Depressed mood amplifies heart-related symptoms in persistent and paroxysmal atrial fibrillation patients: a longitudinal analysis--data from the German Competence Network on Atrial Fibrillation.

AIMS: There is limited evidence of an association between the burden of atrial fibrillation (AF)-related symptoms and depressed mood (DM). We used follow-up data from two randomized trials to relate AF symptoms, perceived AF burden, and DM. METHODS AND RESULTS: Baseline data on 319 persistent AF patients from the Flec-SL trial and 244 paroxysmal AF patients from the ANTIPAF trial were available. Data on 400 patients were available at 6-month follow-up. Depressed mood was measured using the major depression inventory, AF symptoms using the AF Symptom Checklist. Generalized estimating equation models were used to assess the association between symptom burden and DM. At baseline, 194 patients (35.2%) reported DM, 294 (52.2%) reported severe AF symptom burden. Burden from all symptoms except fainting was significantly elevated in patients with DM. An improvement in DM from baseline to follow-up was associated with reduced symptom burden [odds ratio (OR) = 2.06; 95% confidence interval (CI): 1.22-3.51]. Patients with DM had three-fold increased odds of severe symptom burden after adjustment for perceived AF-frequency and -duration, sex, and chronic obstructive pulmonary disorder (COPD) (OR = 3.19; 95% CI: 2.65-8.45). Women reported significantly more severe symptom burden than men (OR = 1.44; 95% CI: 1.36-1.95). Uneasiness, nausea, and shortness of breath were most strongly associated with DM. The effect of DM on nausea was more pronounced for men (P(interaction) = 0.041). Perceived AF-frequency and -duration were not associated with DM (P = 0.717 and 0.236, respectively). CONCLUSION: Depressed mood is associated with AF symptom burden over 6 months after adjustment for perceived frequency and duration of AF episodes, COPD, and sex.

Depression in paroxysmal and persistent atrial fibrillation patients: a cross-sectional comparison of patients enroled in two large clinical trials.

AIMS: Despite its high clinical relevance, few studies have investigated depression in patients with atrial fibrillation (AF). We aimed to assess whether depressed mood was more common in persistent or paroxysmal AF patients in controlled models and report frequencies of major depressive disorder. METHODS AND RESULTS: Cross-sectional data from two contemporary clinical trials were used to compare paroxysmal (n = 310) and persistent (n = 392) AF patients' depressed mood severity (measured by the Major Depression Inventory) with each trial including only one patient type. A four-category outcome of depressed mood severity was chosen as exposure variable. Ordinal logistic regression was applied to analyse the association of AF type with depressed mood in a crude model and a confounder control model. In the study sample, 8.4% were classified as having major depressive disorder [10.5% of persistent and 5.8% of paroxysmal patients; odds ratio (OR) = 1.89; 95% confidence interval (CI): 1.07-3.37], according to the diagnostic and statistical manual of mental disorders [(diagnostic and statistical manual of mental disorders (DSM-IV)] criteria. In both the age and sex adjusted crude model and in the confounder control model, the association of persistent AF with more severe depressed mood was significant (OR confounder controlled model = 1.44; 95% CI: 1.13-1.75, P = 0.007). CONCLUSION: Persistent AF patients may suffer from more severe depressed mood than paroxysmal AF patients with similar symptom burden after controlling for relevant factors.

Predictors of discordance between physicians' and patients' appraisals of health-related quality of life in atrial fibrillation patients: findings from the Angiotensin II Antagonist in Paroxysmal Atrial Fibrillation Trial.

BACKGROUND: Assessing health status is fundamental when weighing treatment options for atrial fibrillation (AF) patients. Most health-related quality-of-life (HRQoL) data stem from self-ratings, whereas treatment decisions are based upon physicians' estimations. METHODS: The degree of congruence between patients' and physicians' assessments of the patients' subjective health status was used as an indicator of good communication and shared understanding. A total of 334 patients with paroxysmal AF without significant concomitant heart diseases and their physicians were asked in a prospective blinded study to rate the patients' HRQoL. The Short Form-12 was used for self-ratings; the Short Form-8, for physician ratings. Using baseline data, intraclass correlations and Bland-Altman graphs were used to assess concordance; cross-sectional multivariate regression analyses assessed patient characteristics associated with discordance. RESULTS: On average, physicians rated their patients' HRQoL higher than patients did (∆mental component score [MCS] = -3.23, P < .0001, and ∆physical component score [PCS] = -2.21, P = .0001). Intraclass correlations and Bland-Altman graphs showed unsatisfactory concordance. Physical inactivity (∆ = 4.84) had the greatest bivariate effect on PCS discordance, and major depressive disorder (∆ = 7.01), on MCS discordance. In the regression analyses, depression was significantly associated with discord in the MCS (ß = -0.94, P < .001) and the PCS (ß = -0.37, P < .002). Sleeping disorder was associated with discord in the MCS (ß = -4.13, P < .002), and physical inactivity, with discord in the PCS (ß = -1.47, P = .006). CONCLUSIONS: In patients with AF, even in the absence of significant concomitant cardiac diseases, depression, followed by sleeping disorder and physical inactivity, was significantly associated with discordance. These findings should be considered by physicians when choosing treatment strategies.

Lifetime traumatic experiences and their impact on PTSD: a general population study.

OBJECTIVE: Exploring the relationship of exposure to a traumatic event and the subsequent onset of posttraumatic stress disorder (PTSD) in the population. METHODS: Posttraumatic stress disorder was assessed using the Impact of Event Scale (IES), Posttraumatic Diagnostic Scale (PDS) and interview data. Logistic regression analyses with sex, age, marital status, educational level and traumatic event characteristics were performed. Prevalences were standardised to the sex and age distribution of the German population. RESULTS: A total of 41 % of the subjects reported exposure to a trauma, leading to full PTSD in 1.7 % and to partial PTSD in 8.8 % of the participants. Logistic regression revealed accidents (OR 2.5, 95 % CI 1.3-4.7), nonsexual assault by known assailants (4.5, 2.1-9.8), combat/war experiences (5.9, 2.0-17.4), life-threatening illness (4.9, 2.7-8.9) and interpersonal conflicts (15.5, 2.5-96.0) as risk factors for full PTSD; risk factors for partial PTSD were accidents (3.2, 2.4-4.3), sexual (4.6, 2.2-9.6) or nonsexual (2.3, 1.4-3.8) assault by known assailants, life-threatening illness (6.2, 4.6-8.3), death of relatives (5.0, 3.2-7.8) and interpersonal conflicts (22.0, 8.3-58.1). CONCLUSIONS: Of subjects exposed to traumatic events, only a minority developed PTSD indicating a relationship between characteristics of the exposure and the individual and the onset of PTSD.

Job strain associated CRP is mediated by leisure time physical activity: results from the MONICA/KORA study.

BACKGROUND: Psychological stress at work is considered a cardiac risk factor, yet whether it acts directly through neuroimmune processes, or indirectly by increasing behavioral risk factors, is uncertain. Cross-sectional associations between job strain and serum biomarkers of inflammation and endothelial dysfunction were investigated. Secondary analyses explored the role of psychosocial/cardiometabolic risk factors as mediators of job stress associated inflammation in healthy workers. METHODS: Information on risk factors was obtained in standardized personal interviews of a subcohort of working participants in the MONICA/KORA population (n = 951). Work stress was measured by the Karasek job strain index. Biomarkers were measured from non-fasting venous blood. Multivariate regression analyses were used to examine the association of job strain with inflammatory biomarkers. Mediation analysis (Sobel test) was used to determine the effect of psychosocial risk factors on the association between job strain and C-reactive protein (CRP). RESULTS: High job strain was reported by half (n = 482, 50.7%) of the study participants. While workers with high job strain were more likely to have adverse workplace conditions (competition with coworkers, job dissatisfaction and insecurity), sleeping problems, depressive symptoms, a Type A personality, and be physically inactive, no differences in cardiometabolic risk factors were detected. A strong and robust association between job strain and CRP was observed in age and sex adjusted models, as well as models adjusted for classic coronary heart disease risk factors (ß = 0.39, p = 0.006 and ß = 0.27, p = 0.03, respectively). Adjustment for physical activity abrogated this effect (ß = 0.23, p = 0.07), and a mediating effect of physical activity on stress-associated inflammation was demonstrated (p = 0.04). CONCLUSIONS: The analyses provide evidence for both a direct and an indirect effect of job strain on inflammation.

The association between resilience and diabetic neuropathy by socioeconomic position: cross-sectional findings from the KORA-Age study.

We investigated whether older adults with diabetes mellitus and lower resilience have an increased risk of diabetic neuropathy as compared to older adults with higher resilience, and whether this association varies by socioeconomic position. In total, 3942 individuals took part in a health survey in Augsburg, Germany, in 2008-2010 (KORA-Age study). We found that among participants with low socioeconomic position, those with higher resilience had a lower probability of suffering from neuropathy as compared to participants with lower resilience (absolute risk reduction = 10%). Adjusted odds ratio with 95% confidence intervals for the outcome diabetic neuropathy also showed that lower resilience scores had an independent effect in increasing the risk of diabetic neuropathy among elderly individuals with a low socioeconomic position (odds ratio: 1.83; confidence interval: 1.09-3.08). Health-promoting strategies focussing on resilience should be further explored.

Validation and development of a shorter version of the resilience scale RS-11: results from the population-based KORA-age study.

BACKGROUND: The aim of this study was to assess reliability and validity of the Resilience Scale 11 (RS-11) and develop a shorter scale in a population-based study. METHODS: The RS-11 scale was administered to 3942 participants (aged 64 - 94 years) of the KORA-Age study. To test reliability, factor analyses were carried out and internal consistency (Cronbach's α) was measured. Construct validity was measured by correlating scores with psychological constructs. The criterion for a shorter scale was a minimum internal consistency of .80. Shorter models were compared using confirmatory factor analysis. Sensitivity and specificity of RS-5 to RS-11 was analyzed. RESULTS: Factor analysis of the RS-11 gave a 1-factor solution. Internal consistency was α = .86. A shorter version of the scale was developed with 5 items, which also gave a 1-factor solution and showed good validity. Internal consistency of this shorter scale: Resilience Scale 5 (RS-5) was α = .80. Sensitivity and specificity of RS-5 compared with RS-11 were .79 and .91 respectively. Both scales correlated significantly in expected directions with related constructs. CONCLUSIONS: The RS-11 and the RS-5 are reliable, consistent and valid instruments to measure the ability of elderly individuals to successfully cope with change and misfortune.