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Hopelessness and Risk of Mortality and Incidence of Myocardial Infarction and Cancer
Abstract
We examined the relationship among low, moderate, and high levels of hopelessness, all-cause and cause-specific mortality, and incidence of myocardial infarction (MI) and cancer in a population-based sample of middle-aged men. Participants were 2428 men, ages 42 to 60, from the Kuopio Ischemic Heart Disease study, an ongoing longitudinal study of unestablished psychosocial risk factors for ischemic heart disease and other outcomes. In 6 years of follow-up, 174 deaths (87 cardiovascular and 87 noncardiovascular, including 40 cancer deaths and 29 deaths due to violence or injury), 73 incident cancer cases, and 95 incident MI had occurred. Men were rated low, moderate, or high in hopelessness if they scored in the lower, middle, or upper one-third of scores on a 2-item hopelessness scale. Age-adjusted Cox proportional hazards models identified a dose-response relationship such that moderately and highly hopeless men were at significantly increased risk of all-cause and cause-specific mortality relative to men with low hopelessness scores. Indeed, highly hopeless men were at more than three-fold increased risk of death from violence or injury compared with the reference group. These relationships were maintained after adjusting for biological, socioeconomic, or behavioral risk factors, perceived health, depression, prevalent disease, or social support. High hopelessness also predicted incident MI, and moderate hopelessness was associated with incident cancer. Our findings indicate that hopelessness is a strong predictor of adverse health outcomes, independent of depression and traditional risk factors. Additional research is needed to examine phenomena that lead to hopelessness.
... Psychosocial characteristics and drinking and smoking patterns were assessed with well-validated questionnaires. Psychosocial measures included the Perceived Stress Scale (Sullivan, Sykora, Schneiderman, Naranjo, & Sellers, 1989), the Mini International Neuropsychiatric Interview (MINI) (psychotic score and anxiety score) (Lecrubier et al., 1997), the Kuopio Ischemic Heart Disease (KIHD) Risk Factor Study Hopelessness Scale (Everson et al., 1996), the Patient Health Questionnaire-9 (PHQ-9) assessment of depressive symptoms (Kroenke, Spitzer, & Williams, 2001), an assessment of social network size which is defined as the total number of close friends and children (Dhand et al., 2018). ...
... Hopelessness emerged as an important psychosocial variable associated with frequency of homelessness, with potential impact on efforts to address both smoking and drinking. The literature reports hopelessness as influential on the use of alcohol (Weinberger et al., 2017;Steger, Mann, Michels, & Cooper, 2009;McClave et al., 2009;Baines, Jones, & Christiansen, 2016) and an important indicator for future risk for poor cardiovascular health (Everson et al., 1996;Everson, Kaplan, Goldberg, & Salonen, 2000;Whipple et al., 2009). Hopelessness has mainly been explored in relation to groups experiencing health-related issues alongside smoking, such as pregnancy (Petersen, Steyn, Everett-Murphy, & Emmelin, 2010) and lung cancer (Berg et al., 2013) but it has not been explored in relation to smoking cessation for people experiencing homelessness. ...
The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6). Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.
... The Brief-Hope-Negative Scale (Brief-H-Neg; Everson et al., 1996) is a 2-item self-report measure of hopelessness with regard to the future and the possibility of reaching future goals. The scale utilizes a 5-point Likert-type response scale (0 = strongly agree to 4 = strongly disagree). ...
... Scores on the two items were found to be moderately correlated in a sample of men (r = .53; Everson et al., 1996). Despite its brevity, Fraser et al. (2014) found the Brief-H-Neg scores had good internal consistency ( α = .80), ...
This study evaluated the psychometric properties of the Hope-Action Inventory (HAI) scores with a problematic substance use population (N = 783). The hierarchical seven-factor structure of the HAI fit the data well. Further, the HAI scores had satisfactory internal consistency reliability and good convergent evidence for validity.
... [26] The validity and reliability of the Turkish version of ULS were studied by Demir. [27] Scores are categorized as low (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), moderate (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48), and high (≥49). Higher scores indicating higher levels of loneliness. ...
... [39] In some prior research, hopelessness was associated with an increased risk of incidence and mortality of serious illnesses such as myocardial infarction and cancer. [40] There is a study with a 10-year follow-up period reporting that helplessness and hopelessness are effective in disease-free survival in patients with breast cancer. [41] Gustavsson-Lilius et al. found considerable gender differences in their study of 155 cancer patients in which they investigated the effects of optimism, hopelessness, and partner support on QoL. ...
... 12,13 However, hopelessness has been predicted to increase mortality in advanced cancer patients. 14,15 Hannah Ball et al suggest that the psychological problem of patients with advanced lung cancer are related to uncertainty, hope, hopelessness, stigma, guilt, family and caregiver anxiety, physical distress of the disease, experience of tragedy caused by diagnosis, unexplained distress. 10 In a systematic, it was discovered that patients with lung cancer experienced uncertainty about their future at a rate of 13-70% in the terminal period and had high levels of hopelessness. ...
... 8 It was suggested that hopelessness experienced by advanced cancer patients admitted to palliative care would affect mortality from the disease. 14,15 In our study, we found in patients with advanced lung cancer that among the hopelessness sub-dimensions, the score for feelings and expectations about the future was 1.40 ± 1.66, for loss of motivation it was 3.43 ± 2.41, and for hope it was 2.05 ± 1.75. The mean total score of hopelessness was 7.41 ± 6.01. ...
This research was conducted descriptively to determine the symptom intensities, performance and hopelessness levels of advanced lung cancer patients for the palliative care approach. The research sample consisted of 130 patients with advanced lung cancer, who were selected from 600 lung cancer populations in thoracic surgery and intensive care, outpatient chemotherapy, oncology in a university hospital in Turkey. Ethics Committee permission and the patients’ written consent was obtained. Study data were collected face to face between January 2020 and July 2020 using the Edmonton Symptom Assessment System, Karnofsky Performance and Beck Hopelessness Scale. The mean age of the patients was 62.68 ± 8.867, 72.3% were males, and 89.2% were not currently working. The most common symptom in the patients was found to be fatigue 5.46 ± 2.12, worsening in general health and well-being 5.69 ± 1.87, loss of appetite 5.40 ± 2.59, and total symptom score 47.17 ± 19.03. Feelings and expectations about the future 1.40 ± 1.66, loss of motivation 3.43 ± 2.41, hope 2.05 ± 1.75, and total score of hopelessness 7.41 ± 6.01. There was a positive correlation between the patients’ hopelessness level and their symptom burden, and a negative correlation was found with Karnofsky performance ( P < .05). A significant difference was found between the patients’ age, months since diagnosis, gender, education and employment status, stage of the disease, presence of metastases and analgesic use, and hopelessness scores ( P < .05). It was determined that the symptom burden of patients with advanced lung cancer increased and as their Karnofsky performance decreased, their hopelessness level further increased. Hopelessness scores are affected by the socio-demographic and disease variables of the patients.
... There is considerable reason to believe that hope promotes health and well-being, and that hopelessness is toxic. Evidence suggests that hopeful people feel better [6−8], weather stress more successfully [9,10], and live longer [11,12], even when diagnosed with serious diseases [13−16]. Hope has been associated with cognitive flexibility and creativity [17] and with academic achievement [18]. ...
... Hope has been associated with cognitive flexibility and creativity [17] and with academic achievement [18]. Hopelessness, on the other hand, is associated with increased risk of developing hypertension [19] and atherosclerosis [20], of myocardial infarction and cancer [11,21], of anxiety [22] and depression [23], of cognitive decline [24], and of more severe PTSD symptoms [25]. Among young people, hopelessness predicts violent behavior, substance abuse, and early sexual activity [26−28]. ...
Hope has been viewed since ancient times as a bedrock of human thriving, and contemporary evidence suggests that hope is a determinant of health. However, the climate crisis, in addition to its many direct and indirect threats to human health, erodes hope in many people. This article describes medical aspects of hope and hopelessness, including clinical definitions, measurement methods, and treatments. It then touches on literary and philosophical perspectives on hope, from both ancient and modern sources, emphasizing the centrality of hope to human thriving. Finally, it applies these perspectives to the climate crisis, arguing that health professionals should propel hope in themselves, their patients, and the broader society, and drawing on clinical insights to propose concrete ways of doing so.
... NSAL participants completed the Everson Hopelessness Scale (Everson, et al., 1996), This scale is comprised of two items (1) I sometimes think I am no good, and (2) It is impossible to reach my goals with a four response scale (1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree). These items were summed together and recoded where participant responses of less than five indicated moderate hopelessness and participant responses above six indicated high hopelessness (Everson et al., 1996). ...
... NSAL participants completed the Everson Hopelessness Scale (Everson, et al., 1996), This scale is comprised of two items (1) I sometimes think I am no good, and (2) It is impossible to reach my goals with a four response scale (1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree). These items were summed together and recoded where participant responses of less than five indicated moderate hopelessness and participant responses above six indicated high hopelessness (Everson et al., 1996). ...
Research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in African American and first generations Caribbean Black clients. Data was from the National Survey of American Life (NSAL). Bivariate associations showed that respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having Major Depressive Disorder (MDD). The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease. Caribbean Blacks were more likely to report depression compared to African Americans. Additionally, respondents who reported higher discrimination scores were more likely to report depression. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.
... A sample item is "I hardly ever expect things to go my way". We also used a two-item hopelessness scale developed to measure negative views of oneself and the future (Everson et al., 1996;Fraser et al., 2014). This two-item scale is internally reliable and stable over time and has excellent concurrent validity with the Beck Hopelessness Scale (Beck et al., 1974) and the Center for Epidemiologic Studies Depression scale. ...
Background:
Forgiveness is one form of emotion-focused coping, and the positive effects of such a practice on mental well-being have been confirmed by numerous meta-analyses. The biopsychosocial model assumes that feeling burdened is determined by a number of physical, psychological, and social factors, suggesting a multidimensional relationship between forgiveness and distress. In this study, we tested a model according to which various sociopsychological variables (i.e., health, outlook, spirituality, aggression, and social support) mediate the negative association between episodic forgiveness (also known as state forgiveness) and distress.
Participants and procedure:
We tested the model on a cross-sectional sample of 436 young adults from the United States (62% of whom were women) using structural equation modelling (SEM).
Results:
The results of the overall model supported our indirect effects hypotheses. An analysis of specific indirect effects revealed that variables such as health, a negative outlook, aggressiveness, and social support play a special role in adaptation to stressful life events in forgiving individuals.
Conclusions:
The relationship between episodic forgiveness and distress can be explained through complex sociopsychological mechanisms, including feelings of health, outlook, or social support, and attitudes, experiences, and behaviours related to these mechanisms can influence each other and collectively contribute to preventing or reducing perceived burden in young American adults.
... Those with a hopeful outlook are inclined to adopt healthier behaviors, such as regular exercise and proper nutrition, contributing to overall well-being and longevity [16]. Hope emerges as a predictor of improved cardiovascular health and reduced mortality [17]. Furthermore, hopeful individuals are more likely to initiate and sustain social connections, a key factor in promoting health [18]. ...
... First, even if major depression does not meet the diagnostic criteria, cardiac risk increases in the presence of depressive symptoms [123] . Secondly, studies have associated the severity of depression with the risk of experiencing a cardiac condition in the future [123,124] . The effect of depression on cardiac diseases is explained by psychophysiological mechanisms including platelet activity, imbalance in hypothalamic-pituitary-adrenal axis function, abnormal autonomic nervous system function, changes in immune functions and inflammation, and biobehavioral mechanisms including risky health behaviors [122] . ...
p class="Default">Cardiovascular diseases (CVDs) are cited as the deadliest of illnesses. Their incidence and prevalence around the world are steadily rising. CVDs are the cause of approximately one-third of all deaths in the world. It has been stated in empirical studies over the years that poor socioeconomic status, the lack of social support, stress at work and in the family, depression, and psychosocial risk factors such as anxiety and feelings of hostility aggravate the risk of developing coronary heart disease and also worsen the clinical course and prognosis. Additionally, psychobiological, and behavioral mechanisms have been identified in this context. Psychosocial risk factors should be identified in clinical practice and medical results shared with individuals with CVDs, who should also be screened for anxiety, stress, and stress management, as well as for symptoms of depression. Individuals at risk or who are diagnosed as displaying symptoms of anxiety and depression should be referred to psychiatric professionals to ensure that they receive assistance. Cardiac rehabilitation may involve psychosocial interventions that include cognitive behavioral therapy, problem-solving therapy, and stress management programs, applied on their own or together with other interventions. The aim of this review article is to examine CVDs and community mental health, determine which applications may be adopted as standard practice in this context, and raise awareness about this topic among the public and especially among health professionals. </p
... The Everson et al. (1996) Hopelessness scale was used as the final measure of psychological well-being. This measure included the following 2 items: ...
This study addresses the question of whether there is an association between tracing family roots and indicators of psychological well-being among African Americans, specifically self-esteem, mastery, and feelings of hopelessness. Data from a nationally representative sample of African Americans was used for this analysis. The findings of the bivariate regression models showed that having traced one’s family roots (i.e., personally or a family member of the respondent) was associated with significantly higher levels of mastery and self-esteem and reduced feelings of hopelessness. The relationships between tracing one’s family roots, self-esteem, and feelings of hopelessness remained after adjusting for relevant socio-demographic, health, and psychosocial factors. Study limitations and directions for future research are discussed.
... [10] İkincisi, çalışmalar depresyonun şiddeti ile gelecekte kardiyak durum yaşanması arasında eğilim olduğunu desteklemektedir. [10,11] Depresyonun kardiyak hastalıklara etkisi; trombosit aktivitesi, Hipotalamus-Hipofiz-Adrenal eksen fonksiyonunda dengesizlik, anormal otonom sinir sistemi fonksiyonu, immün fonksiyonlarda ve inflamasyonda değişimi içeren psikofizyolojik ve riskli sağlık davranışlarını içeren biyodavranışsal mekanizmalarla açıklanmaktadır. [8,9] Depresyonun önemli bir belirtisi olan umut kaybı, özel bir dikkat gerektirir. ...
... Socio-demographic variables and caring responsibilities were categorised according to the UK Office for National Statistics national census categories 24 31 one item each; Depression: PHQ-9, 23 eight items as item 9 (suicidal ideation) was used as the dependent variable (DV); Anxiety: Generalised Anxiety Disorder Questionnaire (GAD7), 32 sum of seven items; Paranoia: Five-item Persecution and Deservedness Scale (PaDS-5), 33 sum of five items; Well-being: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), 34 sum of seven items, abbreviated; Self-esteem: Self-Esteem Scale, 35 one item; Empathy: Interpersonal Reactivity Index (IRI), 36 sum of five items, abbreviated; Locus of control: Levenson Locus of Control Scale, 37 three subscales (Chance, Self, Powerful Others), sum of three items on each, abbreviated; Hopelessness: Brief-H-Pos, 38 sum of two items. ...
Objective
Given the paucity of evidence-based research investigating different suicidal ideation profiles and trajectories, this project sought to investigate health and socio-economic factors associated with the presence of suicidal ideation and changes in ideation over time.
Design
Longitudinal cohort design, using logistic regression analysis.
Setting
A public health survey was administered at two timepoints in a community setting across the North West of England. In the 2015/2016 survey, participants were recruited from high (n=20) and low (n=8) deprivation neighbourhoods. In the 2018 survey, only the 20 high-deprivation neighbourhoods were included.
Participants
4287 people were recruited in 2015/2016 and 3361 were recruited in 2018. The 2018 sample was subdivided into those who responded only in 2018 (n=2494: replication sample) and those who responded at both timepoints (n=867: longitudinal sample).
Primary outcome measures
Suicide ideation was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire instrument.
Results
The prevalence of suicidal ideation was 11% (n=454/4319) at 2015/2016 and 16% (n=546/3361) at 2018.
Replication study results highlighted: persistent debilitation from physical ill health and/or medication side effects; demographic factors (ie, middle-aged, single or never married); and personal coping strategies (ie, smoking) as risk factors for suicidal ideation. A static/improved financial position and high levels of empathy were protective factors.
Longitudinal study results confirmed three suicidal ideation trajectories: ‘onset’, ‘remission’ and ‘persistence’. Similar findings to the replication study were evidenced for the onset and persistence trajectories. Persistent suicidal ideation was synonymous with higher levels of practical support which may correspond to the higher levels of debilitation and functional disability reported within this group. Remission was characterised by fewer debilitating factors and higher levels of self-agency.
Conclusion
A greater appreciation of the heterogeneity of suicidal trajectories should lead to the implementation of broad clinical assessments and targeted interventions.
... First, hopelessness is present at a clinically relevant level in 9-12% of the general population globally (Greene, 1981;Haatainen et al., 2003Haatainen et al., , 2004Mair et al., 2012), with roughly similar magnitude in men and women (Greene, 1981;Poch et al., 2004). Second, strong evidence indicates that hopelessness is a major predictor of important future outcomes, such as depressive symptoms and episodes (Abramson et al., 1989;Alford et al., 1995;Hamilton et al., 2013;Joiner, 2005;Joiner et al., 2005;Mac Giollabhui et al., 2018), suicidal ideation and suicide death (Beck et al., 1989;Franklin et al., 2017), poor health (Roane et al., 2017), and increased mortality (Everson et al., 1996;Stern et al., 2001). Third, hopelessness is a critical indicator to consider in treatment contexts, given its association with reduced help-seeking behavior among university students with high levels of suicidal ideation (i.e., help-negation; Wilson & Deane, 2010, although see Deane et al., 2001). ...
Hopelessness is a painful cognitive state that is related to depression and suicide. Despite its importance, only unsystematic efforts have been made to specifically target hopelessness in interventions, and no comprehensive review is currently available to guide future clinical studies. In this narrative review, we first analyze the phenomenon of hopelessness, by highlighting its components (e.g., dismal expectations, blocked goal-directed processing, and helplessness), antecedents (e.g., inferential styles), and contextual factors (e.g., loneliness and reduced social support). Then, we review the currently available interventions and manipulations that target these mechanisms, either directly or indirectly, and we highlight both their strengths and lacunae. Finally, we propose possible avenues to improve our clinical toolbox for breaking the vise of hopelessness.
... P e s s im is m e e r b e s lae g te t me d de pr e s s i v i nds t i l l i ng, og r e l a t i one n t i l ne ur ot i c i s me ka n må s ke f orklare de sam m enhae nge, som er fundet m ellem pessim ism e og sym ptomog sygdom sadfae rd. I nyere undersøgelser har m an endvidere fundet samme nhaenge me l l e m hå bl øs he d og døde l i ghe d s a mt r i s i ko f or hj e r t e l i de lser og cancer (Everson et al., 1996). ...
I artiklen diskuteres sammenhængen mellem personlighed og fysisk sygdom. Først omtales de vigtigste metodeproblemer inden for området, og det påpeges, at sikre konklusioner om sammenhængen mellem personlighed og sygdom kun kan drages på basis af prospektive longitudinelle undersøgelser af raske personer. Dernæst diskuteres forskellige modeller, der kan forklare mulige sammenhænge mellem personlighed og helbred: symptom- og sygdomsadfærd, sundhedsrelateret adfærd, individets forarbejdning af stress, individets fremprovokering af stress, og endelig en mulig relation mellem personlighed og konstitutionelle dispositioner. Fem-faktor modellen beskriver personligheden ved fem overordnede personlighedsdimensioner: neuroticisme, introversion-extroversion, samvittighedsfuldhed, fjendtlighed-venlighed, og intelligens. Sammenhængen mellem hvert af disse personlighedstræk og helbred diskuteres på basis af udvalgt litteratur, og det konkluderes, at der er en sandsynlig sammenhæng mellem depressiv indstilling og sygdom og mellem fjendtlighed og sygdom.
... We know, however, from animal models, that experiences and situations in dogs [15,16] and pigs [17] influence the occurrence of arrhythmias. In humans it is proven that depression, hopelessness and "vital exhaustion" [18][19][20], increase the risk of ischaemic heart disease in healthy individuals, and the risk of reinfarction and sudden cardiac death in individuals with a past history of myocardial infarction [21]. This makes it obvious that medical interventions in emergencies are best based on empirical evidence. ...
... In addition to affecting the emotional, anxiety and depression also provide physiological effects on the body (Cohen, Edmondson, & Kronish, 2015). There is ample evidence that depressed individuals without heart disease are at increased risk of developing cardiovascular morbidity (Engel, 1968;Bruhn, Paredes, & Wolf, 1974;Everson et al., 1996;Glassman, & Shapiro, 1998). Anda et al. (1993) demonstrated an increased incidence of fatal ischemic heart disease related to depressed mood and hopelessness in a sample of 2832 adults. ...
Prior studies have demonstrated that anxiety and depression explain the increase of adverse cardiovascular events an failure to modulate cardiac activity. This study of the nonlinear heart rate (HR) variability (HRV) behavior can provide additional information concerning the autonomic recovery of HR after exercise. The dynamics of these indices in exercise-mediated situations may reveal other ways to assess HRV recovery after physical effort. We studied nonlinear HRV recovery after submaximal exercise in subjects with higher Hospital Anxiety and Depression Scale (HADS) scores. Sixty-six young adults were recruited, and 50 completed the HADS rating scale to quantify their degree of anxiety and depression for later allocation to a suitable group. After experimental procedures, the final sample involved 20 participants (15 female) who were allocated to the group with low HADS scores (LHADS) and 21 (16 female) to the group with high HADS scores (HHADS). We logged HRV data before and during recovery from submaximal aerobic exercise and analyzed this data using symbolic analysis. Young adults with High HADS scores (HHADS) had a slower recovery of the symbolic analysis of HRV via index 2LV% (two like variations) and 2ULV% (two unlike variations) after aerobic exercise. Participants with higher HADS scores presented delayed nonlinear HRV recovery after submaximal exercise.
... As described above, loss of coping can lead to feelings of hopelessness, a well-known risk factor for mortality and morbidity [291]. In analogy, and in line with search for internal psychosocial resources, the concept of optimism has recently been given more attention [292]. ...
... The other four items are fillers. Each item is scored using a Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree) (Everson et al., 1996). Therefore, the total score ranges from 8 to 32. ...
Despite head and neck cancer (HNC) association with various negative impacts, collective evidence is accumulating regarding the positive impacts of positive psychology on cancer survivors. However, data on how positive psychology is related to the psychological complications of HNC across time are lacking. This longitudinal study examined the trends of positive psychology (e.g., posttraumatic growth [PTG], hope, and optimism), perceived spousal support, and psychological complications (e.g., depression, anxiety, and posttraumatic stress symptoms) and determined the association between them, psychological complications, and PTG across two timelines among a cohort of HNC patients. A total of 175 HNC respondents exhibited an increasing trend of positive psychology and perceived spousal support while reporting a decreasing trend of psychological complications between baseline and follow-up assessments. A greater degree of hope and perceived spousal support contributed to a higher degree of PTG across time. Conversely, a higher severity of anxiety symptoms was associated with a lower degree of PTG over time. Female gender had a moderating effect on the association between severity of anxiety symptoms and PTG, but did not moderate the association between hope, perceived spousal support and PTG. This study indicates the pivotal role of incorporating psychosocial interventions into the treatment regimen to enhance the degree of hope and perceived spousal support and reduce the severity of anxiety symptoms, which, in turn, will facilitate the development of PTG in HNC patients.
... The four other items are fillers. Each item is scored using a Likert scale ranging from definitely false to definitely true [60]. The Malay version of the Scale was validated among the Malaysian cancer patient population, and it has good internal consistency with a Cronbach's alpha of 0.716 [61]. ...
Background and aim:
Head and neck cancer patients are vulnerable to various psychological complications due to the effects of both cancer itself and cancer treatment on patients' appearance and physical well-being. Nevertheless, few data have been obtained on effective psychosocial interventions that could protect this group of cancer patients' psychological well-being. Therefore, this three-armed, parallel-group, double-blind, randomized control trial (RCT) aims to evaluate and compare the effects of acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR) on positive psychology (such as posttraumatic growth [PTG], hope, and optimism), quality of life (QoL), and psychological complications (depression, anxiety, and experiential avoidance) among newly diagnosed head and neck cancer patients.
Methods and analysis:
This RCT will target newly diagnosed head and neck cancer patients who have been treated only with surgery or who have not yet received any treatment. In total, 120 patients who meet all of the study's inclusion criteria and none of its exclusion criteria will be randomly assigned into three groups-an ACT group, an MBSR group, and a treatment-as-usual control group-at a 1:1:1 allocation ratio. Participants in the two intervention groups (the ACT and MBSR groups) will undergo an eight-week group intervention program. During this program, each intervention will comprise eight modules based on ACT and MBSR, respectively. Outcome assessments will be performed across a three-point timeline, including before the intervention (t0), immediately after the psychosocial intervention at eight weeks (t1), and six months after the intervention (t2). The primary outcome that will be assessed during this RCT is PTG. Meanwhile, the secondary outcomes that will be evaluated in this study are such as QoL, hope, optimism, depression, anxiety, and experiential avoidance.
Trial registration number:
NCT04800419 (ClinicalTrials.gov). Registered on March 16, 2021.
... (HH) (Everson, et al., 1996) : ...
... Item responses were averaged to construct each scale. Hope was assessed using two items from Everson et al. (1996) ("I feel it is impossible for me to reach the goals that I like to strive for" and "The future seems hopeless to me and I can't believe that things are changing for the better") and two items from Beck et al. (1974) ("I don't expect to get what I really want" and "There is no use in trying to get something I want because I probably won't get it"). Each item was reverse-coded such that higher values were indicative of greater hope. ...
Objective: We assessed the effects of hope, purpose in life, and religiosity on trajectories of depressive symptoms among middle-aged and older Blacks, with a focus on age differences in these associations. Methods: Data come from 1906 respondents from the 2006-2016 Health and Retirement Study. Linear mixed models were estimated and included interactions between age and time and between age and each psychosocial resource. Results: Depressive symptoms decreased for Blacks ages 51-64, did not change for those 65-74, and increased among Blacks age 75+. Hope and purpose in life were inversely associated with symptom levels but were not associated with change over time in symptomology. Associations were stronger among the youngest age group and weakest among the oldest. Religiosity was unrelated to depressive symptoms. Discussion: Psychosocial resources protect against depressive symptoms in age-dependent ways among middle-aged and older Blacks. Differences in these effects may be related to aging, cohort, and selection effects.
... H ope-a positive mental state that enables people to persist and proceed toward their goals and on their life paths 1 -is increasingly understood as vital to health and well-being. 2 At individual and population levels, greater levels of hope are correlated with better physical and mental health outcomes, health-related behaviors, emotional well-being, social relationships and support, life satisfaction, and quality of life. [3][4][5][6][7][8][9] Even before the onset of the COVID-19 pandemic, the national discourse about hope and related constructs was elevated by evidence suggesting that increased mortality from suicide, drug overdose, and alcohol-related conditions-identified as deaths of despair-underlay unprecedented and sustained declines in life expectancy for the United States. 10,11 The pandemic and its health, economic, and social consequences have further heightened concerns about hope, hope's role as a determinant of health and well-being, and potential consequences from population-level declines in hope. ...
Objectives. To describe national- and county-level trends and variation in a novel measure of hope.
Methods. Using data from the Gallup National Health and Well-Being Index (n = 2 766 728), we summarized the difference between anticipated life satisfaction (ALS) and current life satisfaction (CLS), measured by the Cantril Self-Anchoring Scale, for each year from 2008 to 2020 and by county over two 5-year periods in the United States.
Results. Across all years, there was a significant positive trend in the difference between ALS and CLS for the nation (P = .024), which remained positive but not significant when we excluded 2020. Maintenance of ALS with a decrease in CLS drove the 2020 increase. From 2008–2012 to 2013–2017, 14.5% of counties with 300 or more responses (n = 599) experienced an increase in the difference of more than 1 SD, whereas 13.9% experienced a more than 1 SD decrease. Fifty-two counties experienced decreases in ALS and CLS.
Conclusions. Responding to trends in the gap between ALS and CLS at national and local levels is essential for the collective well-being of our nation, especially as we navigate and emerge from crisis.
... The measures used in this analysis were collected in the 16-month follow-up survey in the BOLD study and the summer 2020 cross-sectional survey in the GOLD study. Our primary outcomes of interest were continuous scores of validated instruments of existential outcomes: hopelessness (Kuopio Ischemic Heart Disease (KIHD) study hopelessness scale), [17] sense of meaning, sense of peace, and spirituality (the three subscales of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; FACT-SP 12), [18] PTG (Post-traumatic Growth Inventory Short Form; PTGI-SF), [19] and loneliness (The Direct Measure of Loneliness) [20]. ...
BackgroundA cancer diagnosis may lead to existential despair but potentially also to perceived inner growth. This growth may be fostered through meaningful connections with others. We sought to describe existential and related psychosocial outcomes and their association with a sense of connection with others in individuals with gynecological and breast cancers.Methods
We used cross-sectional data from two ongoing cohort studies of gynecologic (N = 236) and breast (N = 62) cancer survivors at the University of Minnesota. We summarized self-reported post-traumatic growth (PTG), sense of meaning, peace, spirituality, hopelessness, loneliness, and three exploratory measures of sense of connections with others, and used multivariate linear regression models to describe the associations between them.ResultsHope, sense of meaning, peace, and spirituality were generally high among participants, but PTG and loneliness scores varied more. Sense of connection with others was consistently associated with greater PTG and decreased loneliness with medium effect sizes: for example having positive interactions with most/all versus nobody on one’s medical team, PTG (coefficient 10.49, 95% CI: 4.10, 16.87, Cohen’s D 0.44); loneliness (coefficient − 0.85, 95% CI: − 1.36, − 0.34, Cohen’s D 0.43). Those who knew someone in a similar life situation felt a strong sense of connection with such a person; however, 28% of participants had not met anyone in a similar situation.Conclusions
There may be untapped opportunities to nurture beneficial existential outcomes in cancer survivors. Potential interventions include connecting survivors with one another and creating opportunities for more authentic patient-provider relationships, for example, within palliative care.
... Although not a diagnosable condition, hopelessness is a risk factor for depression 12 and suicidality, 13 as well as cardiovascular diseases such as hypertension, 14 carotid atherosclerosis, 15 and myocardial infarction. 16 Hopelessness is also associated with occupational burnout in health care workers, 17 which increases the risk for medical errors and poor patient safety outcomes. 18 Identification of health care workers at high risk for negative mental health outcomes is important for providing adequate support services to reduce these physical and psychological consequences. ...
Background: In the United States, New York State’s health care
system experienced unprecedented stress as an early epicenter of
the coronavirus disease 2019 (COVID-19) pandemic. This study
aims to assess the level of hopelessness in New York State
physicians working on the frontlines during the first wave of the
COVID-19 outbreak.
Methods: A confidential online survey sent to New York State
health care workers by the state health commissioner’s office was
used to gather demographic and hopelessness data as captured
by a brief Hopelessness Scale. Adjusted linear regression models
were used to assess the associations of physician age, sex, and
number of triage decisions made, with level of hopelessness.
Results: In total, 1330 physicians were included, of whom 684
were male (51.4%). Their average age was 52.4 years (SD=12.7),
with the majority of respondents aged 50 years and older
(55.2%). Almost half of the physician respondents (46.3%)
worked directly with COVID-19 patients, and 163 (12.3%) were
involved in COVID-19-related triage decisions. On adjusted
analysis, physicians aged 40 to 49 years had significantly higher
levels of hopelessness compared with those aged 50 years or more
(μ=0.441, SD= 0.152, P=0.004). Those involved in 1 to 5
COVID-19-related triage decisions had a significantly lower
mean hopelessness score (μ= −0.572, SD=0.208, P=0.006)
compared with physicians involved in none of these decisions.
Conclusion: Self-reported hopelessness was significantly higher
among physicians aged 40 to 49 years and those who had not yet
been involved in a life or death triage decision. Further work is
needed to identify strategies to support physicians at high risk for adverse mental health outcomes during public health emergencies
such as the COVID-19 pandemic.
Key Words: COVID-19, health care workforce, mental health
(J Neurosurg Anesthesiol 2022;34:152–157)
... Hopelessness was measured as the second component of mental health. We used a brief two-item index of hopelessness (Everson et al., 1996(Everson et al., , 1997. The items are: "The future seems to me to be hopeless, and I can't believe that things are changing for the better, " and "I feel it is impossible for me to reach the goals that I would like to strive for." ...
The purpose of this study was to examine multiple direct and indirect pathways of the association between older age and mental health through COVID-19-related stress perceptions, meaning in life, and forgiveness of situations. Participants were 1,382 U.S. adults who were part of the Harvard Digital Lab for the Social Sciences panel who volunteered to complete a 12 min survey in the spring of 2020. The sample had an average age of 56 years, was slightly more male (55%) than female (44%) or other (2%), mostly White (88%), well-educated (70% bachelors degree or more), and middle-income ($60,000–$75,000 annually). Measures included: COVID-19-related stress perceptions (e.g., concerns about infection, job, lack of necessities), presence of and search for meaning in life, forgiveness of situations, psychological distress, hopelessness, and optimism. A latent mental health variable was created that was comprised of psychological distress, hopelessness, and optimism. All hypothesized direct effects were in evidence, and all but one indirect effect were observed. Specifically, older age was related to better mental health through higher presence of meaning and lower search for meaning. Older age was also related to better mental health through a serial indirect pathway from lower COVID-19-related stress perceptions to higher presence of and lower search for meaning and higher forgiveness of situations to mental health. The proposed model was largely supported and confirms existing theory and research on aging, positive psychological processes, and mental health. Findings also offer new insights on the unique potential role of forgiveness of situations and its theoretical relevance to offending situations such as the COVID-19 pandemic. The present study offers a beginning for theorists, researchers, and practitioners to consider the connections between aging and mental health and the intricate interconnections between stress appraisal and positive coping resources that may serve to support it.
... Feelings of hopelessness and resignation can emerge when people experience grief (Weir, 2020). Furthermore, mental and physical health can deteriorate when people do not feel hope (Scheier and Carver, 1992;Everson et al., 1996), with suicide being associated with feelings of hopelessness (Horwitz et al., 2017). ...
Disasters pose fundamental tests to human resilience not only for physical survival but also on socio-political civility. Internationally, armed conflict remains a significant problem for human security causing humanitarian crises, such as forced migration and food shortages. Globally, there is an increasing recognition that disasters have moved from random events of nature to an increased consciousness that human activity has escalated the frequency and severity of climate catastrophes such as wildfires, famines, storms and rising sea levels. Alongside communities, social work has a critical role to play in preparing and responding to disasters and working with people to rebuild, maintain and achieve their hopes. This article broadens social work’s orientation to hope beyond the therapeutic ‘installation of hope’ by including emancipatory hope in the context of disasters and recovery. Drawing from Braithwaite’s work, this article describes a framework for practice, which advocates for the strategic integration of cognitive change (aligned with Snyder’s view of hope) and structural change (aligned with emancipatory hope) that social workers could mobilise before, during and after disasters. We argue that whilst social workers must build individual psychological hope, this cannot be done without structural change and advocacy to enable viable pathways for achieving hopes.
... Such negative emotional states are particularly common in older adults living in residential care facilities [25,26]. Studies of older adults indicate that hopelessness is a strong mortality predictor, even when controlling for age-associated increases in risks of depression and other medical conditions in older age groups [27][28][29][30]. Therefore, a sense of hope is essential for wellbeing in older adults. ...
This study investigated the effects of an 8-week horticultural activity intervention on attitudes toward aging, sense of hope, and hand–eye coordination in 88 older adults in residential care facilities. In the experimental group, the mean score for “attitudes toward aging” increased from 3.81 before the intervention to 4.74 points after the intervention (standard deviation SD = 0.24 and 0.27, respectively), and the control group dropped from 3.75 to 3.70 (standard deviations, respectively SD = 0.27 and 0.28). The mean score for “sense of hope” increased from 3.28 before the intervention to 3.81 points after the intervention (SD = 0.49 and 0.26, respectively). In contrast to the control group, the mean score gradually declined from 3.26 to 3.16 points (standard deviation SD = 0.54 and 0.48, respectively). In the test of hand–eye coordination, the time required to complete the cup stacking test significantly decreased from 33.56 to 25.38 s in the experimental group but did not significantly change in the control group. Generalized estimating equation analysis revealed a significant interaction between group and time (p < 0.001). The data trends revealed significant differences in outcomes between the experimental group and the control group. At 3 months after the end of the study, the effect size in the experimental group remained higher than that in the control group.
... We chose this approach, as it was not feasible to measure these factors using 5 psychological questionnaires in their entirety to measure these aspects. In addition, it has previously been shown that it may be possible to assess some of these factors through very brief questionnaires [21]. Furthermore, these questions were not intended as a means of diagnosis, but rather as indications of the patients' psychological status at the time of measurement. ...
Background
More than 37 million people worldwide have been diagnosed with heart failure, which is a growing burden on the health sector. Cardiac rehabilitation aims to improve patients’ recovery, functional capacity, psychosocial well-being, and health-related quality of life. However, cardiac rehabilitation programs have poor compliance and adherence. Telerehabilitation may be a solution to overcome some of these challenges to cardiac rehabilitation by making it more individualized. As part of the Future Patient Telerehabilitation program, a digital toolbox aimed at enabling patients with heart failure to monitor and evaluate their own current status has been developed and tested using data from a patient-reported outcome questionnaire that the patient filled in every alternate week for 1 year.
Objective
The aim of this study is to evaluate the changes in quality of life and well-being among patients with heart failure, who are participants in the Future Patient Telerehabilitation program over the course of 1 year.
Methods
In total, 140 patients were enrolled in the Future Patient Telerehabilitation program and randomized into either the telerehabilitation group (n=70) or the control group (n=70). Of the 70 patients in the telerehabilitation group, 56 (80.0%) answered the patient-reported outcome questionnaire and completed the program, and these 56 patients comprised the study population. The patient-reported outcomes consisted of three components: (1) questions regarding the patients’ sleep patterns assessed using the Spiegel Sleep Questionnaire; (2) measurements of physical limitations, symptoms, self-efficacy, social interaction, and quality of life assessed using the Kansas City Cardiomyopathy Questionnaire in 10 dimensions; and (3) 5 additional questions regarding psychological well-being that were developed by the research group.
ResultsThe changes in scores during 1 year of the study were examined using 1-sample Wilcoxon signed-rank tests. There were significant differences in the scores for most of the slopes of the scores from the dimensions of the Kansas City Cardiomyopathy Questionnaire (P
... Psychiatric Morbidity Study, 33 23 conditions, 1 item each; medication side effects-Health Survey for England, 34 2 items; alcohol consumption and smoking-Merseyside Lifestyle Survey, 35 1 item each; depression-PHQ-9, 27 8 items as item 9 (SI) was used as the dependent variable; anxiety-Generalised Anxiety Disorder Questionnaire (GAD7), 36 sum of 7 items; paranoia-Five-item Persecution and Deservedness Scale (PaDS-5), 37 sum of 5 items; well-being-Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), 38 sum of 7 items, abbreviated; self-esteem-Self-Esteem Scale, 39 1 item; empathy: Interpersonal Reactivity Index (IRI), 40 sum of 5 items, abbreviated; hopelessness-sum of 2 items (Brief-H-Pos: reverse scored) 41 ; and locus of control-Levenson Locus of Control Scale, 42 sum of 9 items, abbreviated. Descriptive statistics for each measure are provided in online supplementary table 2. ...
Objectives
To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample.
Design
In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI.
Setting
Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK.
Participants
4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women.
Primary outcome measures
SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument.
Results
454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI.
Conclusions
This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI.
... Such an association independent of depression suggests that hopelessness is an entity distinct from depression (11) with consequences distinct from those associated with depression (26). This notion is potentially important because hopelessness can be observed in the absence of depression (11), and the notion is further supported by findings of previous research showing the predictive role of hopelessness on the development of cardiovascular risks such as hypertension and myocardial infarction is independent of depression (26,27). A number of explanations are possible for the predictive association between hopelessness and sarcopenia: as was shown in the general population, hopelessness may increase levels of pro-inflammatory cytokines such as cytokine interleukin-6 (IL-6) (12),12 and low-grade inflammation in turn leads to protein degradation and muscle wasting that is observed in advanced CKD and dialysis (6,28). ...
Background/Objectives
Depression and hopelessness are frequently experienced in chronic kidney disease (CKD) and are generally associated with lessened physical activity. The aim of this study was to quantify the associations between sarcopenia as determined by SARC-F with both depression and hopelessness.
Design and Setting
This multicenter cohort study involving cross-sectional and longitudinal analyses was conducted in a university hospital and four general hospitals, each with a nephrology center, in Japan.
Participants
Participants consisted of 314 CKD patients (mean age 67.6), some of whom were receiving dialysis (228, 73%).
Measurements
The main exposures were depression, measured using the Center for Epidemiologic Studies Depression (CES-D) questionnaire, and hopelessness, measured using a recently developed 18-item health-related hope scale (HR-Hope). The outcomes were sarcopenia at baseline and one year after, measured using the SARC-F questionnaire. Logistic regression models were applied.
Results
The cross-sectional and longitudinal analyses included 314 and 180 patients, respectively. Eighty-nine (28.3%) patients experienced sarcopenia at baseline, and 44 (24.4%) had sarcopenia at the one-year follow-up. More hopelessness (per 10-point lower, adjusted odds ratio [AOR]: 1.33, 95% confidence interval [95% CI] 1.12–1.58), depression (AOR: 1.87, 95% CI 1.003–3.49), age (per 10-year higher, AOR: 1.70, 95% CI 1.29–2.25), being female (AOR: 2.67, 95% CI 1.43–4.98), and undergoing hemodialysis (AOR, 2.92; 95% CI, 1.41–6.05) were associated with a higher likelihood of having baseline sarcopenia. More hopelessness (per 10-point lower, AOR: 1.69, 95% CI 1.14–2.51) and depression (AOR: 4.64, 95% CI: 1.33–16.2) were associated with a higher likelihood of having sarcopenia after one year.
Conclusions
Among patients with different stages of CKD, both hopelessness and depression predicted sarcopenia. Provision of antidepressant therapies or goal-oriented educational programs to alleviate depression or hopelessness can be useful options to prevent sarcopenia.
... Между интенсивными курильщиками и никогда не курившими выявлены значительные различия по ряду важных психических характеристик. Их негативное влияние на жизненный прогноз показано во многих наблюдениях [21,24,25]. Зависимость этого эффекта от возраста в настоящем исследовании не подтверждается, поскольку группы имели одинаковые возрастные показатели. ...
1 Образовательное учреждение профсоюзов высшего образования «Академия труда и социальных отношений», 119454, Москва; 2 ФГАУ ВО «Первый московский государственный медицинский университет имени И.М. Сеченова» (Сеченовский университет)» Министерства здравоохранения Россий-ской Федерации, 119991, Москва Введение. Известно, что курильщики имеют более высокую смертность, чем никогда не курившие. В то же время отказ от курения в профилактических программах не сопровождался улучшением прогноза. Возможно, привычка курения обусловлена неблагоприятными особенностями жизни, которые сами по себе оказывают негативное влияние на здоровье. Проверка этой гипотезы, выполненная ранее в популяции рабочих, показала наличие неблагоприятных психических характеристик курящего населения по сравнению с некурящими. Подтверждение этого вывода имеет важное значение для профилактической медицины. Цель-изучить психические особенности и показатели здоровья мужчин-курильщиков в сравнении с никогда не курившими. Материал и методы. Обследована популяция работников металлургического комбината-1059 мужчин 32-60 лет. Стан-дартными методами измерены систолическое и диастолическое артериальное давление, рост, масса тела, пульс. Определялись самооценка здоровья и наличие ряда неинфекционных заболеваний. Для анализа выделены группы интенсивных курильщиков (132 человека; ≥ 20 сигарет в день) и никогда не куривших (403 человека). Результаты. Между группами не выявлено различий по возрасту, физиологическим показателям и частоте неинфекционных заболеваний. У курильщиков обнаружено больше лиц с признаками психического дискомфорта, с недостаточной массой тела. У них был ниже уровень образования. Заключение. Интенсивные курильщики по сравнению с никогда не курившими отличаются менее благоприятными показате-лями психического статуса и рядом более низких показателей здоровья, оказывающими негативное влияние на продолжитель-ность жизни. Это требует включения в программы по борьбе с курением мер оздоровления социально-гигиенических условий среды. К л ю ч е в ы е с л о в а : курение; факторы риска; образ жизни; профилактика заболеваний; психическое состояние. Для цитирования: Гундаров И.А., Флорес М.А. Оценка показателей здоровья и психических особенностей мужчин-курильщиков в сравнении с никогда не курившими. Гигиена и санитария. 2020; 99 (5): DOI: https://doi.org/10.33029/0016-9900-2020-99-5-Для корреспонденции: Гундаров Игорь Алексеевич, доктор мед. наук, проф., гл. специалист Первого МГМУ им. И.М. Сеченова. Благодарность. Авторы выражают благодарность за помощь в проведении исследования Симаковой Е.В., главному врачу районной поликлиники. Конфликт интересов. Авторы сообщают об отсутствии конфликта интересов. Финансирование. Исследование не имело спонсорской поддержки. Участие авторов: концепция и дизайн исследования-Гундаров И.А.; получение данных, обработка данных-Флорес М.А.; анализ и интерпретация ре-зультатов-Гундаров И.А.; написание статьи-Флорес М.А.; утверждение окончательного варианта статьи, ответственность за целостность всех частей статьи-все соавторы.
... Cognitive appraisals directly relevant to theoretical models of suicide, including hopelessness (Klonsky & May, 2015;Van Orden et al., 2010), defeat and entrapment (Siddaway, Taylor, Wood, & Schulz, 2015), and criticism (Zelkowitz & Cole, 2018), are also likely exacerbating factors related to suicidal thoughts and behaviors in chronic illness populations. Individuals living with chronic medical conditions often describe themselves as feeling hopeless (Coyle & Atkinson, 2018;Dunn, 2005); such hopelessness has been linked to mortality and suicide-related outcomes among individuals with chronic illness (Eskelinen et al., 2015;Everson et al., 1996). Likewise, although less well studied within populations of individuals with chronic health conditions, defeat and entrapment, characterized by perceptions of being powerless and unable to enact change to move past an aversive state (Taylor, Wood, Gooding, Johnson, & Tarrier, 2009), have been associated with suicide-related outcomes, above and beyond the influence of depression (Taylor, Gooding, Wood, & Tarrier, 2011). ...
Suicide rates are elevated in individuals with chronic illness, yet few studies have examined risk factors for suicide in this population. Drawing from theoretical models and risk factors identified in the suicide literature more broadly, this article provides a conceptual overview of cognitive (e.g., pain catastrophizing, self-criticism), affective (e.g., emotion dysregulation), interpersonal (e.g., perceived burdensomeness, thwarted belongingness, critical expressed emotion), and behavioral factors that may contribute, at least in part, to the link between chronic illness, and illness-specific factors, and suicidal thoughts and behaviors. We also outline several avenues for future research in this area and provide specific considerations and recommendations for the screening, assessment, and initial intervention of suicide risk within individuals with chronic health conditions.
Literatürde günümüz üniversite öğrencilerinin çeşitli etken ve faktörlere bağlı olarak umutsuzluk yaşadıkları vurgulanmaktadır. Özellikle öğrencilerin sosyo-demografik değişkenlere bağlı olarak umutsuz düzeyleri farklılaşabilmektedir. Öğrencilerin yaşadıkları umutsuzluk onların kariyer ve geleceğe yönelik beklentilerinde önemli roller oynayabilmektedir. Bu bağlamda çalışmada Süleyman Demirel Üniversitesi İktisadi ve İdari Bilimler Fakültesinde eğitimine devam eden öğrencilerin umutsuzluk düzeyleri ve umutsuzluklarının sosyo-demografik değişkenlere göre farklılık gösterip göstermediği analiz edilmiştir. Bu örneklemin seçilmesinin gerekçesi ise, daha önce bu örneklem grubuna yönelik nerdeyse hiç araştırma yapılmamış olmasıdır. Karşılaştırmaya dayalı ilişkisel tarama modeline göre gerçekleştirilen araştırmanın verileri ilgili örneklem grubundan toplanmıştır. 415 öğrenciden toplanan veri seti, SPPS programı yardımıyla t testi ve ANOVA analizi yapılarak test edilmiştir. Öğrencilerin umutsuzluk düzeylerinin sosyo-demografik değişkenlere göre farklı olup olmadığına yönelik analizler sonucunda hipotezler test edilmiştir. Elde edilen bulgulara göre, ilgili fakültede okuyan öğrencilerin hafif ve orta düzeyde umutsuzluk yaşadıkları tespit edilmiştir. Ayrıca katılımcı öğrencilerin umutsuzluk düzeylerinin cinsiyet, eğitimden memnuniyet, bölümü bilinçli tercih etme, okuduğu alanda çalışma isteği, çalışmak istenen ülke tercihi, sınıf düzeyleri, not ortalaması (akademik başarı) ve bölüm gruplarına göre istatistiksel olarak anlamlı bir farklılık olduğu tespit edilmiştir. Buna karşın, öğrencilerin umutsuzluk düzeylerinin bilgisayar kullanma bilgi düzeyi, ekstra bilgisayar program bilgisi, yabancı dil bilgi düzeyi, ailenin gelir düzeyi ve öğrencilerin mezun olduktan sonra çalışmak istedikleri sektör gruplarına göre istatistiksel olarak anlamlı bir farklılık tespit edilememiştir.
Háttér és célkitűzések: A koronavírus világjárvány kihívásai – saját és hozzátartozók egészségének féltése, fokozott halálszorongás, társas izoláció, anyagi biztonság elvesztése – kedvezőtlenül hatnak a krízissel való hatékony megküzdésre, ezáltal befolyásolják a mentális egészséget. Jelen tanulmány célja a vonáshála összefüggéseinek feltárása néhány mentális egészség szempontjából jelentős pszichológiai konstruktummal, valamint a hálaintervenció lelki jóllétre gyakorolt hatásának vizsgálata. Módszer: Online, kvantitatív vizsgálatunkban 163 (129 nő, 34 férfi) 18 év feletti (MD=36, SD= 14,85; min.- max.=18–66) egészséges személy adatait elemeztük. A résztvevőket kísérleti (n=112) és kontrollcsoportra (n=51) osztottuk. Elsőként mindenki kitöltött egy kérdőívcsomagot, majd a kísérleti csoport tagjai két hétig hálanaplót vezettek. A kontrollcsoport tagjai semmilyen instrukciót nem kaptak. A két hét elteltével mindkét csoport ismételten kitöltötte ugyanazon kérdőíveket. Vizsgálatunkban a következő mérőeszközöket alkalmaztuk: GRAT Hála Kérdőív, Pszichológiai Jóllét Kérdőív, Élét Értelme Kérdőív, Reménytelenség Skála, valamint Multidimenzionális Halálfélelem Skála. Eredmények: Vizsgálataink azt mutatják, hogy a vonáshála teljes skálája, valamint azon belül a „bőség érzékelése” van figyelemreméltó kapcsolatban a pszichológiai jólléttel. Továbbá ezek a tényezők azok, amelyek az intervenció hatására a vizsgálati csoportban változást mutatnak (teljes hála kérdőív: (F(1, 80,2)=15,323; p=,0025**)); (bőség érzékelés faktor: (F(1, 161) = 8,788; p = 0,003**)). Emellett a hálanapló vezetés hozzájárul az élet értelmességének nagyobb megéléséhez (F(1, 161) = 6,826; p = 0,001**), továbbá a teljes reménytelenség (F(1, 161) = 4,359; p = 0,0384*), valamint a reménytelenség jövővel kapcsolatos negatív érzéseinek (F(1, 161) = 11,621; p <0,001***) csökkenéséhez. Összegzés: Eredményeink alapján elmondható, hogy a vonáshála pozitív kapcsolatban áll a mentális egészség több aspektusával. A hálaintervenció pedig olyan tapasztalatokkal gazdagítja az egyént, amelyek értékelhetővé teszik számára az egyszerű, mindennapi élményeket, az élet egészét megélésre érdemesebbnek mutatják, továbbá kimozdíthatják az önmagára, a jövőjére és a világra vonatkozó negatív várakozások rendszeréből.
The present study aimed to identify psychosocial risk factors for binge eating disorder (BED) in Black individuals from the National Survey of American Life (NSAL). A matched pair case-control study design was used to compared individuals with BED (n = 88) against healthy controls (n = 88) on family dysfunction and self-concept. Family dysfunction was assessed through feelings of closeness, emotional support, and frequency of negative interactions. Self-concept included measures for self-esteem, hopelessness, and mastery. Results indicated a higher likelihood of BED when family dysfunction or a weak self-concept was present (Hypotheses 1 and 2). A significant relationship between family dysfunction and low mastery predicting BED was found (Hypothesis 3), but no evidence was found for family dysfunction predicting a weak self-concept in individuals with BED (Hypothesis 4). This study supports the importance of psychosocial factors, particularly family dysfunction and low mastery, as risk factors for BED in Black individuals. Future research should focus on understanding the role of family environment and self-concept, especially as it relates to mastery, in the development and persistence of BED and other eating disorders, which will inform the development of targeted intervention strategies and prevent the development of eating disorders and other psychiatric conditions.
Objectives:
Acute heart failure (AHF) hospitalisation is associated with 10% mortality. Outpatient based management (OPM) of AHF appeared effective in observational studies. We conducted a pilot randomised controlled trial (RCT) comparing OPM with standard inpatient care (IPM).
Methods:
We randomised patients with AHF, considered to need IV diuretic treatment for ≥2 days, to IPM or OPM. We recorded all-cause mortality, and the number of days alive and out-of-hospital (DAOH). Quality of life, mental well-being and Hope scores were assessed. Mean NHS cost savings and 95% central range (CR) were calculated from bootstrap analysis. Follow-up: 60 days.
Results:
Eleven patients were randomised to IPM and 13 to OPM. There was no statistically significant difference in all-cause mortality during the index episode (1/11 vs 0/13) and up to 60 days follow-up (2/11 vs 2/13) [p = .86]. The OPM group accrued more DAOH {47 [36,51] vs 59 [41,60], p = .13}. Two patients randomised to IPM (vs 6 OPM) were readmitted [p = .31]. Hope scores increased more with OPM within 30 days but dropped to lower levels than IPM by 60 days. More out-patients had increased total well-being scores by 60 days (p = .04). OPM was associated with mean cost savings of £2658 (95% CR 460-4857) per patient.
Conclusions:
Patients with acute HF randomised to OPM accrued more days alive out of hospital (albeit not statistically significantly in this small pilot study). OPM is favoured by patients and carers and is associated with improved mental well-being and cost savings.
Background:
Subjective social status (SSS) refers to a person's perception of their social rank relative to others and is cross-sectionally linked to systemic inflammation independently of objective socioeconomic status.
Purpose:
We test the extent to which SSS relates to multiyear changes in inflammation, or if associations differ by race or sex.
Methods:
Healthy adults (N = 331; 30-51 years) completed a baseline visit and 278 participants returned for a second visit 2.85 years later. At both visits, participants underwent a fasting blood draw and completed community (SSSC) and US (SSSUS) versions of the MacArthur Scale. Multiple linear regression analyses examined change in interleukin-6 (IL-6) and C-reactive protein (CRP) predicted by each type of SSS, adjusting for time between visits, sex, race, age, body mass index, smoking, baseline inflammation, and objective socioeconomic status. Additional analyses further adjusted for hopelessness and depressive symptoms. Interactions examined moderations by sex and race.
Results:
Lower SSSC was longitudinally associated with greater IL-6 independently of all covariates, including education and income (β = -0.06), hopelessness (β = -0.06), and depressive symptoms (β = -0.06). Lower SSSUS was longitudinally associated with greater IL-6 independently of demographic covariates including education and income (β = -0.06), but was slightly attenuated after adjusting for hopelessness (β = -0.06) and depressive symptoms (β = -0.06). There were no associations for CRP or moderation by race or sex.
Conclusions:
Lower SSS may be associated with greater circulating markers of inflammation over time as suggested by increases in IL-6.
Aims:
Depressive symptoms are common in patients with heart failure, and are associated with adverse outcomes in this group. This study examined depressive symptoms and associated determinants in patients with heart failure based on the hopelessness theory of depression.
Methods and results:
In this cross-sectional study, a total of 282 patients with heart failure were recruited from three cardiovascular units of a university hospital. Symptom burden, optimism, maladaptive cognitive emotion regulation strategies, hopelessness, and depressive symptoms were assessed using self-report questionnaires. A path analysis model was established to evaluate the direct and indirect effects. The prevalence of depressive symptoms was 13.8% in the patients. Symptom burden had the greatest direct effect on depressive symptoms (β = 0.406; P < 0.001), optimism affected depressive symptoms both directly and indirectly with hopelessness as the mediator (direct: β = -0.360; P = 0.001; indirect: β = -0.169; P < 0.001), and maladaptive cognitive emotion regulation strategies only had an indirect effect on depressive symptoms with hopelessness as the mediator (β = 0.035; P < 0.001).
Conclusions:
In patients with heart failure, symptom burden, decreased optimism, and hopelessness contribute to depressive symptoms directly. What's more, decreased optimism and maladaptive cognitive emotion regulation strategies lead to depressive symptoms indirectly via hopelessness. Accordingly, interventions aimed at decreasing symptom burden, enhancing optimism, and reducing the use of maladaptive cognitive emotion regulation strategies while declining hopelessness, may be conducive to relieving depressive symptoms in patients with heart failure.
Aims:
Melatonin is known to inhibit platelet aggregation induced by arachidonic acid (AA). In the present study we investigated whether agomelatine (Ago), an antidepressant with agonist activity at melatonin receptor 1 (MT1) and MT2 could reduce platelets aggregation and adhesion.
Main methods:
Human platelets from healthy donors were used to test the in vitro effects of Ago in the presence of different platelet activators. We performed aggregation and adhesion assays, thromboxane B2 (TxB2), cAMP and cGMP measurements, intra-platelet calcium registration and flow cytometry assays.
Key findings:
Our data revealed that different concentrations of Ago reduced AA- and collagen-induced human platelet aggregation in vitro. Ago also reduced AA-induced increase in thromboxane B2 (TxB2) production, intracellular calcium levels and P-selectin expression at plasma membrane. The effects of Ago in AA-activated platelets were likely dependent on MT1 as they were blocked by luzindole (a MT1/MT2 antagonist) and mimicked by the MT1 agonist UCM871 in a luzindole-sensitive manner. The MT2 agonist UCM924 was also able to inhibit platelet aggregation, but this response was not affected by luzindole. On the other hand, although UCM871 and UCM924 reduced collagen-induced platelet aggregation and adhesion, inhibition of collagen-induced platelet aggregation by Ago was not mediated by melatonin receptors because it was not affected by luzindole.
Significance:
The present data show that Ago suppresses human platelet aggregation and suggest that this antidepressant may have the potential to prevent atherothrombotic ischemic events by reducing thrombus formation and vessel occlusion.
Acute heart failure (AHF) is associated with 9.3% mortality. Depression and hopelessness are prevalent. We conducted an online survey using Survey Monkey, via the UK Heart Failure (HF) Investigators Research Network of 309 cardiologists, in 2021, to determine: what proportion of UK centres offer outpatient-based management (OPM) for AHF including the use of parenteral diuretics; and what proportion of HF services have clinical psychology support. There were 51 services that responded, and an estimated 25,135 patients with AHF receive inpatient care per year (median 600 per site). There are 2,631 patients (median 50 per site) treated per year with OPM (9.7% of the population of AHF patients). While 65% of centres provided access to OPM, only 20% have a clinical psychology service. In conclusion, nearly 10% of patients with AHF receive outpatient-based intravenous diuretic therapy. Only 20% of hospitals have a clinical psychology service for patients who suffer from HF.
Background
The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients’ voice.
Method
Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis.
Results
Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected.
Conclusion
Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.
Bu çalışma COVID-19 pandemi döneminde üniversite öğrencilerinin kaygı durumlarının umutsuzluk düzeylerine olan etkisini belirlemek amacıyla yapılmıştır. Tanımlayıcı tipte olan bu çalışma bir vakıf üniversitesinde Sağlık Hizmetleri Meslek Yüksekokulunda öğrenim gören 492 öğrenci ile gerçekleştirilmiştir. Verilerin elde edilmesinde öğrencilerin demografik özelliklerinin sorgulandığı sorular, Durumluk-Sürekli Kaygı Ölçeği ve Beck Umutsuzluk Ölçeği kullanılmıştır. Veriler, sayı, ortalama, yüzdelik dağılımlar, standart sapma, One-Way ANOVA, t-test, Pearson korelasyon ve çoklu regresyon analizi ile değerlendirilmiştir. Çalışmaya katılan öğrencilerin ortalama durumluk kaygı puanı (X ̅=41,79±11,49) orta düzeyde, sürekli kaygı puanı (X ̅=42,71±10,59) ve umutsuzluk puanı (X ̅=4,99±5,07) hafif düzeyde bulunmuştur. Üniversite öğrencilerinin durumluk ve sürekli kaygı düzeyleri ile umutsuzluk düzeyleri arasında pozitif yönlü orta düzeyde bir ilişki olduğu görülmüştür (p
Two models of hope have predominated in the literature pertaining to cancer—Snyder’s “Hope Theory” and Herth’s hope model—both of which have produced brief self-report measures. Growing evidence demonstrates that hope, as operationalized in these models, is associated with a number of psychological variables in individuals with cancer, including depression, distress, coping, symptom burden, and posttraumatic growth. Emerging evidence also suggests that hope may predict probability of survival in advanced cancer. Surveys show that patients and families generally prefer healthcare communication that authentically conveys prognosis; such communication is not associated with decreased hope, but may actually foster hope. Finally, several interventions have been developed to enhance hope in people with cancer, which generally demonstrate medium effects.
Objective:
To describe fear of cancer recurrence in a cohort of women with gynecologic cancers and to identify psychosocial predictors of elevated fear of recurrence.
Methods:
Survey data from an ongoing cohort study of gynecologic cancer survivors were used (n=154). Relationships between fear of cancer recurrence measured by the 6-item Cancer Worry Scale in the most recent survey and psychosocial factors (cancer-related distress, depression, anxiety, hopelessness, and posttraumatic growth) assessed 6-18 months prior were examined using univariate and multivariate linear regression models, adjusting for age, cancer stage, cancer type, and time since diagnosis.
Results:
Most participants were ≥60 years old, diagnosed with early-stage cancer, and 2-5 years post-diagnosis. The mean score on the Cancer Worry Scale was 10.31 (SD=3.01), and 46 individuals (30.0%) scored ≥12, indicating high fear of recurrence. In univariate analyses, greater distress (p=0.007), anxiety (p=0.006), hopelessness (p=0.007), and posttraumatic growth (p=0.0006) were significantly associated with higher scores on the Cancer Worry Scale. The associations of hopelessness and posttraumatic growth with higher Cancer Worry Scale scores remained significant after adjustment for covariates.
Conclusions:
Fear of recurrence is frequent among gynecologic cancer survivors. Women who reported more distress, hopelessness, anxiety and, surprisingly, more post-traumatic growth reported more fear. These results contribute to our understanding of which cancer survivors are most at risk of elevated fear of recurrence and highlight the importance of continued focus on psychosocial well-being among cancer survivors. This article is protected by copyright. All rights reserved.
Drawing from existential philosophers, life meaning has been proposed as an important resource to general well-being and psychological health in particular. However, the definition of life meaning has been somewhat variable. The current chapter provides a narrative review of life meaning and its connection to depression and suicidality. Brief review of life meaning as a construct and its working definition are provided, as well as its conceptual link to depression and suicidality. Drawing from recent research, life meaning is proposed as a state of seeing one’s life as having purpose, coherence and significance. The current chapter proposes that life meaning may be linked to these conditions, in part, through its association with hope. Evidence for the association between life meaning and each of depression and suicidality is presented, drawing from cross-sectional and longitudinal correlational research, mediation/moderation studies and treatment/intervention research. Research reviewed shows that lower levels of subjective life meaning are associated with depression, a higher depressive symptomatology and a higher suicidality across samples of varying age, cultural background and psychiatric status. Moreover, life meaning appears to play an important role in medicating, or at least buffering, the impact of stressful life events and psychological symptom load on depressive symptoms and levels of suicidality. That is, higher levels of life meaning may reduce the impact of stressors upon these experiences. As such, life meaning may be a helpful target for assessment, treatment and prevention of mental ill health. Directions for future research are also noted throughout.
This research aims to find out the level of hope, self-efficacy, and quality of life of mothers with special needs children. There has been very little research on mothers’ health of special needs children and there was a significant gap that needed to be addressed. A correlational research design was used with purposive sampling of 30 mothers (N=30) from Amin-Maktab Institute Outreach Program, Lahore, Pakistan, who were involved in this study. A series of questionnaires as the quality of life, hope scale, and self-efficacy scale was administered to mothers after taking consent. Correlation and independent-sample t-tests were used to analyze data. Results revealed that standards/physical health (domain 1) has a strong relationship with hope/pathways (domain 2) with a 0.56 level of significance. Standards (domain 1) and pleasures/social (domain 3) have a strong relationship with 0.42 but there is a difference in the mean between mothers of boys and mothers of girls. The environment affects the physical, psychological, and social health of mothers with special needs children. While mothers with a higher level of hope have a higher quality of life and high self-efficacy leads to high physical health among mothers. Research conclusion specifies that mothers of intellectually disabled boys have had a higher level of hope and pleasure (social relationship) than mothers of girls
The high rate of recurrence and residual symptoms of depression continuously motivate the search for new treatments addressing this challenging condition. In this single-case study, we reported the application of a cognitive rehabilitation skills training based on remote kinematics as a treatment for residual depression by targeting deficits of mental simulations of action. We found that the administration of Kinect-based rehabilitation training resulted in important improvements showed by significant mean baseline reductions (MBLR) of difficulty in imagining positive actions (MBLR= 54 %), negative emotions (MBLR = 36.3 %), cognitive flexibility (MBLR= 69.7 %), depressive symptoms (MBLR= 80%), and physical retardation (MBLR= 50 %). Similarly, improvements in positive affect (MBLR = 107 %) and vividness of motor imagery for positive actions were registered (MBLR= 100 %). We also found unique effects of our intervention such as reports of involuntary action simulations to distant stimuli or extended affordances. The training was well-accepted and the patient considered it was an entertaining way to do physical exercises and to get in physical and mental shape. We concluded that further scientific research of remote Kinematic interventions in depression may be warranted.
Introduction: Depression is regarded as the main cause of individual’s incapacity. One of the component of depression is hopelessness. This study was planned to examine if the digit ratio associates with depression and hopelessness status in the Iranian women. Methods: This cross-sectional study sample included 358 women aged between 20 to 32 years old. The palm side of both hands of individuals was photographed and then the length of index and ring fingers was measured by ImageJ. The Beck’s depression inventory II and Beck’s hopelessness scale (BHS) were used to measure the levels of depression and hopelessness respectively. ANOVA and Student’s t test was applied to compare the study groups in respect to the continuous data. Results: The results showed that the means of 2D:4D ratio of neither right nor left hands were significantly different between the depression study groups. The same insignificant results were derived with hopelessness status too. However, reanalyzing the data, while combination of depression and hopelessness was considered, showed a significantly lower digit ratio of the right hand in the women whit neither depression nor hopelessness (group 1) compared to the women with moderate/severe depression while holding a degree of hopelessness (group 2) (ratio mean for group 1: 0.978 ± 0.003 and for group 2: 0.992 ± 0.005; t = -2.417, P = 0.017). Conclusion: Our data suggested that the 2D:4D ratio of the right hand in the women associates with the severity of depression when accompanied by hopelessness.
Administered the Beck Hopelessness Scale (HS) to 400 randomly selected adults to derive norms for the general population. The mean score was 4.45 with a standard deviation of 3.09, approximately 1 standard deviation lower than the reported means for clinical groups. The relationship between HS scores and sex, age, socioeconomic status, and marital status was also examined. (9 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
purpose . . . is to restate, clarify, expand, and, in some cases, modify the basic postulates of the cognitive theories of depression and to place these theories more explicitly in the context of work in descriptive psychiatry on the heterogeneity among the depressive disorders / second purpose . . . is to critique the work conducted to date that tests the cognitive theories of depression and to explicate the limitations in research strategy associated with this work
conclude by discussing the general implications of our analysis for research on other forms of psychopathology
clarification and revision of the hopelessness theory of depression
clarification of Beck's cognitive theory of depression
cognitive etiological theories as cognitive diathesis-stress models
negative cognition depression: a theory-based subtype of depression
critique of research strategies used to test the cognitive theories
theoretical and clinical importance of providing an adequate test of the cognitive theories of depression (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The primary purpose of this paper is to review recent research examining the beneficial effects of optimism on psychological and physical well-being. The review focuses on research that is longitudinal or prospective in design. Potential mechanisms are also identified whereby the beneficial effects of optimism are produced, focusing in particular on how optimism may lead a person to cope more adaptively with stress. The paper closes with a brief consideration of the similarities and differences between our own theoretical approach and several related approaches that have been taken by others.
The acute myocardial infarction (AMI) register of the FINMONICA study, the Finnish part of the WHO-coordinated multinational MONICA project, operates in the provinces of North Karelia and Kuopio in eastern Finland and in Turku, Loimaa and in communities around Loimaa in southwestern Finland. The AMI register serves as an instrument for the assessment of trends in mortality from coronary heart disease (CHD) and of the incidence and attack rates of AMI among 25-64-year-old residents of the study areas. This report describes the methods used in the FINMONICA AMI register and the findings during the first 3 years of the study, in 1983-1985. The criteria of the multinational WHO MONICA project were used in the classification of fatal events and in the diagnosis of non-fatal definite AMI, but based on the experience within the FINMONICA study, stricter diagnostic criteria than those originally described in the WHO MONICA protocol were used for non-fatal possible AMI. This led to a marked improvement in the comparability of the data from the three study areas with regard to the incidence and attack rates of non-fatal AMI. During the 3-year period the total number of registered events was 6266 among men and 2092 among women. Among men the incidence and attack rates of AMI and mortality from CHD were higher in eastern than in southwestern Finland. Also among women the incidence and attack rates of AMI were higher in eastern than in southwestern Finland, whereas there was no regional difference in mortality from CHD among women. The mortality findings of the FINMONICA AMI Register were in good agreement with the official CHD mortality statistics of Finland.
Defining hope as a cognitive set that is composed of a reciprocally derived sense of successful (a) agency (goal-directed determination) and (b) pathways (planning of ways to meet goals), an individual-differences measure is developed. Studies demonstrate acceptable internal consistency and test-retest reliability, and the factor structure identifies the agency and pathways components of the Hope Scale. Convergent and discriminant validity are documented, along with evidence suggesting that Hope Scale scores augmented the prediction of goal-related activities and coping strategies beyond other self-report measures. Construct validational support is provided in regard to predicted goal-setting behaviors; moreover, the hypothesized goal appraisal processes that accompany the various levels of hope are corroborated.
In both Beck's cognitive theory of depression and Brown & Harris's sociopsychological model, hopelessness is given unwarranted universality and centrality. Empirical evidence contradicting this element of the two theories has been ignored, and two new investigations are presented which suggest the existence of 'non-hopeless' depression. A more complete account of the heterogeneous nature of depression is now required.
In this article, we clarify, expand and revise the basic postulates of the hopelessness theory of depression (Abramson, Alloy & Metalsky, 1988a; Abramson, Metalsky & Alloy, 1987, 1988b; previously referred to as the reformulated helplessness theory of depression: Abramson, Seligman & Teasdale, 1978) and place the theory more explicitly in the context of work in descriptive psychiatry about the heterogeneity among the depressive disorders. We suggest that the hopelessness theory hypothesizes the existence in nature of an, as yet, unidentified subtype of depression--'hopelessness depression'--defined, in part, by its cause. We then give a critique of work conducted to test the hopelessness theory and explicate the limitations in research strategy associated with this line of work. Our critique includes a logical analysis that deduces the conceptual and methodological inadequacies of the research strategies used to test the theory. Finally, we suggest more adequate research strategies for testing the hopelessness theory and discuss conceptual and assessment issues that will arise in conducting such tests with special emphasis on attributional styles.
This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale's psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.
Administered a scale designed to quantify hopelessness to 294 hospitalized suicide attempters, 23 general medical outpatients, 62 additional hospitalized suicide attempters, and 59 depressed psychiatric patients. The scale had a Kuder-Richardson-20 internal consistency coefficient of .93 and correlated well with the Stuart Future Test (SFT) and the pessimism item of the Beck Depression Inventory (BDI; .60 and .63, respectively). The scale was also sensitive to changes in the patient's state of depression over time, as evidenced by a correlation of .49 with change scores on the SFT and .49 with the change scores on the BDI. Findings also indicate that depressed patients have an unrealistically negative attitude toward the future and that seriousness of suicidal intent is more highly correlated with negative expectancies than with depression. A principal-components factor analysis revealed 3 factors which tapped affective, motivational, and cognitive aspects of hopelessness. (16 ref)
33 ALCOHOLICS AND 33 SOCIAL DRINKERS MATCHED FOR AGE, SEX, OCCUPATION, AND MARITAL STATUS WERE COMPARED USING WALLACE'S METHOD OF MEASURING FUTURE TIME PERSPECTIVE. IT WAS FOUND THAT THE ALCOHOLICS HAD SUBSTANTIALLY LESS EXTENSIVE AND LESS COHERENT PERSPECTIVES. A CORRELATION BETWEEN AGE AND EXTENSION FOR THE ALCOHOLICS INDICATES THAT THE DEFICIENCY MAY DEVELOP AS A RESPONSE TO PROBLEM DRINKING RATHER THAN BEING A SELECTIVE FACTOR IN ITS DEVELOPMENT. (PsycINFO Database Record (c) 2006 APA, all rights reserved).
We studied the associations between 11 scales of social functioning and risk of death over an average follow-up time of 71 months in 42- to 60-year-old men in the Kuopio Ischemic Heart Disease Risk Factor Study. In age-adjusted analyses, men were at increased risk of death if they reported few persons to whom they gave or received social support, nonparticipation in organizations, low quality of social relationships, a small number of friends, or not currently being married. Frequency of interaction, shyness, and use of emotional support when troubled were not associated with risk of death; the use of instrumental support when troubled was associated with increased risk. There was little evidence of confounding of these associations by the presence of 31 chronic or acute conditions, perceived health status, or six risk factors. Consistent associations were found in a healthy subgroup. These data add to the growing body of literature linking mortality risk with social functioning, especially in relation to organizational participation and quality of relationships.
Considerable controversy and contradictory data exist about the notion that psychosocial factors can predict longevity in cancer patients. This study further addresses that issue by eliminating some of the methodological weaknesses of prior studies and focusing on a more tightly defined patient population. Forty-nine female metastatic breast cancer patients were given a variety of psychological tests. At the time of the analyses, all patients in the study had died from their disease. Patients were evenly divided into short-term survivors and long-term survivors based on length of survival as calculated both from date of diagnosis and from date of testing. The results indicated that there were no consistent differences between groups on any psychosocial variable assessed. These data suggest that, for breast cancer patients with metastatic disease, disease-related variables probably outweigh the influence of select psychosocial factors in determining length of survival.
The behavioral studies component of the multicenter Cardiac Arrhythmia Pilot Study (CAPS) was designed to examine the relation of biobehavioral factors and frequency of ventricular premature complexes (VPCs), efficacy of antiarrhythmic therapy, and disease end points in a study population that had experienced recent myocardial infarction and significant ventricular ectopy. Biobehavioral factors included both psychosocial (depression, anxiety, social support, type A behavior, mood, defensiveness, and anger expressiveness) and psychophysiological (heart rate and blood pressure reactivity to a videogame Stressor) variables. Data were collected at baseline and at 3-, 6-, 9-, and 12-month follow-ups. Of the 502 patients enrolled in CAPS, 353 participated in the behavioral studies component. At baseline, assessments of psychosocial variables revealed the CAPS study population to be generally similar to other heart disease populations, and no relation between these variables and psychophysiological reactivity or arrhythmias was found. At follow-up among patients assigned to the placebo condition, biobehavioral variables were not related to levels of VPCs or VPC suppression. Cox regression analyses revealed that type B behavior, depression, and reduced heart rate reactivity were associated with increased clinical events, even after controlling for baseline left ventricular ejection fraction, myocardial infarction before the qualifying event, use of β-blockers, use of digitalis, Q wave of qualifying myocardial infarction, and presence of unsustained ventricular tachycardia on baseline electrocardiogram. It is hypothesized that the relation among reduced heart rate reactivity, depression, and clinical events is mediated by diminished cardiac vagal tone.
Defining hope as a cognitive set that is composed of a reciprocally derived sense of successful (1) agency (goal-directed determination) and (2) pathways (planning of ways to meet goals), an individual-differences measure is developed. Studies with college students and patients demonstrate acceptable internal consistency and test–retest reliability, and the factor structure identifies the agency and pathways components of the Hope Scale. Convergent and discriminant validity are documented, along with evidence suggesting that Hope Scale scores augmented the prediction of goal-related activities and coping strategies beyond other self-report measures. Construct validational support is provided in regard to predicted goal-setting behaviors; moreover, the hypothesized goal appraisal processes that accompany the various levels of hope are corroborated.
Objective:
This article presents a new formulation of the relationship between stress and the processes leading to disease. It emphasizes the hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events. It also presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses.Data Sources:
Published original articles from human and animal studies and selected reviews. Literature was surveyed using MEDLINE.Data Extraction:
Independent extraction and cross-referencing by us.Data Synthesis:
Stress is frequently seen as a significant contributor to disease, and clinical evidence is mounting for specific effects of stress on immune and cardiovascular systems. Yet, until recently, aspects of stress that precipitate disease have been obscure. The concept of homeostasis has failed to help us understand the hidden toll of chronic stress on the body. Rather than maintaining constancy, the physiologic systems within the body fluctuate to meet demands from external forces, a state termed allostasis. In this article, we extend the concept of allostasis over the dimension of time and we define allostatic load as the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful.Conclusions:
This new formulation emphasizes the cascading relationships, beginning early in life, between environmental factors and genetic predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to disease. There are now empirical studies based on this formulation, as well as new insights into mechanisms involving specific changes in neural, neuroendocrine, and immune systems. The practical implications of this formulation for clinical practice and further research are discussed.(Arch Intern Med. 1993;153:2093-2101)
Introduction. Survival distributions. Single sample nonparametric methods. Dependence on explanatory variables. Model formulation. The multiplicative log-linear hazards model. Partial likelihood. Several types of failure. Further problems. Exercises. Bibliography. Index.
Prospective studies of the general population have isolated specific social and psychological factors as independent predictors of longevity. This study assesses the ability of these factors, plus two others said to influence survival in patients with cancer, to predict survival and the time to relapse after a diagnosis of cancer. Patients with unresectable cancers (n = 204) were followed to determine the length of survival. Patients with Stage I or II melanoma or Stage II breast cancer (n = 155) were followed to determine the time to relapse. Analysis of data on these 359 patients indicates that social and psychological factors individually or in combination do not influence the length of survival or the time to relapse (P less than 0.10). The specific diagnosis (F = 2.0, P = 0.06), performance status (F = 0.66, P = 0.62), extent of disease (F = 1.12, P = 0.89), and therapy (F = 1.08, P = 0.35) were also unrelated to the psychosocial factors studied. Although these factors may contribute to the initiation of morbidity, the biology of the disease appears to predominate and to override the potential influence of life-style and psychosocial variables once the disease process is established.
Objective.
—To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (Ml) would have an independent impact on cardiac mortality over the first 6 months after discharge.Design.
—Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.Setting.
—A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec.Patients.
—All consenting patients (N=222) who met established criteria for Ml between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male.Primary Outcome Measure.
—Survival status at 6 months.Results.
—By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P=.0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous Ml, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P=.013).Conclusion.
—Major depression in patients hospitalized following an Ml is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous Ml. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.(JAMA. 1993;270:1819-1825)
Major depression has been associated with mortality from ischemic heart disease (IHD). In addition, a symptom of depression-hopelessness-has been suggested as a determinant of health status. We studied the relation of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participated in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline. We used the depression subscale of the General Well-Being Schedule to define depressed affect and a single item from the scale to define hopelessness. At baseline, 11.1% of the cohort had depressed affect; 10.8% reported moderate hopelessness, and 2.9% reported severe hopelessness. Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness were also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal role in the occurrence of both fatal and nonfatal IHD. (Epidemiology 1993;4:285-294)
(C) Lippincott-Raven Publishers.
The behavioral studies component of the multicenter Cardiac Arrhythmia Pilot Study (CAPS) was designed to examine the relation of biobehavioral factors and frequency of ventricular premature complexes (VPCs), efficacy of antiarrhythmic therapy, and disease end points in a study population that had experienced recent myocardial infarction and significant ventricular ectopy. Biobehavioral factors included both psychosocial (depression, anxiety, social support, type A behavior, mood, defensiveness, and anger expressiveness) and psychophysiological (heart rate and blood pressure reactivity to a videogame stressor) variables. Data were collected at baseline and at 3-, 6-, 9-, and 12-month follow-ups. Of the 502 patients enrolled in CAPS, 353 participated in the behavioral studies component. At baseline, assessments of psychosocial variables revealed the CAPS study population to be generally similar to other heart disease populations, and no relation between these variables and psychophysiological reactivity or arrhythmias was found. At follow-up among patients assigned to the placebo condition, biobehavioral variables were not related to levels of VPCs or VPC suppression. Cox regression analyses revealed that type B behavior, depression, and reduced heart rate reactivity were associated with increased clinical events, even after controlling for baseline left ventricular ejection fraction, myocardial infarction before the qualifying event, use of beta-blockers, use of digitalis, Q wave of qualifying myocardial infarction, and presence of unsustained ventricular tachycardia on baseline electrocardiogram. It is hypothesized that the relation among reduced heart rate reactivity, depression, and clinical events is mediated by diminished cardiac vagal tone.
The Multicenter Diltiazem Postinfarction Trial (MDPIT) reported no consistent diltiazem effect on new or worsened congestive heart failure (CHF) during 12-52 months' follow-up after acute myocardial infarction. This was puzzling in light of the observation that patients with findings suggesting left ventricular dysfunction (LVD) at baseline on diltiazem had more cardiac events (cardiac mortality or recurrent nonfatal infarction) than such patients on placebo. We hypothesized that diltiazem increased the frequency of late CHF as well as of cardiac events, but only in patients predisposed by LVD. Using the same characterizing variables as the primary MDPIT analysis, we found that patients with pulmonary congestion, anterolateral Q wave infarction, or reduced ejection fraction (EF) at baseline were more likely to have CHF during follow-up than those without these markers of LVD. CHF was particularly frequent in the patients with LVD who were randomized to diltiazem. Among those with a baseline EF of less than 0.40, late CHF appeared in 12% (39/326) receiving placebo and 21% (61/297) receiving diltiazem (p = 0.004). Life table analysis in patients with an EF of less than 0.40 confirmed more frequent late CHF in those taking diltiazem (p = 0.0017). In addition, the diltiazem-associated rise in the frequency of late CHF was progressively greater with increasingly severe decrements in baseline EF. This diltiazem effect was absent in patients with pulmonary congestion at baseline but an EF of 0.40 or more, suggesting a unique association between diltiazem-related late CHF and systolic LVD.(ABSTRACT TRUNCATED AT 250 WORDS)
One hundred and fifty-five outpatients suffering from major depression with moderate anxiety entered a double-blind study comparing 8 weeks of treatment with buspirone or placebo. Thirty-four percent of buspirone and 41% of placebo patients discontinued treatment before 8 weeks. Results were consistent across all physician- and patient-completed outcome measures, with treatment response to buspirone significantly better than to placebo at treatment endpoint. Seventy percent of buspirone and 35% of placebo patients (p less than .01) were rated moderately or markedly improved after 8 weeks of therapy. Initial levels of anxiety and depression had no significant effect on treatment outcome. Buspirone was found to be safe and well tolerated at doses of up to 90 mg/day.
A complex multidimensional relationship exists between affective disorder and cardiac disease, specifically with respect to pathophysiology, prognosis, and treatment. Though there are a number of possible perspectives from which to view this relationship, in this paper we concentrate on the depressed patient with preexisting cardiac disease with respect to (1) the rates of concurrence of the two disorders, (2) the influence of affective disorder on the prognosis of cardiac disease, and (3) the safe and effective treatment of depression in patients with preexisting illness.
Previous work of ours has demonstrated that a significant amount of natural killer (NK) activity variance after surgery in stage I and II breast cancer patients could be accounted for by both the estrogen receptor (ER) status of the tumor and by social factors, namely, perceived social support and seeking social support as a general coping strategy. As considerable evidence has accumulated that social support in both animal and human populations may have survival value, we sought to test the reliability of this regression model, using coping and perceived support factor values obtained at 3 months after surgery to account for concurrent follow-up NK activity in this serially assessed group of patients. It was found that the most significant variable predicting NK activity at follow-up was tumor ER concentration, with higher NK activity associated with ER- status. In addition, seeking social support as a coping strategy, as well as the perceived quality of support, also entered the model to account for a significant amount of NK activity variance (multivariate F = 5.25, p less than 0.001). If, as the literature suggests, NK activity is relevant to breast cancer control, and since ER- tumors have a worse prognosis, we suggest here that perhaps such tumors are resistant to control by NK cells because they lack the ability to attract an accumulation of effector cells to the tumor site, or because blocking factors at the site of the tumor prevent local tumor control at the site of action. The finding related to social support also replicates results from an independent sample of breast cancer patients. This finding, taken together with other evidence that this social variable is associated with longer survival in breast cancer populations, underscores the potential importance of this social support variable. Our findings also suggest one possible immunological variable involved, with potential clinical significance, for this patient population.
In order to study the association between vital exhaustion and different manifestations of coronary heart disease, a prospective study was conducted among 3877 males, aged 39-65. This group was studied during a mean period of 4.2 years. Vital exhaustion, a mental state characterized by unusual fatigue, a feeling of being dejected or defeated, and increased irritability, were assessed by means of the Maastricht Questionnaire. Subjects who scored in the upper third were labelled as exhausted and were compared with those who scored in the lower or middle third. The age-adjusted relative risk of angina pectoris at screening that was associated with vital exhaustion was 4.17 (p less than 0.01); that of unstable angina pectoris at screening was 17.21 (p less than 0.001). No association was observed between vital exhaustion and past myocardial infarction, except in the youngest age group (OR = 3.76; p = 0.05). Among the subjects free from coronary heart disease at screening, 54 cases of angina pectoris, 38 cases of non-fatal myocardial infarction, and 21 cases of fatal myocardial infarction were observed during follow-up. The age-adjusted relative risk of angina pectoris at follow-up was found to be 1.86 (p less than 0.03) and that of non-fatal myocardial infarction was found to be 2.28 (p less than 0.001). No association was found between vital exhaustion and fatal events.
Demographic, cancer, physical functioning, and psychological data were collected for 90 late-stage cancer, newly admitted nursing home patients. Those who died within 3 months (28%) more often acknowledged their condition as terminal, anticipated greater environmental stress and adjustment problems, and had poorer self-esteem. For cancer patients undergoing the stress of nursing home placement, feelings of hopelessness and helplessness are associated with earlier death.
Fifty-two patients undergoing cardiac catheterization and subsequently found to have significant coronary artery disease (CAD) were given structured psychiatric interviews before catheterization. Nine of these patients met criteria for major depressive disorder. All 52 patients were contacted 12 months after catheterization, and the occurrence of myocardial infarction, angioplasty, coronary bypass surgery and death was determined. Results of the study show that major depressive disorder was the best predictor of these major cardiac events during the 12 months following catheterization. The predictive effect was independent of the severity of CAD, left ventricular ejection fraction, and the presence of smoking. Furthermore, with the exception of smoking, there were no statistically significant differences between those patients with major depressive disorder and the remaining patients on any variable studied. The possible mechanisms relating major depressive disorder to subsequent cardiac events are discussed. It is concluded that major depressive disorder is an important independent risk factor for the occurrence of major cardiac events in patients with CAD.
Drawing on a carefully controlled sample of 52 women with a history of breast carcinoma and 34 healthy controls, this prospective study examined empirical associations between psychological factors and the progression of neoplastic disorders over a follow-up period averaging 624 days. Psychological variables were psychometrically assessed by self-report measures. A multiple regression analysis which controlled for disease stage at original diagnosis, age, total length of disease course, hematological factors, and blood chemistries measured at study onset showed neoplastic spread to be associated with a repressive personality style, reduced expression of negative affect, helplessness-hopelessness, chronic stress, and comforting daydreaming. The identified model of medical and psychological variables accounted for 56% of the observed variance. A psychobiological model of brain-body disregulation provided the best account of the observed associations between psychological functioning and the progression of disease. Future research is necessary to examine the role which psychological functioning may exert upon health-relevant behaviors that might blunt the benefits of professional health care.
Considerable controversy and contradictory data exist about the notion that psychosocial factors can predict longevity in cancer patients. This study further addresses that issue by eliminating some of the methodological weaknesses of prior studies and focusing on a more tightly defined patient population. Forty-nine female metastatic breast cancer patients were given a variety of psychological tests. At the time of the analyses, all patients in the study had died from their disease. Patients were evenly divided into short-term survivors and long-term survivors based on length of survival as calculated both from date of diagnosis and from date of testing. The results indicated that there were no consistent differences between groups on any psychosocial variable assessed. These data suggest that, for breast cancer patients with metastatic disease, disease-related variables probably outweigh the influence of select psychosocial factors in determining length of survival.
The authors intensively studied 207 patients hospitalized because of suicidal ideation, but not for recent suicide attempts, at the time of admission. During a follow-up period of 5-10 years, 14 patients committed suicide. Of all the data collected at the time of hospitalization, only the Hopelessness Scale and the pessimism item of the Beck Depression Inventory predicted the eventual suicides. A score of 10 or more on the Hopelessness Scale correctly identified 91% of the eventual suicides. Taken in conjunction with previous studies showing the relationship between hopelessness and suicidal intent, these findings indicate the importance of degree of hopelessness as an indicator of long-term suicidal risk in hospitalized depressed patients.
It is memory that gives us the power of foresight: We push into the future with images in which we fixed the past. Full consciousness therefore looks both ways, and its most important look ... is into the future. All biological processes are directed toward the future, but man is distinguished by being consciously directed−his consciousness includes the future. J. Bronowski1
Seventy-three inpatients completed Beck's Suicide Ideator Scale, Beck's Hopelessness Scale and the MMPI Depression Scale. As hypothesized, suicide intent was significantly more correlated with hopelessness than with depression. When the effect of hopelessness was removed statistically, there was no relationship between suicide intent and depression.
To test the hypothesis that 'vital exhaustion' (VE), a state characterized by unusual fatigue, increased irritability, and feelings of demoralization, precedes the onset of myocardial infarction (MI) in females, 79 females hospitalized with a first MI (mean age: 59.3; SD = 9.3) and 90 females hospitalized in the departments of general and orthopaedic surgery (mean age: 57.4; SD = 9.1), were compared on the retrospective form of the Maastricht Questionnaire (MQ). Defining 'exhaustion' as a score above the median of the MQ, 63% of the cases and 39% of the controls were exhausted before hospitalization (chi 2 = 10.02; p < 0.00). The relative risk associated with exhaustion, after controlling for age, smoking, coffee consumption, diabetes, hypertension, non-anginal pain, and menopausal status, was estimated as 2.75 (95% CI:I.28-5.81; p < 0.01), thus corroborating the hypothesis. Exploratory analyses of the origins of exhaustion in these females showed that of all biographical characteristics, holding a job and simultaneously taking care of the household was most strongly associated with elevated exhaustion scores.
Excessive tiredness is one of the most prevalent premonitory symptoms of myocardial infarction and sudden cardiac death. This state is labelled as vital exhaustion and consists of three components: fatigue, increased irritability, and demoralization. Vital exhaustion has been found to be an independent risk-indicator of myocardial infarction in one prospective study and several case-control studies. It is as yet unclear whether the association between vital exhaustion and future myocardial infarction can be explained by confounding of (subclinical) coronary artery disease. Therefore, the present study investigates the predictive value of vital exhaustion for the occurrence of new cardiac events after percutaneous transluminal coronary angioplasty (PTCA), while explicitly controlling for the severity of coronary artery disease. Patients with a successful PTCA were followed during 1.5 years. A new cardiac event was defined as present if one of the following end points occurred: cardiac death, myocardial infarction, coronary bypass surgery, repeat-PTCA, increase of coronary atherosclerosis, or new anginal complaints with documented ischemia. Vital exhaustion was assessed using the Maastricht Questionnaire two weeks after hospital discharge. Participants of the present study were 127 patients (mean age 55.6 +/- 9.1; 105 men, 22 women). Fifteen (35%) of the 43 exhausted patients experienced a new cardiac event, whereas 14 (17%) of the 84 not exhausted patients had a new cardiac event (OR = 2.7; CI = 1.1-6.3; p = .02). Multiple logistic regression analysis revealed that vital exhaustion continued to be of predictive value when other significant risk factors for new cardiac events were controlled for (i.e., severity of coronary artery disease and hypercholesterolemia).(ABSTRACT TRUNCATED AT 250 WORDS)
This article presents a new formulation of the relationship between stress and the processes leading to disease. It emphasizes the hidden cost of chronic stress to the body over long time periods, which act as a predisposing factor for the effects of acute, stressful life events. It also presents a model showing how individual differences in the susceptibility to stress are tied to individual behavioral responses to environmental challenges that are coupled to physiologic and pathophysiologic responses.
Published original articles from human and animal studies and selected reviews. Literature was surveyed using MEDLINE.
Independent extraction and cross-referencing by us.
Stress is frequently seen as a significant contributor to disease, and clinical evidence is mounting for specific effects of stress on immune and cardiovascular systems. Yet, until recently, aspects of stress that precipitate disease have been obscure. The concept of homeostasis has failed to help us understand the hidden toll of chronic stress on the body. Rather than maintaining constancy, the physiologic systems within the body fluctuate to meet demands from external forces, a state termed allostasis. In this article, we extend the concept of allostasis over the dimension of time and we define allostatic load as the cost of chronic exposure to fluctuating or heightened neural or neuroendocrine response resulting from repeated or chronic environmental challenge that an individual reacts to as being particularly stressful.
This new formulation emphasizes the cascading relationships, beginning early in life, between environmental factors and genetic predispositions that lead to large individual differences in susceptibility to stress and, in some cases, to disease. There are now empirical studies based on this formulation, as well as new insights into mechanisms involving specific changes in neural, neuroendocrine, and immune systems. The practical implications of this formulation for clinical practice and further research are discussed.
To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (MI) would have an independent impact on cardiac mortality over the first 6 months after discharge.
Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set.
A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec.
All consenting patients (N = 222) who met established criteria for MI between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male.
Survival status at 6 months.
By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P = .0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous MI, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P = .013).
Major depression in patients hospitalized following an MI is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous MI. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.
Depressive symptoms and risk of myocardial infarction and mortality (abstract)
- Sa Evorson
- Ga Kaplan
- Goldberg
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Evorson SA, Kaplan GA, Goldberg DE, et al: Depressive symptoms and risk of myocardial infarction and mortality (abstract). Am J Epidemiol 141:S37, 1995
Personality and social factors in cancer outcome
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Levy SM, Heiden LA: Personality and social factors in cancer
outcome. In Friedman HS (ed), Personality and Disease. New
York, John Wiley & Sons, 1990
Hope and health Handbook of Social and Clinical Psychology
- Cr Snyder
- Lm Irving
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Snyder CR, Irving LM, Anderson JR: Hope and health. In
Snyder CR, Forsyth DR, (eds), Handbook of Social and Clinical Psychology. Elmsford, NY, Pergamon Press, 1991
- Scheier