Biomarkers as predictors of CBT responsiveness in major depressive disorder: The role of heart rate variability and inflammation.

OBJECTIVE: Biological risk factors for cardiovascular disease may relate to poor treatment responsiveness in major depressive disorder (MDD). These factors encompass low-grade inflammation and autonomic dysregulation, as indexed by decreased heart rate variability (HRV) and increased heart rate (HR). This secondary analysis examined whether higher levels of inflammatory markers or autonomic alterations relate to lower responsiveness to cognitive behavioral therapy (CBT) among individuals with MDD. METHODS: Eighty antidepressant-free patients with MDD were randomly assigned to 14 weeks of CBT or waitlist (WL). Potential biological moderators at study entry included HR and HRV (24-h, daytime, nighttime) and inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. Forty non-clinical controls were involved to verify biological alterations in MDD at study entry. Depressive symptoms were assessed at baseline and at the end of treatment. RESULTS: Individuals with MDD exhibited reduced total 24-h HRV (i.e., triangular index) and daytime HRV (i.e., triangular index, HF-HRV, LF-HRV, RMSSD), as well as increased levels of inflammatory markers. Patients who received CBT exhibited stronger reductions in self- and clinician-rated depressive symptoms, compared to WL. False discovery rate-adjusted moderation analyses did not show overall moderating effects of biological measures on treatment responsiveness. However, higher CRP levels were specifically associated with poorer improvement in somatic depressive symptoms. CONCLUSIONS: There was no overall evidence for a moderating role of inflammation or autonomic features in CBT responsiveness in MDD. Higher levels of CRP might, however, specifically be associated with less improvement in somatic depressive symptoms during CBT.

Does subjective social status affect pain thresholds? - an experimental examination.

Past research regarding the relationship between different constructs of social status and different aspects of pain has yielded divergent results. So far, there are few experimental studies to investigate the causal relationship between social status and pain. Therefore, the present study aimed to examine the effect of perceived social status on pain thresholds by experimentally manipulating participants' subjective social status (SSS). 51 female undergraduates were randomly assigned to a low- or high-status condition. Participants' perceived social standing was temporarily elevated (high SSS condition) or reduced (low SSS condition). Before and after experimental manipulation participants' pressure pain thresholds were assessed. The manipulation check confirmed that participants in the low-status condition reported significantly lower SSS than participants in the high-status condition. A linear mixed model revealed a significant group x time interaction for pain thresholds: Whereas participants' pain thresholds in the low SSS condition increased post manipulation, pain thresholds of participants in the high SSS condition decreased post manipulation (ß = 0.22; 95% CI, 0.002 to 0.432; p < .05). Findings suggest that SSS may have a causal effect on pain thresholds. This effect could either be due to a change in pain perception or a change in pain expression. Future research is needed to determine the mediating factors.

Associations between indices of 24-hour heart rate variability and inflammation in individuals with major depressive disorder.

Biological cardiac risk factors, including reduced heart rate variability (HRV) and inflammation, are already prominent in patients with major depressive disorder (MDD) without existing cardiovascular disease. Although inverse relations between HRV and inflammation have been found across several populations, little work has been done concerning MDD. The present work thus intended to examine whether measures of HRV indices based on 24-h electrocardiograph recordings (24-h, daytime, nighttime) relate to levels of circulating inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α in eighty antidepressant-free individuals with MDD. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MDD. Individuals with MDD exhibited reduced total 24-h HRV (i.e., triangular index) and reduced daytime HRV (i.e., triangular index, HF-HRV, LF-HRV, RMSSD), as well as increased levels of all inflammatory markers. Multivariate analyses adjusted for age, sex, body mass index, and smoking revealed robust inverse associations of total 24-h HRV (i.e., triangular index) and daytime HRV (i.e., Triangular index, HF-HRV, LF-HRV, RMSSD) with IL-6. An attenuated daytime HRV may relate to higher circulating levels of IL-6 in the context of MDD. These findings show that biological cardiac risk factors may act in concert in MDD.

Subjective social status and nocturnal blood pressure dipping.

OBJECTIVE: Low social status has been linked to cardiovascular disease. Subjective social status (SSS), which represents one's perceived position in a social hierarchy, has been suggested to predict health outcomes beyond objective measures of socioeconomic status. The present study examined if lower SSS is related to reduced nocturnal blood pressure (BP) dipping, a risk factor for cardiovascular disease. METHODS: In this cross-sectional study, a community sample of 53 healthy adults underwent 24-h ambulatory BP monitoring. All participants provided information on SSS and objective measures of socioeconomic status (i.e., education, occupation, and income). SSS was measured in comparison to others in the country (national SSS) as well as in comparison to one's social environment (local SSS) using the German versions of the MacArthur Scales. RESULTS: Analyses found that participants with low local SSS exhibited attenuated nocturnal diastolic blood pressure dipping (ß = 0.29, 95% CI [0.01, 0.57], p = .043) and mean arterial pressure dipping (ß = 0.29, 95% CI [0.01, 0.57], p = .041). These associations remained significant after adjusting for objective socioeconomic status. No significant associations between national SSS and cardiovascular measures were observed. CONCLUSION: In conclusion, one's perceived social position in the social environment (i.e., local SSS) is associated with nocturnal BP dipping. Therefore, local SSS may be an important psychosocial factor linking social inequality and cardiovascular health.

Subjective social status and health-related quality of life-A cross-lagged panel analysis.

Objective: Subjective social status (SSS) refers to individuals' perceived position in the social hierarchy. Prior research suggests that SSS relates to health above and beyond objective socioeconomic status (OSS) such as income, occupation, or education. Most findings in this field, however, stem from cross-sectional studies or longitudinal studies with one-time measurements of SSS only. The aim of this study was to examine reciprocal longitudinal associations of both national SSS (i.e., comparison with people in one's country) and local SSS (i.e., comparison with people in one's social environment) with health-related quality of life. Method: A two-wave cross-lagged panel design with a 2-year follow-up was used to analyze data for national SSS, local SSS, physical and mental health-related quality of life (PHQL and MHQL), as well as OSS from initially 2,156 individuals who participated in the German Socioeconomic Panel Study-Innovation Sample (SOEP-IS). Results: Local and national SSS at baseline predicted PHQL at follow up and partially mediated associations between OSS and PHQL. Local SSS (but not national SSS) also predicted MHQL at follow-up but this association was only marginally significant after inclusion of OSS in the model. Regarding a reverse health-to-SSS pathway, PHQL (but not MHQL) at baseline predicted local and national SSS at follow-up and these associations were partially mediated by income. Conclusion: This study extends cross-sectional observations by confirming that both local and national SSS have unique longitudinal associations with health and provides novel insights into longitudinal pathways linking SSS, OSS, and health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Unemployment and mental health in the German population: the role of subjective social status.

PURPOSE: Subjective social status (SSS) reflects individuals' perceived position in a social hierarchy. Low SSS is associated with several mental health impairments. The aim of this cross-sectional study was to examine if unemployed individuals report lower SSS in Germany (national SSS) and lower SSS in their social community (local SSS) than employed individuals. Moreover, the relationship between unemployment, SSS, and mental health was examined. PATIENTS AND METHODS: 113 unemployed and 1117 employed individuals from a representative German panel provided information on their national and local SSS, their monthly income and their mental health. SSS was assessed with the German version of the MacArthur Scales. Mental health was measured using the mental component scale (MCS) of the SF-12. RESULTS: Unemployed individuals reported significantly lower national SSS, local SSS and mental health compared to employed participants. Mediational analyses suggest that the negative effect of employment status on mental health was explained via a reduction of national SSS. Local SSS did not mediate the association of employment status and mental health. CONCLUSION: Unemployment is associated with lower SSS and reduced mental health. The perceived position relative to others in the country (ie, national SSS) mediates the association between employment status and mental health.

What if I had not fallen from grace? Psychological distress and the gap between factual and counterfactual subjective social status.

The aim of this work was to test the hypothesis that the discrepancy between factual and counterfactual subjective social status (DCS) relates to psychological distress beyond the effect of current (i.e., factual) subjective and objective social status. Participants were 124 single mothers (Study 1) and 310 persons who have become unemployed (Study 2). In both samples, higher DCS was related to more severe symptoms of stress and depression beyond the effect of current subjective and objective social status. Upward counterfactual thinking might be an additional psychological factor in the relationship between social inequality and health in socially deprived individuals.