganized. Chronic stress assessed with TICS did not correlate with recovery.Conclusion
Vision restoration induced by ACS is greater in patients with less stress-prone personality traits and those who show signs of VD. Prospective studies are now needed to determine if personality has (i) a causal influence, i.e., patients with less stress-prone personalities and greater VD signs recover better, and/or (ii) if personality changes are an effect of the treatment, i.e., successful recovery induces personality changes. Though the cause-effect relationship is still open, we nevertheless propose that psychosocial factors and VD contribute to the highly variable outcome of vision restoration treatments in low vision rehabilitation. This has implications for preventive and personalized vision restoration and is of general value for our understanding of outcome variability in neuromodulation and neurological rehabilitation.
... Supporting these ideas, studies have evidenced moderate-to-large relations between frequent worry and future acute myocardial infarction as well as chronic heart disease, even across multiple decades (Davidson, Mostofsky, & Whang, 2010;Kawachi, Sparrow, Vokonas, & Weiss, 1994;Kubzansky et al., 1997). Likewise, increased resting systolic and diastolic blood pressure, cortisol, and body mass index in childhood predicted poorer WM in young adulthood (Evans & Fuller-Rowell, 2013). ...
Background: Affective neuroscience and scar theories propose that increased
excessive worry, the hallmark symptom of generalized anxiety disorder (GAD), predicts
future declines in executive functioning (EF). However, the preponderance of crosssectional designs used to examine between-person chronic worry-EF relations has
blocked progress on understanding their potentially causal within-person associations.
Accordingly, this study used bivariate dual latent change score (LCS) models to test
whether within-person increased GAD severity might relate to future reduced EF.
Methods: Community-dwelling adults (N = 2581, 46 years on average, SD = 11.40,
54.71% female) were assessed for GAD symptom severity (Composite International
Diagnostic Interview-Short Form) across three waves, spaced about nine years apart.
Three aspects of EF (inhibition, set-shifting, mixing costs [MC; a measure related to
common EF]), were assessed with stop-and-go switch tasks. Participants responded to
20 normal and 20 reverse single-task block trials and 32 mixed-task switch block trials.
EF tests were administered at Time 2 (T2) and Time 3 (T3), but not Time 1 (T1).
Results: After controlling for T1 depression, latent change score models revealed that
within-person increased T1–T2 GAD severity substantially predicted future reduced
T2–T3 inhibition and set-shifting (both indexed by accuracy and latency), and MC
(indexed by latency) with moderate-to-large effect sizes (|d| = 0.51–0.96). Conclusions:
Results largely support scar theories by offering preliminary within-person, naturalistic
evidence that heightened excessive worry can negatively predict future distinct aspects
of cognitive flexibility. Effectively targeting pathological worry might prevent difficulties
arising from executive dysfunction.
... Despite these findings, fear of the future has not been addressed as a critical outcome in studies of child maltreatment. This is an important oversight given the evidence linking this fear with the development of stress and trauma-related health problems (Brosschot, Gerin, & Thayer, 2006;Holman et al., 2008;Kubzansky et al., 1997). ...
Background:
Negative childhood experiences are associated with poor health and psychosocial outcomes throughout one's lifespan.
Objective:
We examined associations between childhood bullying and maltreatment and several adulthood outcomes: psychological distress, functional impairment, generalized fear, and physician-diagnosed mental and physical health ailments. The potential mediating role of recent negative life events was also explored.
Participants and setting:
Data were collected through web-based surveys of a U.S. representative national sample of adults.
Methods:
At Wave 1 (N = 3,598), participants reported exposure to negative childhood experiences; at Wave 2 (N = 3,497), physician-diagnosed mental and physical health ailments were provided; at Wave 3 (N = 2,906), participants reported exposure to recent negative life events and psychosocial outcomes.
Results:
Of the sample, 26.29% (weighted n = 946) reported childhood bullying, 15.02% (weighted n = 540) reported physical abuse, 15.56% (weighted n = 560) reported witnessing parental violence, 11.42% (weighted n = 411) reported sexual abuse, and 8.64% (weighted n = 311) reported parental neglect. Respondents who reported bullying, physical abuse, or sexual abuse during childhood reported greater distress, functional impairment, and fear of the future in adulthood, as mediated through recent negative life events, compared to those who did not (ßs: 0.04-.06). Those reporting bullying, neglect, physical abuse, or sexual abuse in childhood reported more mental health ailments in adulthood (IRRs: 1.44-1.66) compared to those who did not. Those reporting bullying or sexual abuse in childhood reported more physical health ailments (IRRs: 1.25-1.39).
Conclusions:
Specific negative childhood experiences have unique links with poor outcomes in adulthood. Recent negative life events partially mediate these associations.
... This is consistent with existing literature showing that trauma-exposed individuals are at high risk for developing clinically significant stress, anxiety, and worry (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). And whereas the current study was not designed to examine worry's consequences, past research has shown that worry (or "perseverative cognition" more broadly) plays a key role in most anxiety disorders and can have physiological sequelae that can lead to long-term health consequences, such as increased risk for coronary heart disease (Brosschot, Gerin, & Thayer, 2006;Kubzansky et al., 1997). Disaster-related worry specifically, along with prior trauma, has been associated with psychological distress and physical health problems (Holman & Silver, 2005). ...
Large oil spills are disasters associated with psychological effects for exposed communities. The amount of worry that individuals experience after a disaster may be influenced by many factors, such as the type and extent of exposure to disaster impacts, prior trauma, and sociodemographic characteristics. This study examined the nature and predictors of worry about ongoing impacts of the 2010 Deepwater Horizon (DH) oil spill reported by Gulf of Mexico coastal residents. A random sample of 2,520 adult residents of Gulf of Mexico coastal counties were administered a telephone survey in 2016, including items about persistent worry and exposure to DH impacts, prior trauma, residence at the time of the spill, and sociodemographic characteristics. Respondents varied in the amount of worry they reported about ongoing health, social, and economic impacts. Controlling for sociodemographic characteristics, higher exposure to the DH oil spill was related to higher levels of worry about ongoing impacts, with past traumatic events related specifically to worry about health impacts. Unexpectedly, those who moved into the region after the spill showed similar levels of worry to residents exposed to the spill, and higher levels than residents who did not recall being exposed to the DH oil spill. This study highlights the impact of the DH oil spill on coastal residents many years after the DH disaster. The findings underscore the need to examine multiple pathways by which individuals experience disasters and for risk researchers to close knowledge gaps about long‐term impacts of oil spills within a multi‐dimensional framework.
... According to the perseverative cognition hypothesis , perseverative cognition prolongs the psychophysiological stress response, by prolonging the mental representation of stressful events beyond their actual presence. This prolonged stress response has been suggested to lead to somatic as well as psychological stress related pathology, including health complaints (Brosschot & Van Der Doef, 2006), cardiovascular disease (Kubzansky et al., 1997) and mood and anxiety disorders. A recent meta-analysis showed that perseverative cognition was related to a range of physiological concomitants including increased heart rate, blood pressure, cortisol, and lower heart rate variability (Ottaviani et al., 2016). ...
Worry is a central process in a wide range of psychopathological and somatic conditions. Three studies (N = 856) were used to test whether a subscale composed of five items of the most commonly used trait anxiety questionnaire, Spielberger’s State Trait Anxiety Inventory-Trait version (STAI-T), is appropriate to measure worry. Results showed that the subscale, named the Brief Worry Scale (BWS), had excellent internal consistency and temporal stability. Convergent and divergent validity were supported by correlation analyses using worry questionnaires and measures of anxious arousal and depression. The BWS was a particularly good predictor of the pathogenic aspects of worry, including worry perseveration in daily life (study 1), measures of clinical worry (study 2) and the uncontrollability of experimentally induced worry (study 3). Taken together, these studies demonstrate that the BWS might be a valuable scale for pathological worry, for which many researchers already have data.
... [4] Recent studies suggest that anxiety, anger, worry, and psychological stresses are associated with coronary heart disease, cardiac death, and MI. [5][6][7][8][9][10][11] Psychological stress may lead to coronary artery spasm, platelet activation, reduction of heartbeat Aim: This study is aimed to comparison between left ventricular (LV) function for people with and without type D personality hospitalized for the first time of myocardial infarction (MI). Materials and Methods: In a descriptive-analytical study, 150 patient hospitalized in heart care centers in Isfahan with definite MI diagnosis were selected by simple available sampling method. ...
Aim: This study is aimed to comparison between left ventricular (LV) function for people with and without type D personality hospitalized for the first time of myocardial infarction (MI). Materials and Methods: In a descriptive-analytical study, 150 patient hospitalized in heart care centers in Isfahan with definite MI diagnosis were selected by simple available sampling method. Data regarding the determination of D and non-D type of personality were collected by a 14-item questionnaire (DS14) and the results from LV performance evaluation using echocardiograph after 1st time heart attack and before clearance from hospital. Collected data were analyzed using SPSS software and t-test, Chi-square, linear and multiple regression tests. Results: The average of ejection fraction (EF) index in total patient was 43 ± 9.47 with the range of 15–60, 14 people (9.3%) normal EF and 136 people (90.7%) had abnormal EF. The average of EF index in 2 groups with D and non-D type of personality were 43.2 ± 10.5 and 42.9 ± 9, respectively, and based on t-test, the average of EF index in 2 groups had no significant difference (P = 0.86). Furthermore, 7 people (12.7%) in group D and 7 people (7.4%) in non-D group had normal EF, and in these two groups, 48 and 88 people had abnormal EF, respectively (87.3% vs. 92.6%), but according to Chi-square test, EF distribution in 2 personality types had no significant difference (P = 0.28). Conclusion: There is no significant relationship of type D personality with LVEF in people with first-time MI.
... Baseline anxiety increases the risk for developing CHD by 26% and cardiac death by 48%, after controlling for other demographic variables, biological risks and health behaviors [105,106]. Such data is consistent with previous work highlighting the impact of worry symptoms on CHD onset [107] and GAD effects on cardiovascular mortality [108]. GAD is commonly accompanied by chronic pain conditions, such as headache, migraine, back pain, gastrointestinal pain, inflammatory bowel syndrome (IBS), and joint pain [109][110][111][112][113][114][115]. ...
Generalized anxiety disorder (GAD) commonly co-occurs with mood disorders, especially major depressive disorder (MDD) and bipolar disorder (BD), which are accompanied by activated neuro-immune and neuro-oxidative pathways. The aim of this narrative review is to review the phe-nomenological similarities and dissimilarities and the shared pathways between GAD and mood disorders. We searched PubMed, Scopus, and Google Scholar for articles published in English from 1980 to present. GAD and mood disorders, either MDD or BD, show some phenomenological overlaps and a high degree of comorbidity, especially between GAD and MDD. Both GAD and mood disorders are also frequently comorbid with other anxiety disorders, substance use disorders and medical conditions, including car-dio-vascular disorder (CVD). Mood disorders have a worse prognosis when GAD is present. GAD and mood disorders are associated with female sex and may partly share genetic variants of risk. Moreover, both GAD and mood disorders frequently share similar environmental risks factors including early life time trauma (ELT) and psychological stressors in adulthood (PSA). Increased nitro-oxidative stress and lipid peroxidation coupled to lowered lipid-associated antioxidant defenses are evident in GAD, MDD and type I bipolar patients. Patients with comorbid GAD and MDD show significantly higher nitro-oxidative biomarkers as compared with patients presenting with either GAD or MDD as well as patients with BD with or without co-occurring GAD. Activated immune-inflammatory processes characterized by increased levels of CRP and pro-inflammatory cytokines are other shared pathways that underpin GAD and mood disorders. Moreover, these pathways may explain comorbidities with medical disorders including CVD. Aberrations in HPA-axis, GABA and glutamate neurotransmission, NMDA and mu opioid-receptors and neuroimaging fields have yielded more inconsistent findings. In conclusion, here we propose a new model explaining GAD and the comorbidity between GAD and mood disorders. Common triggers such as ELT/PSA may underpin GAD and its comorbidity with mood disorders via activated neuro-oxidative, neuro-nitrosative and neuro-immune pathways.
... Kawachi, Spiro, Weiss, Vokonas, & Sparrow, 1997;Wassertheil-Smoller, Applegate, Berge, Chang, Davis, Grimm et al. ...
Das Modell beruflicher Gratifikationskrisen (engl. effort-reward-imbalance, ERI model) gilt in der Stressforschung als ein viel versprechendes Modell zur Vorhersage des Erkrankungsrisikos insbesondere kardiovaskulärer Erkrankungen. Kernpunkt des Modells ist die Annahme, dass ein Ungleichgewicht zwischen beruflicher Verausgabung und Belohnung mit Gesundheitsrisiken verbunden ist. In dieser Arbeit wird die prädiktive Validität des Modells unter Einbezug von Indikatoren allostatischer Last sowie psychologischer Aussenkriterien (gesundheitsbezogene Lebensqualität, depressive Verstimmung, vitale Erschöpfung, Schlafqualität) untersucht. Weiterhin wurde die zugrunde liegende Faktorenstruktur des ERI-Modells durch Strukturgleichungsmodellierung getestet. Die Studienpopulation umfasste mehrere hundert Mitarbeiter in der Fertigung eines europäischen Flugzeugherstellers. Die Ergebnisse bestätigen die prädiktive Validität des Modells im Hinblick auf gesundheitsbezogene Lebensqualität, vitale Erschöpfung, depressive Verstimmung und Schlafstörungen, sowie im Hinblick auf Indikatoren biologischer Verschleissprozesse (Allostatic Load). Konfirmatorische Faktorenanalysen bestätigten die faktorielle Validität des ERI Modells mit der Annahme von "effort" und "reward" und "overcommitment" als eigenständige Subskalen. Die Befunde unterstreichen die Bedeutung der subjektiv wahrgenommenen Austauschgerechtigkeit für die psychische und biologische Gesundheit der Mitarbeitenden. The effort-reward-imbalance model has received considerable attention in occupational health research. This model defines stressful experiences at work as an imbalance between high effort and low reward - a combination that can be aggravated by a particular individual coping style (overcommitment). General aim of this thesis was to evaluate the predictive and internal validity of this model in terms of a wide range of biological indicators of allostatic load and several indices of self-reported health and well-being (health-related quality of life, depressed mood, vital exhaustion, and sleep quality). Further, it was aimed to evaluate the underlying factorial structure of the current ERI model, using the structural equation approach. The studies of this thesis are based on a stratified random sample of employees from two European aircraft manufacturing plants. In general, the studies demonstrate that the effort-reward- imbalance model provides important measures for the evaluation of an adverse working environment. Its predictive validity is high for various psychological health outcomes, such as vital exhaustion, self-reported quality of life, depressed mood, and indicators of allostatic load. The model has high reliability and factorial validity. The findings underline the significance of effort-reward-imbalance as a critical psychological factor for employees' health.
... Baseline anxiety increases the risk for developing CHD by 26% and cardiac death by 48%, after controlling for other demographic variables, biological risks and health behaviors (Batelaan et al., 2014;Roest et al., 2010). Such data is consistent with previous work highlighting the impact of worry symptoms on CHD onset (Kubzansky et al., 1997) and GAD effects on cardiovascular mortality (Phillips et al., 2009). GAD is commonly accompanied by chronic pain conditions, such as headache, migraine, back pain, gastrointestinal pain, inflammatory bowel syndrome (IBS), and joint pain (Grzesiak et al., 2014;Juang et al., 2000;Lucchetti et al., 2013;McWilliams et al., 2003;Puca et al., 1999;Sheftell and Atlas, 2002;Tollefson et al., 1991). ...
Generalized anxiety disorder (GAD) commonly co-occurs with mood disorders, especially major depressive disorder (MDD) and bipolar disorder (BD), which are accompanied by activated neuro-immune and neuro-oxidative pathways. The aim of this narrative review is to review the phenomenological similarities and dissimilarities and the shared pathways between GAD and mood disorders. We searched PubMed, Scopus, and Google Scholar for articles published in English from 1980 to present.
GAD and mood disorders, either MDD or BD, show some phenomenological overlaps and a high degree of comorbidity, especially between GAD and MDD. Both GAD and mood disorders are also frequently comorbid with other anxiety disorders, substance use disorders and medical conditions, including cardio-vascular disorder (CVD). Mood disorders have a worse prognosis when GAD is present. GAD and mood disorders are associated with female sex and may partly share genetic variants of risk. Moreover, both GAD and mood disorders frequently share similar environmental risks factors including early life time trauma (ELT) and psychological stressors in adulthood (PSA). Increased nitro-oxidative stress and lipid peroxidation coupled to lowered lipid-associated antioxidant defenses are evident in GAD, MDD and type I bipolar patients. Patients with comorbid GAD and MDD show significantly higher nitro-oxidative biomarkers as compared with patients presenting with either GAD or MDD as well as patients with BD with or without co-occurring GAD. Activated immune-inflammatory processes characterized by increased levels of CRP and pro-inflammatory
cytokines are other shared pathways that underpin GAD and mood disorders. Moreover, these pathways may explain comorbidities with medical disorders including CVD. Aberrations in HPA-axis, GABA and glutamate neurotransmission, NMDA and mu opioid-receptors and
neuroimaging fields have yielded more inconsistent findings.
In conclusion, here we propose a new model explaining GAD and the comorbidity between GAD and mood disorders. Common triggers such as ELT/PSA may underpin GAD and its comorbidity with mood disorders via activated neuro-oxidative, neuro-nitrosative and neuroimmune pathways.
... Autonomic rigidity has been linked to poor attentional concentration and distractibility (Richards, 1987;Porges, 1992). Research has also shown such rigidity to be a risk factor in coronary heart disease and early mortality (Kristal-Boneh, Raifel, Froom, & Ribak, 1995;Kubzansky et al., 1997). On the other hand, studies show that relaxation interventions are beneficial at increasing autonomic flexibility (Sakakibara, Takeuchi, & Hayano, 1994;Toivanen, Lansimies, Jokela, & Hanninen, 1994). ...
... Baseline anxiety increases the risk for developing CHD by 26% and cardiac death by 48%, after controlling for other demographic variables, biological risks and health behaviors (Batelaan et al., 2014;Roest et al., 2010). Such data is consistent with previous work highlighting the impact of worry symptoms on CHD onset (Kubzansky et al., 1997) and GAD effects on cardiovascular mortality (Phillips et al., 2009). GAD is commonly accompanied by chronic pain conditions, such as headache, migraine, back pain, gastrointestinal pain, inflammatory bowel syndrome (IBS), and joint pain (Grzesiak et al., 2014;Juang et al., 2000;Lucchetti et al., 2013;McWilliams et al., 2003;Puca et al., 1999;Sheftell and Atlas, 2002;Tollefson et al., 1991). ...
This chapter explores psychosocial risk factors and their association with cardiovascular disease. Both social risk factors and psychological risk factors will be considered. Social risk factors include adverse childhood experiences and issues related to socioeconomic status, employment, healthcare access, community, racism, intimate partner violence, and incarceration. Allostatic load helps to explain the link between these stressors and the cardiovascular sequelae. Psychological risk factors include mental illness. Psychiatric medications present their own unique risk factors which will be discussed.
Immigrants often face increased vulnerabilities to disaster-related poor health and recovery, compared to mainstream populations. Little is known about Hurricane Harvey’s impacts among the storm affected area’s large Vietnamese American population. Our study documented diverse psychological experiences and recovery challenges 1 year post-storm among a sample of 120 Vietnamese Americans residing in the Houston, Texas area. Using linear regression modeling, we examined the association between social support and depressive symptom development among these storm-affected Vietnamese Americans. Social support encapsulating both social embeddedness and perceived support was measured by the Louisville Social Support Scale and depressive symptom development was measured by 18 items that assessed emotional distress. These items included loss of appetite, loss of concentration, exposure to persistent pain, and the exhibition of hopelessness, tiredness, sadness, frustration, discouragement, desperation, exhaustion, disgraced, anger, and craziness. We found adverse post-disaster health outcomes, as well as potential avenues to mitigate them, that should be taken into consideration in the design and implementation of inclusive disaster programs. A high level of social support lowered depressive symptomology among Vietnamese Americans post-Hurricane Harvey, even when accounting for Hurricane Harvey-related home damages and injuries/illness. The negative association between social support and depressive symptom development remained after accounting for both post-storm self-rated mental and physical health. Our results suggested that public health practitioners and emergency management entities should prioritize social support resources to foster mental well-being after hurricanes among Vietnamese Americans as future hurricanes are expected to be stronger and more prevalent along the United States Gulf Coast.
Trauma survivors often report experiencing temporal disintegration (e.g., time slowing down, the present feeling disconnected from the past and future) during and after trauma, yet how these distorted time perceptions relate to psychological adjustment and views of the future is poorly understood. We examined the relationships between prior adversity, temporal disintegration, distress, and fear of future trauma following two collective traumas: cross-sectionally among college students following a university-based active shooter event and longitudinally using data from a national sample following the September 11, 2001, terrorist attacks. Temporal disintegration was significantly associated with elevated distress, which was related to greater fear of future trauma. Individuals who experienced prior adversity were especially likely to report temporal disintegration following collective trauma, suggesting that prior adversity may render individuals vulnerable to subsequent deleterious response patterns. Trauma-related temporal disintegration may have lasting implications for psychological adjustment and for how people perceive their futures, especially among individuals with a history of adversity.
Objective:
Poor cognition increases risk for negative health outcomes, and this may be explained by associations with systemic inflammation. Previously, amount of repetitive thought (Total RT) interacted with IQ to predict interleukin-6 (IL-6) in older adults. This study continued the investigation of repetitive thought (RT) as an element involved in the effect of cognition on inflammation.
Design:
Participants (N = 164) came from the Midlife in the United States Refresher project (Mage = 45.33, SD = 11.51, ranges = 25-74; 48.2% female; 85% Caucasian). Cognition was assessed via telephone, inflammatory biomarkers (IL-6, C-reactive protein (CRP), and tumour-necrosis factor-alpha (TNF- α)) analysed after blood draw, and RT derived from daily diary data.
Results:
Cognition significantly interacted with RT valence (p = .009) to explain CRP after covariate adjustment. Better cognition and more negative RT valence was associated with lower CRP (β = -0.190 [-.387, .008]). Worse cognition and more negative RT valence was associated with higher CRP (β = 0.133 [-.031, .297]). No significant effects were found for IL-6 or TNF-α.
Conclusion:
RT may interact with cognition to affect different inflammatory biomarkers. Those with worse cognition may benefit more from skills related to regulating thought than those with better cognition.
Background
Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. The longer-term benefits of treatment for anxiety are not known.
Methods
Patients were randomized to 12 weeks of Escitalopram (up to 20 mg), Exercise (3 times/week), or placebo pill. At the conclusion of treatment, participants were followed for 6-months to determine the persistence of benefit on the primary anxiety endpoint assessed by the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A) and to assess the effects of treatment on major adverse cardiac events over a follow-up period of up to 6 years.
Results
Of the 128 participants initially randomized, 120 (94%) were available for follow-up. Participants randomized to the Escitalopram condition exhibited lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to Exercise (5.5 [4.6, 6.3]) (P = .007) and Placebo (5.3 [4.1, 6.5]) (P = .053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were 29 adverse events but no significant between-group differences.
Conclusion
In the UNWIND trial, 12 weeks of escitalopram treatment was effective in reducing anxiety. These beneficial effects were sustained for 6 months post-treatment. Although moderate or vigorous physical activity has a number of health benefits, exercise was not an effective treatment for anxiety in patients with CHD.
Several regions in the world are seeing an increase in the chances of catastrophic wildfires, driven primarily by climate change. Power companies in places like California are enacting public safety power shutoffs (PSPS), a type of indirect climate adaptation policy, to reduce the risk of wildfires during periods of favorable wildfire conditions. While PSPS may reduce the risk of wildfires, it may also impact health and normal daily activities – e.g., inability to use certain home medical equipment or use a fan during a heat wave to being unable to attend school or perform work. Little is known about how Californians view PSPS, and how personal wildfire experience and existing vulnerabilities may relate to those views. In December 2020, a representative sample of 1,108 Californians was surveyed online and by phone to address this gap. Moderate levels of support for PSPS were observed. More personal wildfire experiences in terms of health, hazard exposures, and hazard outcomes were positively related to wildfire risk appraisal and hazard worries, which in turn was associated with more support for PSPS. However, worry about possible negative impacts from PSPS was negatively related to support for PSPS. Improved communications may provide targeted information to households that are the most exposed or vulnerable to wildfires and their impacts, as well as on ways exposure can be reduced. Climate adaptation policies informed by understanding the climate hazard and climate solutions risks the public faces may reduce unintended consequences, while also allowing for more rapid adaptation to climate change.
Background
There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and worries about adversity may impact health is through effects on sleep.
Methods
We used data from 46,284 UK adults in the COVID-19 Social Study assessed weekly from 01/04/2020-12/05/2020 to study the association between adversities and sleep quality. We studied six categories of adversity including both worries and experiences of: illness with COVID-19, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety. We used random-effect within-between models to account for all time-invariant confounders.
Results
Both the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Each additional experience was associated with a 1.16 (95% CI = 1.10, 1.22) times higher odds of poor quality sleep while each additional worry was associated with a 1.20 (95% CI = 1.17, 1.22) times higher odds of poor quality sleep. When considering specific experiences and worries, all worries and experiences were significantly related to poorer quality sleep except experiences relating to employment and finances. Having a larger social network offered some buffering effects on associations but there was limited further evidence of moderation by other social or psychiatric factors.
Conclusion
Poor sleep may be a mechanism by which COVID-19 adversities are affecting mental health. This highlights the importance of interventions that support adaptive coping strategies during the pandemic.
Background:
Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study.
Methods:
A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex.
Results:
The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes).
Conclusion:
Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.
Background
Trait negative affect (NA) is a central feature of anxiety and depression disorders. Neurocognitive and scar models propose that within‐person increase in NA across one period of time relates to a decline in cognitive functioning at a future period of time and vice versa. Yet, there has been little research on whether a within‐person change in trait NA across one time‐lag precedes and is associated with a change in cognition across a future time lag and vice versa. Due to a growing aging population, such knowledge can inform evidence‐based prevention.
Methods
Participants were 520 dementia‐free community‐dwelling adults (mean age = 59.76 years [standard deviation = 8.96], 58.08% females). Trait‐level NA (negative emotionality scale), spatial cognition (block design and card rotations), verbal working memory (WM; digit span backward), and processing speed (symbol digit modalities) were assessed at five time points (waves) across 23 years. Bivariate dual latent change score (LCS) approaches were used to adjust for regression to the mean, lagged outcomes, and between‐person variability.
Results
Unique bivariate LCS models showed that within‐person increase in trait NA across two sequential waves was related to declines in spatial cognition, verbal WM, and processing speed across the subsequent two waves. Moreover, within‐person reductions in spatial cognition, verbal WM, and processing speed across two sequential waves were associated with future increases in trait NA across the subsequent two waves.
Conclusions
Findings concur with neurobiological and scar theories of psychopathology. Furthermore, results support process‐based emotion regulation models that highlight the importance of verbal WM, spatial cognition, and processing speed capacities for downregulating NA.
Depressive features have emerged, from the arena of psychosocial determinants, as potentially important coronary heart disease risk factors. Despite a large literature, uncertainty remains concerning both the independence of the effect of depression from that of other psychosocial variables, and the pathophysiological mechanism underlying the association. Using data from the Whitehall II study, the relationship between psychological distress (measured by the GHQ-30) and future CHD events has been examined in men, with attention paid to the effect of the persistence of distress. Psychological distress was found to predict future CHD, with some evidence that the association was stronger for transient distress. Analyses using factors of the GHQ-30 did not suggest that depressive features were associated with CHD risk, whereas anxiety items and sleep questions were found to be the strongest predictors of future events. The effect of distress was found to be independent of other psychosocial risk factors, such as employment grade, hostility and life events. The role of health behaviours, other conventional CHD risk factors, inflammatory variables and components of the metabolic syndrome, in the association between distress and CHD was examined. The results did not support a mediating role for these variables. Potentially important differences emerged between transient and more chronic distress. The effect of transient distress on future CHD events was greater in men with evidence of underlying CHD, suggesting an acceleration role for distress. The effect of chronic distress was more consistent with an atherogenic role, although a pathway of action could not be identified in these data. This thesis confirms that psychological distress is a predictive risk factor for CHD, but suggests that transient and more chronic distress may be measuring different facets of psychological risk.
Researchers have traditionally conceptualized hazards that give rise to disasters as “natural” or “technological.” An extensive literature has documented differential social consequences based on this distinction, including the emergence of corrosive community dynamics in the context of technological disasters. There is also growing recognition that many disasters can be conceptualized as “natech”—processes characterized by a combination of natural and technological hazards. On August 25, 2017, Hurricane Harvey made landfall along the central Texas Gulf Coast, causing catastrophic flooding and extensive releases of industrial toxins. We examined variation in institutional trust and future storm worry in the aftermath of Harvey, paying special attention to differences between those who viewed the disaster as being primarily natech and natural. Drawing on the Survey of Trauma, Resilience, and Opportunity in Neighborhoods in the Gulf, we analyzed two waves of cohort panel data collected from households on the Texas Gulf Coast in 2016 and 2018 (before and after Hurricane Harvey). Our findings showed that those who perceived Harvey as natech (compared to natural) were significantly more likely distrust major institutional actors and be worried about the impacts of future storms, even after accounting for pre-hurricane characteristics. Implications for community dynamics and future research are then discussed.
We review research showing that rumination has multiple negative consequences: (a) exacerbating psychopathology by magnifying and prolonging negative mood states, interfering with problem-solving and instrumental behaviour and reducing sensitivity to changing contingencies; (b) acting as a transdiagnostic mental health vulnerability impacting anxiety, depression, psychosis, insomnia, and impulsive behaviours; (c) interfering with therapy and limiting the efficacy of psychological interventions; (d) exacerbating and maintaining physiological stress responses. The mechanisms underlying rumination are examined, and a model (H-EX-A-GO-N - Habit development, EXecutive control, Abstract processing, GOal discrepancies, Negative bias) is proposed to account for the onset and maintenance of rumination. H-EX-A-GO-N outlines how rumination results from dwelling on problematic goals developing into a learnt habit that involves the tendency to process negative information in an abstract way, particularly in the context of poor executive control and negative information-processing biases. These proximal factors integrate experimental evidence to provide a partial answer to the critical question of what maintains rumination. They constitute a pathway by which more distal biological and environmental factors increase the likelihood of rumination developing. Treatments for rumination are reviewed, with preliminary trials suggesting that psychological interventions designed to specifically target these mechanisms may be effective at reducing rumination.
Objective:
Psychological distress may be intensified and prolonged by perseverative thinking (e.g., rumination, worry). The tendency to engage frequently in perseverative thinking has been linked to increased blood pressure (BP). Research is needed to investigate the physiological consequences of time spent perseverating by testing the momentary association between the duration of perseverative thinking and blood pressure. The present study examines the extent to which the duration of perseverative thinking is associated with momentary perceived stress and ambulatory BP elevations during daily life.
Methods:
Participants (N = 373) drawn from a larger project on BP and cardiovascular health completed 24-hour ambulatory BP monitoring accompanied by ecological momentary assessments of their perseverative thoughts and feelings. Multilevel models tested associations among perseveration duration, momentary perceived stress, and systolic and diastolic BP, adjusting for person-level and momentary covariates.
Results:
Higher within-subject perseveration duration was associated with higher stress (B = 0.29; 95% confidence interval [CI] = 0.24, 0.33; p < .001). Although higher perseveration duration was not associated with substantially higher systolic (B = 0.16 mmHg; 95% CI = 0.00, 0.33; p = .056) or diastolic (B = 0.07 mmHg, 95% CI = -0.05, 0.19; p = .25) BP, the associations between higher perseveration duration and higher systolic (p = .032) and diastolic (p = .036) BP were significantly mediated by a higher intensity of momentary perceived stress.
Conclusions:
Findings support the clinically important notion that physiological consequences of perceived stress can be maintained and even heightened by maladaptively prolonged mental activity.
Objective:
Depression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS.
Methods:
Adults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6months of index ACS (baseline), then 2months and 6months later.
Results:
169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6months.
Conclusions:
Rumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease.
The study of relationships between personality traits and health has a long history in psychosomatic research. However, personality science has evolved from an understanding of personality as fixed traits to one that acknowledges that personality is dynamic. Dynamic approaches to conceptualizing and measuring personality and individual differences can enrich personality-health research. In this Presidential Address (American Psychosomatic Society, 2018), I consider how different formulations of personality-stable traits, stable signals in a noisy or variable measure, within-person changes, and intraindividual variability-can be implemented to better understand how personality is related to health and particularly to immune function. These approaches recognize and, in some cases, capitalize on the fact that personality factors can display variability as well as stability over time. They also require repeated measurement and therefore greater methodological sophistication that considers reliability and generalizability, Simpson's paradox, and the difference between variability and flexibility. Dynamic qualities of personality and individual differences potentially influence health, and designs and methodology that incorporate them can illuminate the important processes that occur inside the error bars.
Objective:
To determine whether a 6-week Positivity Program could impact employee cardiovascular inflammation, blood sugars, cortisol, DHEA and/or life satisfaction.
Methods:
Pre- and post-study blood draw and life satisfaction questionnaire tracked changes in 10 cardiovascular and inflammatory biomarkers for sixty-three employees who participated in a 6-week Positivity Program comprised of three interventions: gratitude, HeartMath's Heart Lock-In, and yoga stretches with guided imagery.
Results:
Improvements were recorded in life satisfaction as well as in 7 of 10 cardiovascular and inflammatory biomarkers, including HsCRP (-27%), HbA1c (-1%), glucose (-2%), MPO (-5%), Lp-PLA2 (-9%), ApoB (-6%), and DHEA (1%). No improvements were recorded in cortisol (11%), sdLDL (0%), or OxLDL (7%).
Conclusions:
Data suggest that engaging in 6 weeks of a workplace Positivity Program may improve employee life satisfaction, blood sugar levels, and some markers of cardiovascular inflammation.
review some of the empirically determined characteristics of worry / suggest theoretical perspectives that may account for the functions and origins of this ubiquitous process
nature of worry [conceptual and imaginal cognitive activity, affective experience of worry, attentional activity and memory retrieval, behavioral responding, physiological activity] / functions of worry [cognitive avoidance of threat, inhibition of emotional processing] / origins of chronic worry and [generalized anxiety disorder] GAD [history of trauma, insecure attachment in childhood] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
describe the development of the WDQ [Worry Domains Questionnaire], a 25 item measure of worry content, the construction of which was guided by modular theories of information storage in long-term memory / the WDQ yields a total score, which is the sum of scores on 5 subscales titled (1) Relationships, (2) Lack of Confidence, (3) Aimless Future, (4) Work and (5) Financial / scores on the WDQ are systematically associated with performance on cognitive tests / normative data are reported for non-clinical and clinical groups and the relationship between WDQ scores and a number of other self-report measures is briefly described (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it. Acquisition and performance differ in situations perceived as determined by skill versus chance. Persons may also differ in generalized expectancies for internal versus external control of reinforcement. This report summarizes several experiments which define group differences in behavior when Ss perceive reinforcement as contingent on their behavior versus chance or experimenter control. The report also describes the development of tests of individual differences in a generalized belief in internal-external control and provides reliability, discriminant validity and normative data for 1 test, along with a description of the results of several studies of construct validity.
The Normative Aging Study is a comprehensive interdisciplinary longitudinal study located in the VA Outpatient Clinic in Boston, Mass. The study was inaugurated in 1963 by the VA because of its statutory responsibility for the medical care of 25 million war veterans of whom 2 million are now 65 years of age and over, a figure which will rise to over 7 million in the next 20 years. Approximately 2,000 male veterans are enrolled for their lifetime as research subjects and undergo recurrent examinations administered on an outpatient basis. The focus of the study is on non-pathological aging, so that the subjects were carefully screened in advance to satisfy rigid health criteria regardless of age. The study is distinctive because of its large N and the socioeconomic diversity of its population. Parameters include clinical medicine, biochemistry, special senses, oral medicine, anthropometry and behavior. The study is designed to investigate the relationship between normal aging and the natural history of chronic diseases. The investigation of environmental correlates of age change throughout the logitudinal design will also suggest the intrinsic or extrinsic nature of the aging process. The hybrid cross-sectional-longitudinal design will also enable the partialing of secular from true aging effects. Functional ages pertaining to various aspects of aging are being developed as a tool for assessing relative aging rates and the relationship among such differences in aging.
Purpose: To integrate information from the various disciplines that contribute to the understanding of the cause and prevention of sudden cardiac death: identification of new approaches from applied clinical epidemiology; identification and control of transient risk factors; and evaluation of the results of interventions. Data Sources: A broad range of research reports and interpretations of data from English-language journal articles and reviews, published primarily between 1970 and 1993. The fields of study included epidemiology, experimental electrophysiology, clinical observations, and interventions. Study Selection: Continuous literature surveys, done in relation to ongoing clinical and experimental research on sudden cardiac death since 1972
Purpose: To present an overview of the applicability of heart rate variability measurements in medicine. Data Sources: During a 4-year period all new papers concerning heart rate variability were collected. A selection of the moat recent publications in the presented research area was used for this review. Data Synthesis: The amount of short- and long-term variability in heart rate reflects the vagal and sympathetic function of the autonomic nervous system, respectively. Therefore heart rate variability can be used as a monitoring tool in clinical conditions with altered autonomic nervous system function. In postinfarction and diabetic patients, low heart rate variability is associated with an increased risk for sudden cardiac death
argue . . . that worry is initiated as an attempt to control other unwanted experiences (both future environmental catastrophe and immediate somatic anxiety in response to perceived threat), but that it becomes an unwanted experience in itself that is in turn very difficult to control and contains within itself processes that are self-perpetuating / provide some insight into the role of unwanted cognitive activity in the maintenace of anxiety disorders (PsycINFO Database Record (c) 2012 APA, all rights reserved)
reports the results of a preliminary investigation into the phenomenology of worrying in a [18–59 yr old] non-clinical population / though the present study focuses on non-pathological worry, comparisons between "normal" high and low worriers are reported / it may be the case that continuities exist between non-clinical and clinical populations (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Argues that emotion is best treated as a psychological construct, consisting of cognitive appraisal, physiological activation, motor expression, motivational tendencies, and subjective feeling states. When viewed as a process, rather than a steady state, emotion can be said to be the interface between an organism and its environment, mediating between constantly changing situations and events and the individual's behavioral responses. A variety of stimulus evaluation checks are necessary for adequately evaluating or appraising emotion producing stimuli, for example, novelty, intrinsic pleasantness, goal/plan relevance, coping potential, and norm/self concept compatibility. Moreover, the role of emotions in social interaction may be central to understanding human behavior and social organization. A joint interdisciplinary approach may yield heuristic results. (29 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[discusses] the implications of the emotion–illness linkages for emotion theory / present data from health research which suggest specific answers to [the following] questions / are emotions best represented by a dimensional or a categorical (i.e., differential) model / is social communication the primary function of emotion / are emotions a product of a hierarchically structured processing system / are emotions multicomponent structures . . . that are organized by neural and non-neural processes (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A cross-sectional investigation compared worry and its correlates in elderly people (N = 89) and in college students (N =
74). Consistent with prediction, the elderly adults expressed significantly fewer worries than the college students about
finances and social events. Both groups were equally worried about health issues. The elderly scored higher on the Bradburn
Affect Balance Scale, scored in the external direction on the Nowicki-Strickland Locus of Control Scale, and were more oriented
toward the past and present than the future. Worry in the elderly was related to less favorable attitudes toward the future,
and among college students worry was related to negative attitudes toward the present. For both age groups, an external locus
of control was associated with higher worry scores.
Heart rate (HR) variability index and left ventricular ejection fraction (EF) were compared for the prediction of all-cause mortality, arrhythmic events and sudden death in 385 survivors of acute myocardial infarction. For arrhythmic events, where, for a sensitivity of 75%, HR variability index had a specificity of 76%, EF had a specificity of only 45%. An EF of less than or equal to 40% had a sensitivity of 42% and a specificity of 75% for arrhythmic events; for the same sensitivity an HR variability index of 20 U had a specificity of 92%. An EF less than or equal to 40% had a sensitivity of 40% and a specificity of 73% for sudden death; HR variability index had a specificity of 83% for the same sensitivity. For all cause mortality, where, for a sensitivity of 75%, HR variability index had a specificity of 52%, EF had a specificity of 40%. It is concluded that HR variability index appears a better predictor of important postinfarction arrhythmic complications than left ventricular EF, but both indexes perform equally well in predicting all-cause mortality.
Two traditions of research on the concept of control have developed. One tradition involves the experimental manipulation of control, usually with a focus on enhancing control and thus improving adjustment and well-being. The other tradition regards control as a personality or trait variable and has been concerned with the development and validation of scales to measure it. Linking these two traditions would help determine if people differentially react to control-enhancing manipulations because of control predispositions. This study reports on an investigation into this topic. A sample of 209 subjects responded to the Levenson I-E scale and a control-enhancing manipulation (vs placebo contact and no contact control samples) within the context of a longitudinal assessment of stress and mental health in older adults. Variables assessed included personal mastery and mental health. The results showed significant interactions of the trait and manipulated variables. Control enhancement was most effective for those high in control beliefs. Some positive benefits of the placebo contact also were found. Subjects low in control beliefs did not respond strongly to control manipulations, while those high in control did. Directions for additional research are discussed.
Acute emotional arousal, regardless of the emotional state, increases sympathetic activity. The sympathetic response, however, does not lead to a uniform change in all sympathetically innervated systems. The response magnitude of specific systems, such as the cardiovascular system, depends to a large extent on constitutional and hereditary factors. The subjective awareness of bodily changes accompanying heightened sympathetic activity is inaccurate; people often recognize the direction but not the degree of change. The level of body awareness depends on various psychologic factors, of which anxiety plays an important role. Acute stress produces sympathetic activation in nonanxious as well as anxious persons. Nonanxious persons tend to have more flexible autonomic responses. They show stronger responses to novel situations but return to lower autonomic levels earlier and habituate faster than do anxious persons. That is, nonanxious persons possess a greater autonomic flexibility than anxious persons. It is important to know the physiologic state of anxiety disorder patients during periods when they do not feel anxious, during times of heightened tension, during the performance of standardized stress tasks, during exposure to psychopathology-specific stressors, and during "spontaneously" occurring surges of anxiety, such as panic attacks. At present only limited information concerning these conditions is available. There is little evidence that anxiety disorder patients, perhaps with the exception of very severe cases, have an increased sympathetic tone when they do not feel anxious. However, all anxiety disorders, with the exception of simple phobia, show some sort of physiologic activation in threatening situations, including the recording of physiologic baseline values in laboratories. The type of activation differs among anxiety disorders. During periods of rest, social phobics and panic disorder patients tend to show sympathetic activation, generalized anxiety disorder patients show increased muscular tension without sympathetic activation, and obsessive-compulsive patients show increased muscular tension along with sympathetic inhibition. Under laboratory stress, both normals and anxiety disorder patients react with sympathetic arousal. However, in generalized anxiety and obsessive-compulsive patients the response is weaker than in normals, suggesting the presence of an inhibitory process. Thus, the autonomic flexibility of anxiety disorder patients is reduced.(ABSTRACT TRUNCATED AT 400 WORDS)
The present paper reports two questionnaire studies and an experimental investigation of worrying. Worry correlated more highly than general tension reports with a variety of affect scales and was characterized by: (a) feelings of anxiety, tension and apprehension; (b) moderate awareness of somatic cues including muscle tension and upset stomach; and (c) concerns over future rather than past or present situations. Self-labeled worriers were most distinguished from non-worriers by their reported uncontrollability of cognitive intrusions once worrying was initiated. In the experimental study, worriers and non-worriers were assessed for their ability to focus their attention on a monotonous (breathing) stimulus before and after 0, 15 or 30 min of worrying. Worriers reported significantly higher anxiety. depression and hostility, a lower frequency of focused attention and a greater frequency of negative thought intrusions than did non-worriers prior to the worry period. For both worriers and non-worriers. 15 min of worry resulted in an apparent incubation of negative cognitive intrusions on the subsequent attention-focusing task.
High levels of hostility as assessed by a MMPI scale (Ho) have been found associated with increased levels of arteriographically documented coronary atherosclerosis. In this study we examined the relationship between hostility and subsequent health status in a 25-year follow-up of 255 medical students who completed the MMPI while in medical school. High Ho scores were found to be predictive of both clinical coronary disease incidence and total mortality.
Many anecdotes and several uncontrolled case series have suggested that emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute myocardial infarction. However, controlled studies to determine the relative risk of myocardial infarction after episodes of anger have not been reported.
We interviewed 1623 patients (501 women) an average of 4 days after myocardial infarction. The interview identified the time, place, and quality of myocardial infarction pain and other symptoms, the estimated usual frequency of anger during the previous year, and the intensity and timing of anger and other potentially triggering factors during the 26 hours before the onset of myocardial infarction. Anger was assessed by the onset anger scale, a single-item, seven-level, self-report scale, and the state anger subscale of the State-Trait Personality Inventory. Occurrence of anger in the 2 hours preceding the onset of myocardial infarction was compared with its expected frequency using two types of self-matched control data based on the case-crossover study design. The onset anger scale identified 39 patients with episodes of anger in the 2 hours before the onset of myocardial infarction. The relative risk of myocardial infarction in the 2 hours after an episode of anger was 2.3 (95% confidence interval, 1.7 to 3.2). The state anger subscale corroborated these findings with a relative risk of 1.9 (95% confidence interval, 1.3 to 2.7). Regular users of aspirin had a significantly lower relative risk (1.4; 95% confidence interval, 0.8 to 2.6) than nonusers (2.9; 95% confidence interval, 2.0 to 4.1) (P < .05).
Episodes of anger are capable of triggering the onset of acute myocardial infarction, but aspirin may reduce this risk. A better understanding of the manner in which external events trigger the onset of acute cardiovascular events may lead to innovative preventive strategies aimed at severing the link between these external stressors and their pathological consequences.
Prospective cohort studies suggest that phobic anxiety is a strong risk factor for fatal coronary artery disease, in particular, sudden cardiac death. It has also been established that reduced heart rate (HR) variability can identify patients at high risk for subsequent sudden cardiac death. We therefore hypothesized that persons with symptoms of phobic anxiety may exhibit reduced HR variability. We tested our hypothesis in 581 men, aged 47 to 86 years, enrolled in the Normative Aging Study who were free of coronary artery disease and diabetes. Symptoms of anxiety were assessed using the Crown-Crisp index, an instrument that has been demonstrated in previous prospective studies to strongly predict risk of sudden cardiac death. HR variability was measured under standardized conditions, with paced deep breathing (6 breaths/1 min). Two measures of HR variability were used: the SD of HR and the maximal minus minimal HR over 1 minute. Men reporting higher levels of phobic anxiety had a higher resting HR (p = 0.025 for linear trend). After adjusting for age, mean HR, and body mass index in analyses of covariance, men reporting higher levels of phobic anxiety had lower HR variability, whether measured by the SD of HR (p = 0.03 for linear trend). These data suggest that phobic anxiety is associated with altered cardiac autonomic control, and hence increased risk of sudden cardiac death.
Several studies have suggested an increased risk of fatal coronary heart disease (CHD) among patients with panic disorder, phobic anxiety, and other anxiety disorders. We prospectively examined this association in the Normative Aging Study.
An anxiety symptoms scale was constructed out of five items from the Cornell Medical Index, which was administered to the cohort at baseline. During 32 years of follow-up, we observed 402 cases of incident coronary heart disease (137 cases of nonfatal myocardial infarction, 134 cases of angina pectoris, and 131 cases of fatal CHD: made up of 26 cases of sudden cardiac death and 105 cases of nonsudden death). A nested case-control design (involving 1869 control subjects who remained free of diagnosed CHD) was used to assess the association between anxiety and risk of CHD. Compared with men reporting no symptoms of anxiety, men reporting two or more anxiety symptoms had elevated risks of fatal CHD (age-adjusted odds ratio [OR] = 3.20, 95% confidence interval [CI]: 1.27 to 8.09), and sudden death (age-adjusted OR = 5.73, 95% CI: 1.26 to 26.1). The multivariate OR after adjusting for a range of potential confounding variables was 1.94 (95% CI: 0.70-5.41) for fatal CHD and 4.46 (95% CI: 0.92-21.6) for sudden death. No excess risks were found for nonfatal myocardial infarction or angina.
These data suggest an association between anxiety and fatal coronary heart disease, in particular, sudden cardiac death.
To examine prospectively the association between self-reported symptoms of phobic anxiety and subsequent risk of coronary heart disease, a 2-year follow-up study was conducted of a cohort of 33,999 US male health professionals, aged 42 to 77 years in 1988, who were free of diagnosed cardiovascular disease at baseline. Levels of phobic anxiety were assessed using the Crown-Crisp index, a short, diagnostic self-rating scale used for common phobias. Main outcomes were incidents of coronary heart disease consisting of nonfatal myocardial infarction (MI) and fatal coronary heart disease (CHD).
One hundred sixty-eight incident cases of CHD occurred during 2 years of follow-up (128 cases of nonfatal MI and 40 cases of fatal CHD). The age-adjusted relative risk of fatal CHD among men with highest levels of phobic anxiety (scoring 4 or higher on the Crown-Crisp index) was 3.01 (95% confidence interval, 1.31 to 6.90) compared with men with the lowest levels of anxiety (scoring 0 or 1 on the phobia index). Risk of fatal CHD increased with levels of phobic anxiety (P trend = .002). When fatal CHD was further categorized into sudden and nonsudden coronary death, the excess risk was confined to sudden death (relative risk among men scoring 3 or higher on the phobia index was 6.08; 95% confidence interval, 2.35 to 15.73). No association was found between phobic anxiety and risk of nonfatal MI. These findings remained essentially unchanged after adjusting for a broad range of cardiovascular risk factors.
The specificity, strength, and dose-response gradient of the association, together with the consistency and biological plausibility of the experimental and epidemiologic evidence, support a strong causal association between phobic anxiety and fatal CHD.
To integrate information from the various disciplines that contribute to the understanding of the cause and prevention of sudden cardiac death: identification of new approaches from applied clinical epidemiology; identification and control of transient risk factors; and evaluation of the results of interventions.
A broad range of research reports and interpretations of data from English-language journal articles and reviews, published primarily between 1970 and 1993. The fields of study included epidemiology, experimental electrophysiology, clinical observations, and interventions.
Continuous literature surveys, done in relation to ongoing clinical and experimental research on sudden cardiac death since 1972.
Included on the basis of relevance to the topics discussed and with confirmation of data and concepts by more than one investigator when available.
Information from several disciplines was integrated by the authors to synthesize new ways to view the problem of sudden cardiac death. Quantitative information was used primarily to derive qualitative statements about new perspectives on sudden cardiac death.
Progress in the prevention of sudden death will require development of new approaches, including epidemiologic techniques to address risk characteristics specific to the problem; characterization of triggering events and identification of specific persons at risk for responding adversely to these events; and methods of evaluating outcomes appropriate to the nature of sudden cardiac death.
Studies evaluating the risk of cardiovascular disease in the psychiatrically ill yield mixed results. Phobic anxiety in men is associated with an increased risk for cardiovascular disease, particularly sudden coronary death. This finding is in need of replication in women, and hypotheses regarding the potential mechanisms for this association warrant pilot testing. Other than this finding, there is only weak evidence supporting an association between psychiatric illness and risk for cardiovascular disease. This is surprising in light of the strong evidence that psychiatric illness in general is associated with elevated rates of cigarette smoking. In addition, there may also be higher rates of hypertension, hypercholesterolemia, and physical inactivity in some psychiatric disorders. Why the high rates of cigarette smoking and possibly other cardiovascular disease risk factors have not translated into consistently detectable elevated cardiovascular disease risk in individuals with psychiatric diagnoses is not apparent. Weaknesses in study designs and variations in assessment methods may partially explain the inconsistent results. Future studies of cardiovascular disease in the psychiatrically ill should be prospective, use nonclinical samples of men and women, have clear diagnostic criteria, determine order of onset of the two disorders if they coexist, and control for variability in known cardiovascular disease risk factors.
Recent laboratory and epidemiological studies have suggested that high levels of anger may increase the risk of coronary heart disease (CHD).
We examined prospectively the relationship of anger to CHD incidence in the Veterans Administration Normative Aging Study, an ongoing cohort of older (mean age, 61 years) community-dwelling men. A total of 1305 men who were free of diagnosed CHD completed the revised Minnesota Multiphasic Personality Inventory (MMPI-2) in 1986. Subjects were categorized according to their responses to the MMPI-2 Anger Content Scale, which measures the degree to which individuals have problems controlling their anger. During an average of 7 years of follow-up, 110 cases of incident CHD occurred, including 30 cases of nonfatal myocardial infarction hostility. (MI), 20 cases of fatal CHD, and 60 cases of angina pectoris. Compared with men reporting the lowest levels of anger, the multivariate-adjusted relative risks among men reporting the highest levels of anger were 3.15 (95% confidence interval) [CI]: 0.94 to 10.5) for total CHD (nonfatal MI plus fatal CHD) and 2.66 (95% CI: 1.26 to 5.61) for combined incident coronary events including angina pectoris. A dose-response relation was found between level of anger and overall CHD risk (P for trend, .008).
These data suggest that high levels of expressed anger may be a risk factor for CHD among older men.
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