Are illness perceptions, beliefs about medicines and Type D personality associated with medication adherence among thyroid cancer survivors? A study from the population-based PROFILES registry.

Objective: To examine self-reported medication adherence and its association with illness perceptions, beliefs about medication and personality among thyroid cancer survivors. Methods: Individuals diagnosed with thyroid cancer between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received our survey; 86% (n = 306) responded.Results: Many patients reported that they never forgot taking their medicines (n = 168; 56%), never altered the dose (n = 258; 88%), never stopped taking them (n = 291; 99%), never decided to miss a dose (n = 284; 97%) and never took less than instructed (n = 286; 97%). Fifty-two percent were classified as nonadherent; of which 14% intentional nonadherent only, 70% were nonintentional nonadherent only and 16% were both intentional and nonintentional nonadherent. Nonadherers were younger, more highly educated, more often employed, had a lower stage at diagnosis, and less often reported ≥2 comorbid conditions than adherers. Furthermore, their illness affected them more emotionally and they more often reported that their life would be impossible without their medicine. Logistic regression models showed that higher age, lower education and lower perceived necessity of medication was associated with better adherence while beliefs about medication, illness perceptions, and personality were not associated with adherence.Conclusions: Despite lifelong dependence on supplement therapy, 52% of thyroid cancer survivors were nonadherent.

Increase of depressive symptomatology during pregnancy over 25 years' time in four population based cohorts.

BACKGROUND: The use of psychotropic drugs for depression during pregnancy has increased over the past decades, but it is unclear whether women are becoming more depressed over time. METHODS: We investigated the occurrence of depressive symptoms during pregnancy in four cohorts (N 300-2000) in the same area in the Netherlands over a period of 25 years using a similar study design. Depressive symptoms were assessed using the Edinburgh Depression Scale (EDS) at various time points during pregnancy. Demographics, lifestyle factors, obstetric characteristics and EDS scores were compared between the four cohorts. RESULTS: From 1988 to 2014, Mean EDS scores during the first and third trimester of pregnancy increased significantly (P < 0.001). The number of women with elevated EDS scores doubled from 7% in 1988-1989 to 14% in 2012-2014 (P = 0.001). The number of highly educated women increased from 23% to 66% and those with paid employment from 75% to 95%, while smoking and alcohol use decreased significantly (all Ps < 0.001). These trends were similar to those of the National Statistics. A previous history of depression, multi-parity and paid employment were associated with higher EDS scores. LIMITATIONS: Women were highly educated, predominantly Caucasian and had a partner. CONCLUSIONS: Paradoxically, there was a significant increase in depressive symptomatology during pregnancy over a period of 25 years, while protective factors for depression during pregnancy improved. Potential explanations could be greater awareness, high societal expectations, use of social media or the stressful combination of paid work and children at home.

Incidence of cardiovascular disease up to 13 year after cancer diagnosis: A matched cohort study among 32 757 cancer survivors.

We examined the incidence of cardiovascular disease (CVD) among 32 757 cancer survivors and age-, gender-, and geographically matched cancer-free controls during a follow-up period of 1-13 years, and explored whetherCVD incidence differed by received cancer treatment, traditional cardiovascular risk factors, age, or gender. Adult 1-year cancer survivors without a history ofCVD diagnosed with breast (n = 6762), prostate (n = 4504), non-Hodgkin (n = 1553), Hodgkin (n = 173), lung and trachea (n = 2661), basal cell carcinoma (BCC; n = 12 476), and colorectal (n = 4628) cancer during 1999-2011 were selected from the Netherlands Cancer Registry and matched to cancer-free controls without a history ofCVD. Drug dispenses and hospitalizations from thePHARMO Database Network were used as proxy forCVD. Data were analyzed using Cox regression analyses. Prostate (HR: 1.17; 95%CI: 1.01-1.35) and lung and trachea (HR: 1.48; 95%CI: 1.10-1.97) cancer survivors had an increased risk for developingCVD compared to cancer-free controls. This increased risk among lung and trachea cancer survivors remained statistically significant after including traditional cardiovascular risk factors and cancer treatment information (HR: 1.41; 95%CI: 1.06-1.89). Among prostate cancer survivors, the increased risk of incidentCVD was limited to those who received hormones and those without traditional cardiovascular risk factors. Breast, non-Hodgkin,BCC, and colorectal cancer survivors showed no increasedCVD risk compared to cancer-free controls. There was an increased risk of incidentCVD among prostate, and lung and trachea cancer survivors compared to age-, gender- and geographically matched cancer-free controls. Studies including longer follow-up periods are warranted to examine whether cancer survivors are at increased risk of long-term incidentCVD.

PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories): Overview of Design and Rationale of an International Prospective Peripheral Arterial Disease Study.

BACKGROUND: Health status outcomes, including symptoms, functional status, and quality of life, are critically important outcomes from patients' perspectives. The PORTRAIT study (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) was designed to prospectively define health status outcomes and examine associations between patients' characteristics and care to these outcomes among those presenting with new-onset or worsened claudication. METHODS AND RESULTS: PORTRAIT screened 3637 patients with an abnormal ankle-brachial index and new, or worsened, claudication symptoms from 16 peripheral arterial disease (PAD) specialty clinics in the United States, the Netherlands, and Australia between June 2, 2011, and December 3, 2015. Of the 1608 eligible patients, 1275 (79%) were enrolled. Before treatment, patients were interviewed to obtain their demographics, PAD symptoms and health status, psychosocial characteristics, preferences for shared decision-making, socioeconomic, and cardiovascular risk factors. Patients' medical history, comorbidities, and PAD diagnostic information were abstracted from patients' medical records. Serial information about patients' health status, psychosocial, and lifestyle factors was collected at 3, 6, and 12 months by a core laboratory. Follow-up rates ranged from 84.2% to 91%. Clinical follow-up for PAD-related hospitalizations and major cardiovascular events is ongoing. CONCLUSIONS: PORTRAIT systematically collected serial PAD-specific health status data as a foundation for risk stratification, comparative effectiveness studies, and clinicians' adherence to quality-based performance measures. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.

Predictive value of Type D personality for impaired endothelial function in patients with coronary artery disease.

BACKGROUND: Type D personality (high negative affectivity and social inhibition) is associated with cardiovascular events and coronary plaque severity. Whether Type D is also related to functional vasomotion abnormalities is unknown. We examined concurrent and predictive associations of Type D with endothelial dysfunction in patients with coronary artery disease (CAD). METHODS: At baseline, 180 CAD patients (90% men; M = 58.0 years) completed Type D (DS14) and depression scales, and entered a 12-week exercise program. Flow-mediated dilation (FMD) of the brachial artery and circulating CD34+/KDR+/CD45+dim endothelial progenitor cells (EPCs) were assessed at baseline, 3 months, and 12 months. Logistic regression and linear mixed models were used to analyze endothelial function. RESULTS: Type D personality was associated with decreased FMD across baseline, 3 months, and 12 months (mixed model analysis, p = 0.04), after adjustment for clinical characteristics, exercise training and depression. There was no significant association between Type D and decreased EPCs (p = 0.07). Age and smoking were other significant correlates of FMD and EPCs. Using a FMD <5.5% cut-off, Type D patients more often had endothelial dysfunction at baseline (24/37 = 65%) than non-Type Ds (63/143 = 44%); OR = 3.03, 95% CI 1.04-8.80. This significant Type D effect was confirmed in prospective analyses of endothelial dysfunction at 12 months (OR = 3.43, 95% CI 1.01-11.64), and in subgroup analyses of male patients. CONCLUSIONS: Type D personality was associated with impaired endothelial function in men with CAD. This association was robust across time, independent from depressive symptoms, and supports the notion that Type D has an adverse effect on cardiovascular health in patients with CAD.

Patient-reported causes of heart failure in a large European sample.

BACKGROUND: Patients diagnosed with chronic diseases develop perceptions about their disease and its causes, which may influence health behavior and emotional well-being. This is the first study to examine patient-reported causes and their correlates in patients with heart failure. METHODS: European heart failure patients (N = 595) completed questionnaires, including the Brief Illness Perceptions Questionnaire. Using deductive thematic analysis, patient-reported causes were categorized into physical, natural, behavioral, psychosocial, supernatural and other. Clinical data were collected from medical records. RESULTS: Patients who did not report any cause (11%) were on average lower educated and participated less often in cardiac rehabilitation. The majority of the remaining patients reported physical causes (46%, mainly comorbidities), followed by behavioral (38%, mainly smoking), psychosocial (35%, mainly (work-related) stress), and natural causes (32%, mainly heredity). There were socio-demographic, clinical and psychological group differences between the various categories, and large discrepancies between prevalence of physical risk factors according to medical records and patient-reported causes; e.g. 58% had hypertension, while only 5% reported this as a cause. Multivariable analyses indicated trends towards associations between physical causes and poor health status (Odds ratio (OR) = 1.41, 95% confidence interval (95% CI) = 0.95-2.09, p = 0.09), psychosocial causes and psychological distress (OR = 1.54, 95% CI = 0.94-2.51, p = 0.09), and behavioral causes and a less threatening view of heart failure (OR = 0.64, 95% CI = 0.40-1.01, p = 0.06). CONCLUSION: European patients most frequently reported comorbidities, smoking, stress, and heredity as heart failure causes, but their causal understanding may be limited. There were trends towards associations between patient-reported causes and health status, psychological distress, and illness perceptions.

The tense, the hostile and the distressed: multidimensional psychosocial risk profiles based on the ESC interview in coronary artery disease patients - the THORESCI study.

BACKGROUND: While single psychosocial factors have been associated with cardiovascular outcomes, it is still unclear how they cluster. Therefore, we examined whether latent multidimensional psychosocial risk profiles could be identified in the European Society of Cardiology (ESC) psychosocial screening interview. Additionally we examined whether these profiles were associated with specific sociodemographic, clinical, and psychosocial characteristics. METHOD: 681 coronary artery disease patients (age=64.9±10.6; 80% men) completed the ESC interview, comprising 15 items on 7 predefined components. Multiple self-report questionnaires focusing on demographics, mood symptoms, personality, coping, and life events were used. Clinical information was extracted from patients' medical records. RESULTS: Latent class analysis identified four psychological classes: 1. Low psychological distress (62%), 2. High hostility (19%), 3. High tension (11%), 4. High psychological distress (8%), and two social classes: Low chronic stress (81%), and High work stress (%19). Characteristics increasing the odds to belong to the "High hostility" class were male sex, negative affectivity, and psychiatric history. "High tension" membership was associated with female sex, being single, a sedentary lifestyle, seeking social support, NA, early adverse life-events, depression, anxiety, and psychiatric history. "High psychological stress" characteristics were younger age, smoking, a sedentary lifestyle, NA, depression, anxiety, early adverse life-events, psychiatric history. Being younger, alcohol use and avoidance-oriented coping increased the odds to be in the "High work stress" class. CONCLUSIONS: This study characterized four psychological and two social latent risk profiles. Results indicate the importance of a multidimensional psychosocial screening, potentially uncovering differential mechanistic pathways, which also may prove beneficial in clinical practice and in risk prevention strategies.

Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors.

PURPOSE: To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics in a population-based observational study. METHODS: Adult 1-year breast cancer survivors (n = 7227), diagnosed between 01-01-1999 and 12-31-2010, with no history of CVD, were selected from the Netherlands Cancer Registry. Drug dispensing data were derived from the PHARMO Database Network and used as proxy for CVD, anxiety, and depression. By multivariable Cox regression analysis, we examined the risk associated with pharmaceutically treated anxiety and depression for developing CVD after cancer diagnosis, adjusting for age, pharmaceutically treated hypertension, hypercholesterolemia, and diabetes mellitus in the year prior to cancer diagnosis, tumor stage, and cancer treatment. RESULTS: During the 13-year follow-up period, 193 (3%) breast cancer survivors developed CVD. Women pharmaceutically treated for anxiety in the year prior to their cancer diagnosis had a 48% increased hazard for CVD [HR = 1.48; 95% CI 1.05-1.08] after full adjustment. This association was restricted to breast cancer survivors who were 65 years or younger. Depression was not associated with CVD risk [HR = 0.89; 95% CI 0.52-1.53]. Older age [HR = 1.06; 95% CI 1.05-1.08], hypertension [HR = 1.80; 95% CI 1.32-2.46], and hypercholesterolemia [HR = 1.63; 95% CI 1.15-2.33] were associated with an increased hazard for incident CVD, whereas hormone therapy [HR = 0.59; 95% CI 0.42-0.83] was protective. CONCLUSIONS: Anxiety present in the year prior to breast cancer diagnosis increases the risk of incident CVD in 1-year breast cancer survivors, after adjustment for depression, traditional cardiovascular risk factors, and clinical characteristics.

Is Type D personality a risk factor for all-cause mortality? A prospective population-based study among 2625 colorectal cancer survivors from the PROFILES registry.

Objective Our goal was to examine whether Type D personality and its components, negative affectivity (NA) and social inhibition (SI), were associated with all-cause mortality among colorectal cancer (CRC) patients. METHODS: CRC patients diagnosed between 2000 and 2009, as registered in the Dutch population-based Eindhoven Cancer Registry, received a questionnaire on Type D (DS14) on average 5.3years after diagnosis. Survival status (31-12-2013) was obtained from the Central Bureau for Genealogy. We used a Cox proportional hazard model to relate personality to all-cause mortality, while adjusting for demographics, clinical characteristics and cardiovascular disease (CVD). RESULTS: Fifty percent was categorized as the 'reference group' (n=1281), 17% as 'SI only' (n=421), 12% as 'NA only' (n=309), and 21% as 'Type D' (n=532). After adjustment, CRC patients in the 'NA only' and 'Type D' groups showed an increased risk (HR=2.0, 95% CI=1.4-2.8, p<0.01, and HR=1.7, 95% CI=1.3-2.4, p<0.01) for all-cause mortality. This adverse effect of NA was limited to men aged >70. There was an additional adverse effect of SI on all-cause mortality in older men without CVD (HR=2.3, 95% CI=1.2-4.4, p=0.01). Personality was not related to mortality in women. Entering personality continuously, showed an increased risk for NA among older survivors, men and patients with comorbid CVD. Neither SI nor the interaction term was predictive in both the un- and adjusted Cox models. CONCLUSION: Our findings suggest that it is the NA component that drives the adverse effect of psychological distress on survival in CRC patients, which is most prominent among older men.

Type D personality: Application of DS14 French version in general and clinical populations.

The aim of this study was to validate the French-language version of the Type D personality scale-14 among general and clinical populations (acute coronary syndrome and breast cancer patients). The two-factor structure of the Type D personality scale-14 was confirmed by factorial and confirmatory analyses. Internal consistency for both subdimensions of Type D personality scale-14 (negative affectivity and social inhibition) was very good with α = .87 for each. Contrary to our expectations, the Type D prevalence was much higher in the breast cancer group than in the acute coronary syndrome patients. In conclusion, the French-language Type D personality scale-14 showed good psychometric properties among general and clinical populations.

Personality, health behaviors, and quality of life among colorectal cancer survivors: Results from the PROFILES registry.

PURPOSE: There is a paucity of research looking into the relationship between personality and health behaviors among cancer survivors. The aim of this study was to investigate whether Type D personality and its two constituent components, negative affectivity (NA) and social inhibition (SI), are associated with health behaviors, quality of life (QoL), and mental distress among colorectal cancer (CRC) survivors. METHODS: A population-based study was conducted among 2,620 CRC patients diagnosed between 2000 and 2009, who completed measures of personality (DS14), health behaviors, QoL (EORTC QLQ-C30), and mental distress (hospital anxiety and depression scale). RESULTS: Personality was not associated with body mass index or smoking. Those scoring high on NA (with or without SI) were more often nondrinkers and less physically active compared to those scoring high on neither or only SI. Personality (high scores NA) and health behaviors (inactivity) were independently associated with poor QoL and mental distress. CONCLUSIONS: CRC survivors with high scores on NA are at risk of being inactive and have worse health outcomes.

Advanced Glycation End Product (AGE) Accumulation in the Skin is Associated with Depression: The Maastricht Study.

BACKGROUND: Depression is a highly prevalent disease with a high morbidity and mortality risk. Its pathophysiology is not entirely clear. However, type 2 diabetes is an important risk factor for depression. One mechanism that may explain this association may include the formation of advanced glycation end products (AGEs). We therefore investigated the association of AGEs with depressive symptoms and depressive disorder. In addition, we examined whether the potential association was present for somatic and/or cognitive symptoms of depression. METHODS: Cross-sectional data were used from the Maastricht Study (N = 862, mean age 59.8 ± 8.5 years, 55% men). AGE accumulation was measured with skin autofluorescence (SAF) by use of the AGE Reader. Plasma levels of protein-bound pentosidine were measured with high-performance liquid chromatography and fluorescence detection. Nε-(carboxymethyl)lysine (CML) and Nε-(carboxyethyl)lysine (CEL) were measured with ultraperformance liquid chromatography and tandem mass spectrometry. Depressive symptoms and depressive disorder were assessed by the nine-item Patient Health Questionnaire and the Mini-International Neuropsychiatric Interview. RESULTS: Higher SAF was associated with depressive symptoms (ß = 0.42, 95% CI 0.12-0.73, P = .007) and depressive disorder (OR = 1.42, 95% CI 1.04-1.95, P = .028) after adjustment for age, sex, type 2 diabetes, smoking, BMI, and kidney function. Plasma pentosidine, CML, and CEL were not independently associated with depressive symptoms and depressive disorder. CONCLUSIONS: This study shows that AGE accumulation in the skin is independently associated with higher levels of depressive symptoms and depressive disorder. This association is present for both somatic and cognitive symptoms of depression. This might suggest that AGEs are involved in the development of depression.

Depression and markers of inflammation as predictors of all-cause mortality in heart failure.

BACKGROUND: In patients with heart failure (HF) depressive symptoms have been associated with mortality, as well as biological risk factors, including inflammation, nitric oxide (NO) regulation, and oxidative stress. We investigated the joint predictive value of depressive symptoms, inflammation and NO regulation on all-cause mortality in patients with HF, adjusted for covariates. METHODS: Serum levels of inflammation (TNFα, sTNFr1, sTNFr2, IL-6, hsCRP, NGAL), NO regulation (l-arginine, ADMA, and SDMA), and oxidative stress (isoprostane 8-Epi Prostaglandin F2 Alpha) were measured in 104 patients with HF (mean age 65.7±SD 8.4years, 28% women). Depressive symptoms (Beck Depression Inventory, BDI) were measured as continuous total, cognitive, and somatic symptoms, as well as categorized presence of mild/moderate depression (cut-off BDI ⩾10). In Cox proportional hazard models we adjusted for age, sex, poor exercise tolerance and comorbidity. RESULTS: After on average 6.1years follow-up (SD=2.9, range 0.4-9.2), 49 patients died. Total and somatic depressive symptoms, mild/moderate depression, higher NGAL, sTNFr2, IL-6, hsCRP and SDMA serum levels were significantly associated with a higher all-cause mortality rate, adjusted for covariates. The findings were most consistent for CRP level and somatic depressive symptoms. When combined, both depressive symptoms and markers of inflammation and NO regulation remained significantly associated with all-cause mortality. These associations were not confounded by age, sex, poor exercise tolerance and comorbidity. CONCLUSION: Depressive symptoms and markers of inflammation and NO regulation are codominant risk factors for all-cause mortality in heart failure.

Associations of low grade inflammation and endothelial dysfunction with depression - The Maastricht Study.

BACKGROUND: The pathogenesis of depression may involve low-grade inflammation and endothelial dysfunction. We aimed to evaluate the independent associations of inflammation and endothelial dysfunction with depressive symptoms and depressive disorder, and the role of lifestyle factors in this association. METHODS: In The Maastricht Study, a population-based cohort study (n=852, 55% men, m=59.8±8.5years), depressive symptoms were assessed with the Patient Health Questionnaire-9 and (major and minor) depressive disorder with the Mini-International Neuropsychiatric Interview. Plasma biomarkers of inflammation (hsCRP, SAA, sICAM-1, IL-6, IL-8, TNF-α) and endothelial dysfunction (sVCAM-1, sICAM-1, sE-selectin, vWF) were measured with sandwich immunoassays and combined into two standardized sum scores. RESULTS: Biomarkers of inflammation (hsCRP, TNF-α, SAA, sICAM-1) and endothelial dysfunction (sICAM-1, sE-Selectin) were univariately associated with depressive symptoms and depressive disorder. The sum scores of inflammation and endothelial dysfunction were associated with depressive disorder after adjustment for age, sex, type 2 diabetes, kidney function and prior cardiovascular disease (OR 1.54, p=0.001 and 1.40, p=0.006). Both sum scores remained significantly associated with depressive disorder after additional adjustment for lifestyle factors smoking, alcohol consumption and body mass index. The sum score of inflammation was also independently associated with depressive symptoms, while the sum score of endothelial dysfunction was not. CONCLUSIONS: Inflammation and endothelial dysfunction are both associated with depressive disorder, independent of lifestyle factors. Our results might suggest that inflammation and endothelial dysfunction are involved in depression.

Prevalence and relevance of Type D personality in fibromyalgia.

OBJECTIVE: Distressed (Type D) personality, combining high negative affectivity and social inhibition, is linked to poor health in various populations. Because patients with fibromyalgia experience high negative affect and show signs of social inhibition, this study aimed to examine the prevalence of Type D's components and their associations with health in an additive (worse health with both components present) or synergistic way (components amplifying each other's effects). METHOD: Type D personality and physical and mental health were assessed online by 558 patients with self-reported fibromyalgia (94% women, age 47 ± 11 (21-77)years) by the Type D Scale-14 and RAND-36 Health Status Inventory. RESULTS: Using the standard cutscores, Type D personality was present in 56.5% of patients. Negative affectivity alone and combined with social inhibition was associated with worse mental and, more limited, physical health, but no interactive (synergistic) associations were found. CONCLUSIONS: Type D personality in fibromyalgia exceeds prevalence estimates in general, cardiovascular and chronic pain populations. Some indication of an additive but not of a synergistic effect was found, particularly for mental health, with clearly the largest associations for negative affectivity. The high prevalence of Type D's components may have specific treatment implications.

Determinants of Dyspnea in Chronic Heart Failure.

BACKGROUND: Dyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress. METHODS AND RESULTS: Dyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70% men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations. CONCLUSIONS: The experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF.

Depressive Symptom Clusters Differentially Predict Cardiovascular Hospitalization in People With Type 2 Diabetes.

BACKGROUND: Depression has been associated with the development of cardiovascular disease in people with type 2 diabetes. OBJECTIVE: We examined whether symptoms related to the 2 core features of depression--dysphoria and anhedonia--and anxiety were differentially associated with cardiovascular hospitalization and whether there were symptom-specific mechanisms (alcohol, smoking, physical activity, body mass index, glucose, cholesterol, and blood pressure) in play. METHOD: A total of 1465 people in Dutch primary care completed the Edinburgh Depression Scale in 2005 and were followed up until first cardiovascular hospitalization during follow-up (event) or December 31, 2010 (study end). Cox regression analyses examined (1) differences in time to hospitalization for a cardiovascular event between people with a low vs a high baseline dysphoria/anhedonia/anxiety score (adjusting for demographic and clinical confounders) and (2) mediating mechanisms. RESULTS: A total of 191 people were hospitalized for a cardiovascular event. In univariable analysis, dysphoria predicted a shorter time to cardiovascular hospitalization (hazard ratio = 1.49, 95% CI: 1.02-2.17). After adjustment for confounders, neither dysphoria (hazard ratio = 1.55, 95% CI: 0.91-2.64) nor anhedonia (hazard ratio = 0.83, 95% CI: 0.47-1.48) was significantly associated with time to cardiovascular hospitalization. Anxiety was associated with a longer time to cardiovascular hospitalization (adjusted hazard ratio = 0.49, 95% CI: 0.27-0.89). However, none of the selected factors qualified as a mediator for the (adjusted) association between anxiety and time to cardiovascular hospitalization. DISCUSSION: Dysphoria was associated with a shorter time to cardiovascular hospitalization in unadjusted analyses only, whereas anxiety predicted later hospitalization after confounder adjustment. Anhedonia did not show a significant association. Mechanistic pathways remain unclear.

NGAL and other markers of inflammation as competitive or complementary markers for depressive symptom dimensions in heart failure.

OBJECTIVES: Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory marker associated with the pathophysiology of heart failure (HF), the psychopathology of depression and the co-existing symptoms of depression in HF patients. The aim of this study is to determine whether the association of serum NGAL levels with depressive symptoms dimensions in HF is independent of well-known inflammatory markers. METHODS: Serum NGAL, high sensitive C-reactive protein (hsCRP), tumour necrosis factor-α (TNF-α), its two soluble receptors; sTNFR1, sTNFR2, Interleukin-6 (IL-6) and leukocytes were measured in 104 patients with HF at baseline and 12 months. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI) at both timepoints. Correlations between NGAL and inflammatory markers and depressive symptoms dimensions were determined. The effect of hsCRP, IL-6, TNF-α, sTNFR1, sTNFR2 and leukocytes on the association of NGAL with depressive symptoms was determined and adjusted for time, demographics, cardiac disease severity, and kidney function. RESULTS: NGAL levels were significantly correlated with hsCRP, TNF-α, sTNFR1, sTNFR2 and leukocytes. NGAL was significantly associated with somatic depressive symptoms, independent of abovementioned markers. CONCLUSIONS: Serum NGAL is an independent inflammatory marker for somatic depressive symptoms in HF and may function as an immunopathogen linking somatic symptoms of depression to HF.

Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study.

BACKGROUND: Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level. METHODS: Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease. RESULTS: In the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE. CONCLUSIONS: Generalized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.

The role of personality in the course of health-related quality of life and disease-specific health status among colorectal cancer survivors: A prospective population-based study from the PROFILES registry.

BACKGROUND: Prospective studies in various cardiovascular populations show that Type D personality predicted impaired health-related quality of life (HRQoL) and disease-specific health status. We examined the effect of negative affectivity (NA), social inhibition (SI) and their combined effect (Type D personality) on HRQoL and disease-specific health status among colorectal cancer (CRC) patients. METHODS: CRC patients diagnosed between 2000 and 2009, as registered in the Dutch population-based Eindhoven Cancer Registry, received questionnaires on Type D personality (DS14), HRQoL (EORTC QLQ-C30) and disease-specific health status (EORTC QLQ-CR38) in 2010, 2011 and 2012. RESULTS: Response rates were 73% (n = 2625), 83% (n = 1643) and 82% (n = 1458), respectively. Analyses were done on those completing at least two questionnaires (n = 1735). Individuals with Type D (NA+/SI+; 19%) and high NA (NA+/SI-; 11%) reported a significantly worse HRQoL and disease-specific health status compared to NA-/SI+ and NA-/SI-. Differences were stable over time. Linear mixed effects models showed that Type Ds had a lower quality of life, cognitive and emotional functioning, more insomnia, diarrhea, gastrointestinal, defecation and stoma-related problems and poor body image and future perspective compared to the reference group (NA-/SI-), even after controlling for sociodemographic and clinical variables. High NA individuals (NA+/SI-) reported similar poor health outcomes as Type Ds. However, they also reported lower social functioning and more fatigue, pain, micturition- and financial problems, while Type Ds reported more constipation, sexual problems and less sexual enjoyment. CONCLUSIONS: Type D personality and high NA both have a significant negative stable impact on HRQoL and disease-specific health status among CRC patients.