Social Contagion of Vasovagal Symptoms in Blood Donors: Interactions With Empathy.

BACKGROUND: Vasovagal reactions (VVRs) are commonly experienced in medical situations such as blood donation. Many believe that psychosocial contagion can contribute to the development of VVRs, but this is largely clinical lore. PURPOSE: The goal of the present investigation was to examine the physiological effects of observing another experience a reaction, focusing on the potential moderating effects of empathy. METHODS: This study was part of a randomized controlled trial of behavioral techniques on the prevention of VVRs in blood donors. The sample was composed of 530 healthy university students. Measures of symptoms were obtained with the Blood Donation Reactions Inventory (BDRI) and through observation. Physiological variables were measured using respiratory capnometry and a digital blood pressure monitor. The Affective and Cognitive Measure of Empathy was administered to 230 participants. RESULTS: Donors who witnessed another experiencing a reaction were more likely to spontaneously report symptoms during the blood draw, to be treated for a reaction, to score higher on the BDRI, and to exhibit smaller compensatory heart rate increases. Donors with higher affective empathy reported more symptoms, exhibited hyperventilation, and were more likely to be treated. Donors with higher cognitive empathy were less likely to require treatment if they witnessed a reaction. CONCLUSION: These results suggest that psychosocial contagion of physical symptoms can occur. The moderating effects of empathy differed depending on the subtype of empathy. Perhaps a better cognitive understanding of how other people are feeling functions as a coping response, whereas feeling sympathetic about others' distress increases one's own.

Parity and Psychosocial Risk Factors Increase the Risk of Depression During Pregnancy Among Recent Immigrant Women in Canada.

Prior investigations have examined risk factors associated to postpartum depression in immigrant women, but depression during pregnancy has received less attention. This study describes the prevalence and early determinants of antenatal depression among recent (≤ 5 years) and long-term immigrants (> 5 years), compared to Canadian-born women. 503 women completed standardized self-report questionnaires measuring sociodemographics and psychosocial factors. Multivariate logistic regressions identified first trimester risk factors for depression in each immigrant group. The prevalence of depressive symptoms was highest for recent immigrant (25.3-30.8%) compared to long-term immigrant (16.9-19.2%) and Canadian-born women (11.7-13.8%). Among recent immigrants, multiparity, higher stress and pregnancy-specific anxiety in early pregnancy increased the risk of antenatal depression. Among long-term immigrants, stress in the first trimester was significantly associated with antenatal depressive symptoms. Knowledge of modifiable risk factors (pregnancy-specific anxiety and stress) may help improve antenatal screening and inform the development of tailored interventions to meet the mental health needs of immigrant women during the perinatal period.

Maternal blood pressure trajectories and associations with gestational age at birth: a functional data analytic approach.

BACKGROUND: Research has revealed group-level differences in maternal blood pressure trajectories across pregnancy. These trajectories are typically constructed using clinical blood pressure data and multivariate statistical methods that are prone to bias and ignore the functional, dynamic process underlying a single blood pressure observation. The aim of this study was to use functional data analysis to explore blood pressure variation across pregnancy, and multivariate methods to examine whether trajectories are related to gestational age at birth. METHODS: Clinical blood pressure observations were available from 370 women who participated in a longitudinal pregnancy cohort study conducted in Montreal, Quebec, Canada. Functional data analysis was used to smooth blood pressure data and then to conduct a functional principal component analysis to examine predominant modes of variation. RESULTS: Three eigenfunctions explained greater than 95% of the total variance in blood pressure. The first accounted for approximately 80% of the variance and was characterized by a prolonged-decrease trajectory in blood pressure; the second explained 10% of the variance and captured a late-increase trajectory; and the third accounted for approximately 7% of the variance and captured a mid-decrease trajectory. The prolonged-decrease trajectory of blood pressure was associated with older, and late-increase with younger gestational age at birth. CONCLUSION: Functional data analysis is a useful method to model repeated maternal blood pressure observations and many other time-related cardiovascular processes. Results add to previous research investigating blood pressure trajectories across pregnancy through identification of additional, potentially clinically important modes of variation that are associated with gestational age at birth.

The relationship of trait mindfulness to physical and psychological health during pregnancy.

INTRODUCTION: Research on mindfulness has extended to the prevention of psychopathology and physical conditions during pregnancy. The purpose of this study was to investigate the relationship between trait mindfulness assessed in the first or early second trimester to health outcomes throughout pregnancy. METHODS: A total of 510 women were recruited at McGill University-affiliated obstetrics clinics (average gestational age: 13.43 weeks, sd = 1.2). The Mindful Awareness and Attention Scale (MAAS) was administered at baseline. At three timepoints during pregnancy, participants completed the Perceived Stress Scale (PSS-10), the Edinburgh Postnatal Depression Scale (EPDS), the Prenatal Distress Questionnaire-revised (PDQR) and a measure of pregnancy symptom intensity and indicated whether they had been diagnosed with gestational diabetes or high blood pressure. RESULTS: Higher MAAS scores predicted lower PSS, EPDS and PDQR scores and less severe physical discomforts throughout pregnancy. MAAS scores were a stronger predictor of PSS scores earlier in pregnancy. Logistic regressions found that trait mindfulness did not predict the presence of physical discomforts, diabetes or high blood pressure. CONCLUSIONS: These results indicate that trait mindfulness is an important predictor of subjective stress, depression, anxiety and the severity of physical discomforts during pregnancy. These findings suggest that interventions earlier in pregnancy may increase the impact of mindfulness on maternal health.

Hyperventilation as a Predictor of Blood Donation-Related Vasovagal Symptoms.

OBJECTIVE: Most of the research on vasovagal reactions has focused on the contributions of cardiovascular activity to the development of symptoms. However, other research suggests that additional mechanisms like hyperventilation may contribute to the process. The goal of the present investigation was to examine the influences of cardiovascular and respiratory variables on vasovagal symptoms. METHODS: This study was part of a randomized controlled trial investigating the effects of behavioral techniques on the prevention of vasovagal reactions in blood donors. Data from the no-treatment control group were analyzed. The final sample was composed of 160 college and university students. Observational and self-report measures of symptoms were obtained. Physiological variables were measured mainly using respiratory capnometry. RESULTS: Although respiration rate remained stable throughout donation, change in end-tidal carbon dioxide was associated with requiring treatment for a reaction during donation (odds ratio = 0.57, 95% confidence interval [CI] = 0.41 to 0.79, p = .001) and self-reported symptoms measured in the postdonation period using the Blood Donation Reactions Inventory (ß = -0.152, 95% CI = -0.28 to -0.02, t = -2.32, p = .022). Individuals with higher levels of predonation anxiety displayed larger decreases in end-tidal carbon dioxide throughout the procedure (F(2,236) = 3.64, p = .043, ηp = 0.030). Blood Donation Reactions Inventory scores were related to changes in systolic (ß = -0.022, 95% CI = -0.04 to -0.004, t = -2.39, p = .019) and diastolic blood pressure (ß = -0.038, 95% CI = -0.06 to -0.02, t = -4.03, p < .001). CONCLUSIONS: Although the vasovagal reaction has traditionally been viewed as a primarily cardiovascular event, the present results suggest that hyperventilation also plays a role in the development of vasovagal symptoms.

Predicting blood donation intention: the importance of fear.

BACKGROUND: Blood donor recruitment remains an important worldwide challenge due to changes in population demographics and shifts in the demand for blood. Various cognitive models help predict donation intention, although the importance of affective deterrents has become increasingly evident. This study aimed to identify fears that predict donation intention, to explore their relative importance, and to determine if self-efficacy and attitude mediate this relationship, thus providing possible targets for intervention. STUDY DESIGN AND METHODS: A total of 347 individuals (269 nondonors and 78 donors) living in Québec responded to questionnaires assessing medical fears, psychosocial factors related to donation intention including the Theory of Planned Behavior (TPB) constructs, anticipated regret, and facilitating factors (i.e., time commitment and rewards). To examine the relative importance of these factors in the context of blood donation, the same questions were also asked about other medical activities that involve salient needle stimuli: flu vaccinations and dental examinations. RESULTS: Medical fears, especially blood-related fears, were significantly associated with donation intention. Bootstrapping tests confirmed that this relation was mediated by attitude and self-efficacy. Underlining the importance of medical fears in the blood donation context, these fears were not associated with attitudes and intentions for dental examinations or flu vaccinations. CONCLUSION: These results suggest that medical fears, especially blood-related fears, play a key role in predicting donation attitudes and intentions. Mediational pathways provide support for interventions to improve donation intentions by addressing specific fears while also improving a donor's belief in his or her ability to manage donation-related fears.

The Association Between Pregnancy-Specific Anxiety and Exclusive Breastfeeding Status Early in the Postpartum Period.

BACKGROUND: Exclusive breastfeeding is recommended for the first 6 months of life and has significant benefits for both mother and child. Pregnancy-specific anxiety is a distinct and definable syndrome that has been identified as a robust predictor of pregnancy outcomes, but whether it is associated with exclusive breastfeeding status has not been determined. RESEARCH AIMS: To examine the association between pregnancy-specific anxiety in each trimester of pregnancy and exclusive breastfeeding status early in the postpartum period. METHODS: Data were available from 412 women who participated in a longitudinal pregnancy cohort study. Pregnancy-specific anxiety and exclusive breastfeeding status were assessed using an online self-report questionnaire. RESULTS: Logistic regression analyses showed that a one-unit increase in pregnancy-specific anxiety in the first (OR = 0.94, 95% CI [0.90, 0.98]) and third (OR = 0.95, 95% CI [0.91, 0.99]) trimester of pregnancy was associated with a 5-6% decrease in the odds of exclusive breastfeeding at 6-8 weeks postpartum. CONCLUSIONS: Pregnancy-specific anxiety was associated with lower odds of exclusive breastfeeding at 6-8 weeks postpartum. Prenatal interventions designed to increase exclusive breastfeeding duration may benefit from the incorporation of strategies that help reduce worries and concerns unique to the pregnancy experience.

Hypertensive Disorders of Pregnancy and Symptoms of Depression and Anxiety as Related to Gestational Age at Birth: Findings From the All Our Families Study.

OBJECTIVE: The aim of the study was to investigate whether symptoms of depression or state anxiety changed the strength or nature of the association between hypertensive disorders of pregnancy (HDP) and gestational age at birth. METHODS: We conducted a secondary analysis of data from the All Our Families Cohort, a prospective pregnancy cohort study based in Calgary, Alberta, Canada. Self-reported depressive symptoms and state anxiety were assessed between 3 and 5 months of gestation, and obstetrical information, including diagnosis of HDP, parity, type of delivery, and gestational age at birth, was retrieved from the maternal discharge abstract. All models were adjusted for sociodemographic and obstetric confounders. RESULTS: Of 2763 women who had a singleton pregnancy and live birth, 247 (9%) were diagnosed with HDP. Women with HDP had significantly shorter gestational length relative to those without the diagnosis (M = 37.87 versus M = 38.99 weeks of gestation), t(2761) = 9.43, p < .001. Moderation analyses showed significant HDP by depressive symptoms and HDP by state anxiety interactions, such that the strength of the association between HDP and gestational age at birth increased alongside greater depressive symptom and state anxiety severity. CONCLUSIONS: Results suggest that depressive symptoms and state anxiety may add to the increased risk for shortened gestation associated with HDP. Women at high risk of cardiovascular complications during pregnancy may benefit from additional resources to manage symptoms of depression or anxiety.

Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma.

OBJECTIVE: Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS: One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS: There was a statistically significant association between depressive disorder (P = 0.0195) and forced expiratory volume in 1 second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P < 0.001). CONCLUSION: The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects.

Respiration and applied tension strategies to reduce vasovagal reactions to blood donation: A randomized controlled trial.

BACKGROUND: Whether produced by breathing too fast or too deeply, hyperventilation is common in stressful situations and may contribute to blood donation-related vasovagal symptoms. The effects of some previously tested interventions for vasovagal symptoms, for example, applied tension (AT), may be related to reduction of hyperventilation. More targeted breathing techniques might be useful. STUDY DESIGN AND METHODS: This was a randomized controlled trial comparing the effects of AT, a slow, shallow "anti-hyperventilation" breathing technique previously tested in phobic individuals (respiration control [RESP]), the combination of AT and RESP, and no intervention on blood donors participating in university clinics. A total of 547 eligible donors were assigned randomly to one of these four groups. Observational, self-report, and physiologic measures (primarily via respiratory capnometry) were obtained. RESULTS: Although both RESP and AT had some positive impact on blood donation outcome, the effects of RESP were more numerous, albeit limited primarily to donors who had less general fear of medical procedures. For example, lower-fear donors assigned to practice RESP had significantly lower Blood Donation Reaction Inventory scores and were significantly less likely to require treatment for symptoms than no-treatment individuals. In general, RESP led to a significant decrease in respiration rate, though it did not influence end-tidal CO2 , a more precise measure of hyperventilation. CONCLUSION: While the mechanisms remain somewhat unclear and the interventions did not benefit more fearful, higher-risk donors, respiration control is a promising additional approach to reducing vasovagal symptoms.

Parasympathetic Response Patterns are Associated with Metabolic Syndrome Among Older Women but Not Men.

BACKGROUND: Little is known about the role of physiological stress responses in metabolic syndrome (MetS). PURPOSE: To examine whether patterns of autonomic response to psychological stress are associated with MetS and whether this association is moderated by sex. METHODS: 1121 men and women (Mage = 65.3 ± 6.77 years) with and without coronary artery disease (CAD) underwent an anger recall stressor task. Heart rate and heart-rate variability (HRV; HF, LF/HF) were assessed. Clusters of participants showing similar patterns of response across baseline, stress, and recovery periods were created using ACECLUS and FASTCLUS in SAS. Logistic regressions included clusters and interaction between clusters and sex as independent variables, controlling for relevant covariates. ANCOVAs were conducted in secondary analyses utilizing a continuous composite representation of MetS. RESULTS: Men and women showing greater tonic and phasic HR elevations were more likely to meet MetS criteria (OR = 1.45, [95% CI = 1.02-2.07], p = .037). HF-HRV cluster interacted significantly with sex (p < .001) to predict MetS. In women, those with significant parasympathetic withdrawal to stress and poor recovery were more likely to have MetS than women with a more moderate response (OR = 2.56, [95% CI = 1.23-5.41], p = .013). Women who displayed stress-related parasympathetic activation were also at greater risk of MetS (OR = 2.30, [95% CI = 1.30-4.07], p = .004). Results using a continuous measure of MetS were generally consistent with these findings. CONCLUSION: Among older participants with CAD or other noncardiovascular disease, hyperreactivity to stress was associated with greater prevalence of MetS, particularly in women. Consistent with emerging literature, women who showed blunting or activation of parasympathetic responses to stress were similarly at greater risk.

Health Locus of Control Is Associated With Physical Activity and Other Health Behaviors in Cardiac Patients.

PURPOSE: Physical inactivity, smoking, and excessive alcohol use are well-recognized modifiable risk factors for cardiovascular disease (CVD), yet uptake of strategies to mitigate these poor health behaviors varies widely among patients with cardiovascular disease. Part of this variation may be explained by health locus of control (HLOC), defined as the extent to which individuals believe their health is a consequence of their own actions, chance, or the influence of others (eg, physicians). METHODS: A total of 599 cardiac outpatients (30% female, 61.4 ± 9.4 y of age) completed the Multidimensional Health Locus of Control questionnaire and a structured health behavior questionnaire assessing physical activity, smoking, and alcohol use, at baseline and a 4-y follow-up. Relationships between health behaviors and HLOC were assessed cross-sectionally and longitudinally using general linear models and logistic regression models adjusting for medical and sociodemographic factors. RESULTS: Higher Internal HLOC was found to be associated with higher levels of leisure time physical activity (LTPA) (ß = .21, P = .0008), while lower Internal HLOC was associated with decreasing levels of alcohol consumption over time (ß = .26, P = .03). Increasing Chance HLOC was related to lower levels of leisure time physical activity (ß = -.15, P = .047) and increased likelihood of being a smoker (ß = .10, P = .01), and increasing physician HLOC was associated with decreased likelihood of being a smoker (ß = -.17, P = .01). CONCLUSIONS: Associations between HLOC and multiple health behaviors were observed in a large sample of cardiac outpatients. Results suggest that assessing and targeting HLOC beliefs of cardiac patients may be clinically relevant for behavior change in settings, such as in rehabilitation programs where behavior change is a goal.

Respiratory and hemodynamic contributions to emotion-related pre-syncopal vasovagal symptoms.

Vasovagal reactions are conventionally understood as resulting from systemic changes in cardiovascular activity; however, there exists a complementary perspective focused on specific changes in cerebral vasoconstriction associated with hyperventilation-induced hypocapnia. The present study investigated the role of cardiovascular and respiratory activity in self-reported pre-syncopal vasovagal reactions to a surgery video in a sample of 49 healthy women. Participants who indicated more previous real-life episodes of dizziness reported experiencing significantly more symptoms in the laboratory consistent with a vasovagal response. They also showed lower total peripheral resistance and higher pre-ejection period in general, suggesting lower sympathetic nervous system activity. Significant decreases in end-tidal carbon dioxide (PETCO2) occurred during the surgery video among susceptible participants, without significant increases in respiration rate. Further, participants who experienced reductions from the neutral video in PETCO2, systolic blood pressure, or both, reported vasovagal symptoms during the surgery video. The results suggest that patterns of respiration associated with decreases in PETCO2 may contribute to vasovagal symptoms reported in non-clinical groups as well as those with blood-injection-injury phobia and are associated with susceptibility to dizziness.

Disgust stimuli reduce heart rate but do not contribute to vasovagal symptoms.

BACKGROUND AND OBJECTIVES: The vasovagal response demonstrates a unique form of stress response, common in medical settings yet provoked by a variety of blood-injury-injection stimuli. This study aimed to better understand the psychophysiological mechanisms of the vasovagal response.. METHODS: 16 undergraduates with and 42 without a self-reported history of fainting watched five 3-5 min videos with different emotional content. One documentary clip (Neutral condition) described a campus environmental project while another (Blood/Injury) depicted portions of an open heart surgery. Three additional clips were also used, including Medical, Threat, and Contamination stimuli. Vasovagal symptoms and physiological variables were assessed during each video. RESULTS: As predicted, while the disgust-related stimuli (Blood/Injury, Medical, Contamination) were associated with generally lower heart rate, the Blood/Injury video produced the highest symptoms and the only significant difference between previous fainters and non-fainters. The physiological measures also revealed that participants with a fainting history experienced higher stroke volume and lower systolic blood pressure throughout, as well as several main effects of video. LIMITATIONS: An additional decrease in systolic blood pressure and respiration produced by watching the Blood/Injury video may have been sufficient to trigger symptoms in some, though results also suggest that systemic variables do not entirely explain susceptibility to symptoms. More careful evaluation of regional blood flow may be required. CONCLUSIONS: Participants who had previously experienced strong vasovagal responses displayed what appeared to be an anticipatory response to the Blood/Injury video. Finally, disgust stimuli may reduce heart rate but do not appear to contribute to vasovagal symptoms.

Increasing nondonors' intention to give blood: addressing common barriers.

BACKGROUND: Recruiting new donors is a challenging experience for most blood collection agencies. A modest proportion of the population is eligible to give blood and few of these individuals volunteer. The goal of this study was to examine the effects of brief behavioral interventions on nondonors' intention to give blood, by addressing some commonly reported obstacles. STUDY DESIGN AND METHODS: A total of 244 young adults who were eligible to give blood but had never done so participated in the study. They were assigned randomly to an applied tension (AT) instruction condition, a relaxation instruction condition, a Web browsing condition, or a no-treatment control condition. After the 20-minute experimental intervention, half watched three short injection and blood draw videos and the others sat quietly. Intention to give blood and different cognitive constructs associated with blood donation were measured using a Theory of Planned Behavior questionnaire. RESULTS: Participants in all three active conditions had significantly greater increases in intention to donate blood compared to controls, although those who learned AT had greater increases than Web browsing. Bootstrapping tests of mediation indicated particular importance of increased perceived behavioral control in AT and relaxation treatment effects. Follow-up analyses revealed a significant association between degree of within-session increase in intention and subsequent blood clinic attendance. CONCLUSION: These results suggest that simple interventions can be effective in increasing nondonors' intention to donate blood and, perhaps, actual attendance. The mediational analyses suggest that interventions can selectively target different barriers associated with blood donation.

A composite measure of gender and its association with risk factors in patients with premature acute coronary syndrome.

OBJECTIVE: To create a gender index by using principal component analyses (PCA) and logistic regression, and to determine the association between gender, sex, and cardiovascular risk factors among patients with premature acute coronary syndrome (ACS). METHODS: GENESIS-PRAXY is a cohort study including ACS patients aged 55 years or below, and with ACS recruited between 2009 and 2013 from 26 centres across Canada, the United States, and Switzerland. A sample of 1075 patients was used for this study. Psychosocial variables assumed to differ between sexes (i.e., gender related) were included in PCA. Variables identified on retained components were included in logistic regressions where coefficient estimates of variables associated with sex were used to calculate a gender score. Cardiovascular risk factors were assessed using self-report and chart review data. RESULTS: After the inclusion of 26 psychosocial variables in PCA, we identified 17 variables within retained components; 7 of which were associated with sex in logistic regression. The gender distribution revealed that half of women had a more androgyne or masculine gender score, and 16% of men exhibited a more feminine gender score. In univariable analyses, feminine gender scores and female sex were associated with hypertension, diabetes, family history of cardiovascular disease (only gender), and depressive/anxious symptoms. In multivariable models including both gender score and sex, feminine gender score but not female sex was associated with the presence of risk factors. CONCLUSIONS: Sex and gender are distinct constructs, and the derived gender index offers a current and pragmatic option to measure gender within ACS populations. Our results further suggest that traditional sex differences in cardiovascular disease risk factors may be partly explained by patient's gender-related characteristics.

The vasovagal response during confrontation with blood-injury-injection stimuli: the role of perceived control.

The vasovagal response (VVR) is a common medical problem, complicating and deterring people from various procedures. It is an unusual stress response given the widespread decreases in physiological activity. Nevertheless, VVR involves processes similar to those observed during episodes of strong emotions and pain. We hypothesized that heightened perceived control would reduce symptoms of VVR. Eighty-two young adults were randomly assigned to perceived control or no perceived control conditions during exposure to a stimulus video of a mitral valve surgery, known to trigger VVR in non-medical personnel. Perceived control was manipulated by allowing some participants to specify a break time, though all received equivalent breaks. Outcomes included subjective symptoms of VVR, anxiety, blood pressure, heart rate, and other measures derived from impedance cardiography. Compared to participants with perceived control, participants with no perceived control reported significantly more vasovagal symptoms and anxiety, and experienced lower stroke volume, cardiac output, and diastolic blood pressure. Participants who were more fearful of blood were more likely to benefit from perceived control in several measures. Perceived control appears to reduce vasovagal symptoms. Results are discussed in terms of cognition and emotion in VVR.

Sense of impending doom: inhibitory activity in waiting blood donors who subsequently experience vasovagal symptoms.

This study examined autonomic and hemodynamic processes associated with the development of naturally occurring vasovagal responses. Data from a study assessing the physiological correlates of an intervention to reduce vasovagal responses in blood donors were examined (Ditto et al., 2009). Ninety-eight participants were assigned randomly to groups that either practiced applied tension or not. Dependent variables included ratings of vasovagal symptoms, heart rate, blood pressure, and other parameters derived from ambulatory impedance cardiography. Participants who subsequently experienced vasovagal symptoms had a lower ratio between low and high frequency components (LF/HF HRV) of heart rate variability (HRV) before blood donation, suggesting lower sympathetic nervous system activity. They also showed sharper decreases in total peripheral resistance and lower respiration rates. The results suggest that vasovagal reactions that begin during anticipation of a medical procedure may be characterized by an inhibitory process from the outset and do not support the belief that reactions follow a diphasic pattern.