Measurement invariance of the Pandemic Anxiety Inventory in different demographic groups.

BACKGROUND: The Pandemic Anxiety Inventory (PAI) was developed in the context of the COVID-19 pandemic. Its content allows it to assess anxiety in connection to any pandemic. Previous research has demonstrated the instrument's reliability and validity. An important question for clinicians and researchers, however, remains open: Does the PAI have similar meaning for members of different demographic groups? The finding of measurement invariance would allow clinicians and researchers to comparatively assess pandemic-related anxiety across demographic groups, including favored and disfavored groups. METHODS: We conducted a multi-group confirmatory factor analysis to assess the measurement invariance of the PAI using data obtained from a sample of 379 residents of the United Kingdom. RESULTS: The PAI demonstrated invariance across genders, age groups, individuals who are married or in a relationship and those who are not, as well as individuals with higher and lower incomes. In an ancillary analysis, we found invariance across subsamples of Whites and Nonwhites, although we note that the Nonwhite group was small (n = 60) and heterogeneous. The findings of a supplemental MIMIC analysis were consistent with the above. CONCLUSIONS: The PAI shows measurement invariance across a variety of demographic groups. Our findings suggest that the instrument can be meaningfully employed to compare pandemic-related anxiety across these groups.

"Too much of a burden": Lived experiences of depressive rumination in early adulthood.

Rumination is an established transdiagnostic factor in mental illness, but there remains a significant gap in understanding the subjective experiences of those affected by it. This study explored the lived experiences of depressive rumination in early adulthood, a population notably susceptible to its effects. We interviewed 20 participants aged between 18 and 35 years using a semistructured approach and generated five distinct but interconnected themes using reflective thematic analysis. The first theme delved into recurrent narratives of past traumas and unresolved pain, with participants unable to move on from their past. The second theme illustrated how participants, due to real or perceived pressure, often equated their self-worth with their ability to meet expectations, leading to a distorted self-view and diminished self-esteem. The third theme captured the relentless pursuit of mental peace, with tranquility remaining ever elusive despite the frequent use of distraction. The fourth theme highlighted the profound isolation stemming from internalized mental health stigma, with participants grappling with fears of being perceived as burdensome and facing rejection from their close ones. Finally, the fifth theme underscored the far-reaching and interconnected repercussions of rumination on mental, emotional, and physical health and individuals' ability to achieve their life goals. These findings emphasize the intertwined nature of psychological, physiological, and social risk factors for the development and maintenance of rumination, advocating for a holistic treatment approach to rumination and paving the way for more timely, tailored care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A thematic analysis of how men and women post 56 years unwind from work during their free time.

BACKGROUND: Recent research indicates that as men age, their tendency to ruminate about work decreases, while ruminating remains high in women, which poses an increased risk for impaired health among older women. OBJECTIVE: This study explored gender differences/similarities in the process of unwinding from work in men and women aged between 56-65 years. METHODS: Semi-structured qualitative interviews were conducted online with eight men and eight women, recruited from a UK leading organization that provides health care solutions between May and June 2022. Participants were asked about their job role and responsibilities, their leisure time activities, how they unwind post work, and their experiences of thinking about work related thoughts outside of work. Transcripts were analyzed using an inductive analysis. RESULTS: Three superordinate themes were identified that underpinned their ability to unwind: 'Work style', 'Creating work-life balance' and 'Switching off from one's responsibilities'. Women reported a more perfectionist approach, they set high standards for themselves, were worried about making mistakes, and demonstrated, if in a supervisory role, a more nurturing and holistic approach to their colleagues/subordinates, while men, were more focused on task completion. Most women, but not men, also described difficulties in psychologically switching off from work, and stated they could only truly relax outside the home, when they are away from household activities. CONCLUSION: The study provides nuanced insights into the experiences of unwinding from work, and the findings suggest the need for person-centric approaches in developing interventions to help workers over 56 years to psychologically disengage from work.

Cognitive vulnerability, anxiety, and physical well-being in relation to 10-year cardiovascular disease risk: The ATTICA epidemiological study.

This study aimed to evaluate the association between irrational beliefs and the 10-year cardiovascular disease (CVD) incidence among apparently healthy adults. The ATTICA study is a population-based, prospective cohort (2002-2012) consisting of 853 participants without evidence of CVD (453 men and 400 women) who underwent psychological evaluations. Participants completed the Irrational Beliefs Inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. We conducted a factor analysis to develop irrational beliefs factors to evaluate the association between subcategories of irrational beliefs and CVD incidence. Demographic characteristics, detailed medical history, other psychological factors, and dietary and other lifestyle habits were also evaluated. The incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria. The identified dominant irrational beliefs factor, "cognitive vulnerability to anxiety," consisted of demandingness, perfectionism, emotional irresponsibility, anxious overconcern, dependence on others, and overconcern for the welfare of others, was strongly associated with an increased 10-year CVD risk. Nested multi-adjusted regression analysis revealed that anxiety, as well as negative physical well-being, mediated this relationship, and subset of irrational beliefs predicted CVD risk directly and indirectly through anxiety and negative physical well-being. These findings further map the path through which irrational beliefs can contribute to CVDs and provide insights in favor of preventive healthcare.

Association Between Family History of Diabetes, Irrational Beliefs, and Health Anxiety with 10-Year Risk of Type 2 Diabetes Mellitus: the ATTICA Epidemiological Study (2002-2012).

BACKGROUND: This study aimed to examine the relationship between family history of diabetes, irrational beliefs, and health anxiety in the development of type 2 diabetes mellitus (T2DM). METHOD: ATTICA is a prospective, cohort study (2002-2012). The working sample included 845 participants (18-89 years), free of diabetes at baseline. Α detailed biochemical, clinical, and lifestyle evaluation was performed, while participants' irrational beliefs and health anxiety were assessed through the Irrational Beliefs Inventory and the Whiteley index scale, respectively. We evaluated the association between the participants' family history of diabetes mellitus with the 10-year risk of diabetes mellitus, both in the total study's sample and separately according to their levels of health anxiety and irrational beliefs. RESULTS: The crude 10-year risk of T2DM was 12.9% (95%CI: 10.4, 15.4), with 191 cases of T2DM. Family history of diabetes was associated with 2.5 times higher odds (2.53, 95%CI 1.71, 3.75) of T2DM compared to those without family history. Among participants with family history of diabetes, the highest likelihood of developing T2DM, regarding their tested psychological features (i.e., low/high irrational beliefs in the entire group, low/high health anxiety in the entire group, and low/high irrational beliefs, low/high healthy anxiety), had people with high irrational beliefs, low health anxiety (OR 3.70, 95%CI 1.83, 7.48). CONCLUSIONS: The findings underline the important moderating role of irrational beliefs and health anxiety in the prevention of T2DM, among participants at increased risk of T2DM.

Work-related rumination declines with age but is moderated by gender.

BACKGROUND: Much is known about the physical effects of work and health, but less is known about how older workers unwind mentally from work, and their post-work ruminative thinking. OBJECTIVE: The present study aimed to explore the association between age, gender and two types of work-related rumination: affective rumination, and problem-solving pondering. METHODS: This study utilized a sample of 3991 full-time employees (working 30 or more hours per week), who were stratified into five age bands (18-25, 26-35, 36-45, 46-55, and 56-65 yrs.). RESULTS: Affective rumination was found to significantly decline in the older age groups (46 + yrs.), but this finding was moderated by gender. Males reported lower work-related rumination over the entire age range, but the greatest difference between males and females was observed in the 56-65 age category. The results for problem-solving pondering mirrored those of affective rumination but with the only exception that there was no significant difference in gender between those aged 18-25 years. CONCLUSION: These findings add to our understanding about how workers (between different age groups) mentally switch off from work and highlight the need for interventions to help older workers mentally recover from the effects of work.

Antecedents, outcomes and measurement of work related-cognition in non-work time: A multistudy report using the work-related rumination questionnaire in two languages.

According to the perseverative cognition hypothesis, prolonged activation for example, via work-related rumination impairs recovery and thereby poses a risk to employee health. The extent to which gender, age, occupation or longitudinal stress exposure may alter work-related rumination is an ongoing debate. Whether group or longitudinal comparisons of work-related rumination are valid, however, has never been tested. In this multistudy report, we therefore investigated measurement invariance of the widely used Work-Related Rumination Questionnaire (WRRQ) across gender, age, occupation, and longitudinal measurements by performing secondary analyses of preexisting data on work-related rumination. We examined the psychometric properties of WRRQ measurements in two languages and expand knowledge about the nomological network of affective rumination, problem-solving pondering and detachment in relation to individual employee characteristics (e.g., personality, work engagement, commitment), job stressors (e.g., work intensity, decision latitude, social relations with colleagues and supervisors) and employee health outcomes (e.g., wellbeing, irritation, somatic symptoms). Multigroup confirmatory factor analyses showed partial scalar invariance of English and German WRRQ measurements and full scalar invariance across gender, age, occupation and over the period of 1 week (Study 1, n = 2,207). Correlation analyses supported criterion, convergent and discriminant validity of WRRQ measurements (Study 2, n = 4,002). These findings represent a prerequisite for comparisons of work-related cognition across groups and further the understanding of the antecedents and outcomes of different types of work-related cognition.

Psychological interventions aiming for changing dietary habits in patients with cardiovascular disease: A systematic review and meta-analysis.

BACKGROUND: Diet is a critical component of healthy lifestyle, especially in cardiac rehabilitation. Psychological interventions, as well as mix-treatment interventions, such as psychological components, appear promising approaches in the adoption and maintenance of a healthy diet in patients with cardiovascular disease (CVD). Given the variety of clinical intervention programmes available, we aimed to determine whether psychological interventions and interventions that incorporate psychological components provide better lifestyle outcomes than traditional care, specifically targeting dietary outcomes, and what types of psychological or mix-treatment interventions are more likely to benefit patients with CVD. METHODS: A systematic literature search was performed using MEDLINE (PubMed), Scopus, Cochrane Library and PsycINFO to identify interventional studies, published from 2012 to 2022, written in English, evaluating psychological and mix-treatment intervention programmes for dietary outcomes in patients with CVD. In total, 33 intervention studies (n = 5644 patients) were retrieved and analysed using fixed and random effects models. RESULTS: No significant effect of the psychological intervention was observed regarding fruit and vegetable intake (Hedge's g = +1.06, p = 0.766), whereas a significant reduction was observed in alcoholic beverage consumption in the intervention group, as compared to the control group (Hedge's g = -7.33, p < 0.001). However, based on both our qualitative and quantitative analyses, psychological and mix-treatment interventions were more effective than traditional models in dietary modification. Also, the majority of effective interventions were psychological over mixed-treatment interventions. CONCLUSIONS: Findings add to the growing evidence suggesting that specific psychological interventions may be effective approaches in dietary modification for patients with CVD, potentially forming part of public health agenda.

Is rumination associated with psychological distress after a cancer diagnosis? A systematic review.

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.

Irrational beliefs, depression and anxiety, in relation to 10-year cardiovascular disease risk: the ATTICA Epidemiological Study.

BACKGROUND AND OBJECTIVES: Various bio-psychosocial mechanisms underlying the link between anxiety, depression and cardiovascular disease risk, remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety and depression in the 10-year cardiovascular disease (CVD) incidence, and the effect of biochemical and socio-behavioral factors. DESIGN: 853[453 men (45 ± 13 years) and 400 women (44 ± 18 years)] from the ATTICA study (2002-2012) and without evidence of CVD were assessed. METHODS: The Irrational Beliefs Inventory (IBI), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI) were used for the assessments. Incidence of CVD was defined according to the International Coding Diseases (ICD)-10 criteria. RESULTS: Participants with high irrational beliefs and anxiety symptoms had a 138% greater risk of developing CVD during the 10-year follow-up (2.38; 95%CI 1.75, 3.23) as compared to those without anxiety. Among others, C-reactive protein, interleukin-6 and total antioxidant capacity were mediators in the tested association. Interaction of irrational beliefs and depression was not associated with the 10-year CVD in all models. CONCLUSIONS: Inflammation and oxidative stress, partially explained the associations between irrational beliefs and anxiety in predicting CVD risk. These findings advance psychological research in the area of primary prevention of mental health and cardiovascular diseases.

Working from home during lockdown: the association between rest breaks and well-being.

One of the challenges with working from home (WFH) is the question of its effect on health and well-being. The impact of home working on health has so far not been studied extensively. We address this gap by investigating the association between internal recovery, operationalised as rest break frequency (low, medium, and high) during the working day, on self-reported musculoskeletal pain, and post-work recovery symptoms in WFH knowledge workers (n = 382). The analysis showed that failing to take frequent breaks was associated with a dose-response increased risk of reporting headaches. For post-work recovery symptoms, failing to take rest breaks throughout the day was associated with an increased risk of reporting psychological fatigue, physical fatigue, and sleep problems, and a decreased risk of psychologically detaching from work and experiencing adequate rest. Our findings emphasise the importance of remote workers taking recovery breaks from work demands in the maintenance of health and well-being.Practitioner Summary: For the foreseeable future, many knowledge workers will be obliged to work from home for at least, some days of the week. It is therefore important for workers to learn to regulate their behaviour, and workers need to be educated about the value of taking regular rest breaks throughout the working day.Abbreviations: ICT: Information and communications technology; MSDs: musculoskeletal disorders; MSPs: Musculoskeletal pain symptoms; OR: Odds ratio; WFH: Working from home; WRRQ: Work-Related Rumination Questionnaire Questionnaire.

Exploring the Role of Irrational Beliefs, Lifestyle Behaviors, and Educational Status in 10-Year Cardiovascular Disease Risk: the ATTICA Epidemiological Study.

BACKGROUND: Irrational beliefs, maladaptive emotions, and unhealthy lifestyle behaviors can adversely affect health status. However, limited research has examined the association between irrational beliefs and cardiovascular disease (CVD). The aim of this study was to evaluate the association between irrational beliefs and the 10-year CVD incidence among apparently healthy adults, considering the potential moderating or mediating role of particular social and lifestyle factors. METHODS: The ATTICA study is a population-based, prospective cohort (2002-2012), in which 853 participants without a history of CVD [453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)] underwent psychological evaluations. Among other tools, participants completed the irrational beliefs inventory (IBI, range 0-88), a self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, dietary, and other lifestyle habits were also evaluated. Incidence of CVD (i.e., coronary heart disease, acute coronary syndromes, stroke, or other CVD) was defined according to the International Coding Diseases (ICD)-10 criteria. RESULTS: Mean IBI score was 53 ± 2 in men and 53 ± 3 in women (p = 0.88). IBI score was positively associated with 10-year CVD risk (hazard ratio 1.07, 95%CI 1.04, 1.13), in both men and women, and more prominently among those with less healthy dietary habits and lower education status; specifically, higher educational status leads to lower IBI score, and in conjunction they lead to lower 10-year CVD risk (HR for interaction 0.98, 95%CI 0.97, 0.99). CONCLUSIONS: The findings of this study underline the need to build new, holistic approaches in order to better understand the inter-relationships between irrational beliefs, lifestyle behaviors, social determinants, and CVD risk in individuals.

The Pandemic Anxiety Inventory: A validation study.

The Pandemic Anxiety Inventory (PAI) assesses anxiety symptoms individuals attribute to the presence of a pandemic. We conducted this study of 379 British adults during the COVID-19 pandemic and found that the PAI exhibited excellent reliability and solid criterion validity. Pandemic anxiety was associated with reduced social support, anticipated life changes, financial strain, job loss, economic insecurity, and the hospitalization or death of a close friend or relative. Using correlational and bifactor analyses, we found that the PAI demonstrated solid convergent and discriminant validity. The findings suggest that the PAI can be used in research and clinical practice.

Hyperacusis and Misophonia: A Systematic Review of Psychometric Measures.

BACKGROUND: Hyperacusis can be defined as an intolerance of certain everyday sounds, which are perceived as too loud or uncomfortable and which cause significant distress and impairment in the individual's day-to-day activities. Misophonia is defined as a high magnitude of emotional and behavioral reaction to certain sounds produced by human beings, such as eating sounds and breathing sounds. Several psychometric instruments have been developed to assess symptoms and the impact of hyperacusis and misophonia; however, to the authors' knowledge, no study has evaluated and compared the methodological quality of the studies on psychometric properties of the existing instruments. PURPOSE: This article systematically reviews the research studies assessing the psychometric properties of the instruments used for hyperacusis and misophonia and assesses the quality and appropriateness of the methodologies used. RESEARCH DESIGN: Systematic review. DATA COLLECTION AND ANALYSIS: A systematic literature search was performed using five electronic literature databases (PubMed, Scopus, PsycINFO, Google Scholar, and Web of Science). Studies were included if they were written in English and reported information about the psychometric properties of instruments measuring hyperacusis or misophonia symptoms or their impact. The quality of the studies and that of the psychometric instruments were evaluated using the consensus-based standards for the selection of health-measurement instruments (COSMIN) tool. RESULTS: The title and abstracts of 916 articles were screened and 39 articles were selected for full-text evaluation, with 14 articles meeting the inclusion criteria. From these 14 articles, 8 different instruments (5 for hyperacusis and 3 for misophonia) were identified and reviewed comprising: (1) Hyperacusis Questionnaire (HQ), (2) Inventory of Hyperacusis Symptoms, (3) questionnaire on hypersensitivity to sound, (4) Hyperacusis Handicap Questionnaire, (5) short HQ, (6) Amsterdam Misophonia Scale, (7) MisoQuest, and (8) the Misophonia Questionnaire. CONCLUSION: None of the papers reviewed reported all the information required to meet the COSMIN standards. The studies' methodological quality varied between "very good" and "inadequate" depending on their grade on the COSMIN tool. There is a need for further research on the psychometric properties of the instruments included in this review.

The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder patients-A replication study.

The cortisol awakening response (CAR) is a non-invasive biomarker for hypothalamic-pituitary-adrenal axis (HPA) dysregulation, reflecting accumulated stress over time. In a previous study we reported that a blunted CAR before an inpatient treatment predicted self-reported depressive symptoms six weeks and six months after discharge [Eikeseth, F. F., Denninghaus, S., Cropley, M., Witthöft, M., Pawelzik, M., & Sütterlin, S. (2019). The cortisol awakening response at admission to hospital predicts depression severity after discharge in major depressive disorder (MDD) patients. Journal of Psychiatric Research, 111, 44-50)]. This replication study adopted an improved overall methodology with more stringent assessment protocols and monitoring. The longitudinal design included 122 inpatients from a psychosomatic hospital with a diagnosis of MDD displaying symptoms of moderate to severe major depression (n = 80 females). The CAR was measured at intake. Depression severity was assessed as Beck Depression Inventory II scores at intake, discharge, 6 weeks and 6 months following discharge. Results from the original study were replicated in terms of effect size but did not reach statistical significance (correlation between BDI-II 6 months after discharge and AUCg: r = -0.213; p = 0.054). The replication study yielded nearly identical correlation coefficients as in the original study (BDI-II 6 months and CAR, r = -0.223, p < 0.05). The replication of previously reported effect sizes with a concurrent lack of statistical significance in the more restrictive, larger and better controlled replication study may well inform research on psycho-endocrinological predictors for treatment success, but suggests a rather limited practical relevance for cortisol awakening response measures in this clinical context.

Disentangling change across the time and true stability of employees' resilience using latent state model.

There is debate within the literature about whether resilience should be considered a stable character trait or a dynamic, changeable process (state). Two widely used measures to assess resilience are the Connor-Davidson Resilience Scale (CD-RISC) and the Resilience Scale for Adults (RSA). The aim of this study was to evaluate the true stability (invariance) and change across time in resilience captured by these two measures. Using the perspective of Latent State-Trait theory, the aim was to decipher if the CD-RISC and the RSA are more trait-like or more state-like and to address whether true differences in resilience between participants increased (or decreased) across time. In this longitudinal study, UK-based employees (N = 378) completed the CD-RISC (10-item version) and the RSA (33-item version, aggregated and analyzed under six parcels) at three occasions over six months. A latent-state model and latent-state model with indicator specific residual factors were utilized. The analysis suggested that both questionnaires capture trait and state components of resilience. These results contribute to the discussion about how resilience scales are measuring change and stability, and how we define resilience as a more trait-like or state-like phenomena. The findings also highlight the issue of what resilience scales are measuring and whether resilience is a quantifiable construct.

Chronic Stress Is Associated with Reduced Mindful Acceptance Skills but Not with Mindful Attention Monitoring: A Cross-Sectional Study.

Mindfulness-based interventions (MBIs) are effective in reducing chronic stress, but their therapeutic mechanisms are unclear. One possibility is that MBIs act by re-training attention monitoring and acceptance skills that have been impaired by chronic stress exposure. However, little research has investigated the association between chronic stress, monitoring, and acceptance. In this cross-sectional study we hypothesised observing correlations between stress, and (impaired) monitoring and acceptance. Moreover, we exploratively compared the magnitude of the correlations between chronic stress and four acceptance measures. Finally, we explored whether the association between stress and monitoring is moderated by acceptance. Eighty-five adults participated in the study and completed self-reported chronic stress and acceptance questionnaires and a mindful attention behavioural task. The results revealed that chronic stress was associated with reduced acceptance (all ps < 0.01) but not with monitoring. Exploratory analyses revealed no differences in the magnitude of the correlations between stress and each acceptance measure, except for the combined facets of mindfulness acceptance subscales and nonreactivity subscale (p = 0.023). Further analyses revealed a significant negative association between stress and the interaction between acceptance and the target detection component of monitoring (p = 0.044). Surprisingly, these results show that stress is associated with reduced monitoring at higher levels of acceptance. Theory-driven intervention studies are warranted to complement our results.

Psychological factors in relation to the 10-year incidence of metabolic syndrome: The ATTICA epidemiological study (2002-2012).

BACKGROUND AND AIMS: Various bio-psychological mechanisms underlying the association between mental health problems and metabolic syndrome remain unknown. We investigated the role of irrational beliefs in conjunction with anxiety, depression and hostility in the 10-year metabolic syndrome (MetS) incidence, and the effect of biochemical and socio-behavioral factors on the aforementioned associations. METHODS AND RESULTS: ATTICA is a prospective, cohort study (2002-2012). The sample included 591 participants [51.3% men (aged 41.5 ± 10 years) and 48.7% women (aged 37.5 ± 11.5 years)], free of MetS at baseline. Detailed biochemical, clinical, and lifestyle evaluations were performed, while participants' irrational beliefs, anxiety, depression and hostility were assessed using the Irrational Beliefs Inventory, the Spielberger State-Trait Anxiety Inventory, the Zung Self-Rating Depression Scale and the Hostility and Direction of Hostility Questionnaire, respectively. Multiple logistic regression was applied to estimate the odds ratio (OR) of developing MetS and to control for confounders, as well as stratified logistic regression to detect moderator effects. High irrational beliefs were associated with 1.5-times higher odds of developing MetS than low irrational beliefs. Especially, participants with high irrational beliefs and high anxiety were 96% more likely to develop MetS, compared with those with low irrational beliefs and low or high anxiety (OR = 1.96; 95% CI = 1.01, 3.80). CONCLUSION: The findings of the study underline the important role of irrational beliefs and anxiety in the development of MetS and the need to build new holistic approaches focused on the primary prevention of both mental health and MetS.

Irrational Beliefs, Dietary Habits and 10-Year Incidence of Type 2 Diabetes; the ATTICA Epidemiological Study (2002-2012).

OBJECTIVE: The aim of this study was to evaluate the dietary habits and irrational beliefs of apparently healthy individuals in relation to their 10-year diabetes incidence. METHODS: The ATTICA study (2002-2012) is a prospective populationbased cohort study, in which 853 participants (453 men (aged 45 ± 13 years) and 400 women (aged 44 ± 18 years)) without a history of cardiovascular disease (CVD) underwent psychological evaluations. Among other things, participants completed the Irrational Beliefs Inventory (IBI, range 0-88), a brief, self-reported measure consistent with the Ellis model of psychological disturbance. Demographic characteristics, detailed medical history, and dietary and other lifestyle habits were evaluated as well. Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association. RESULTS: Mean IBI score was 53 ± 10 in men and 51± 11 in women (p = 0.68). IBI was positively associated with the 10-year type 2 diabetes incidence (hazard ratio: 1.14; 95% CI: 1.04-1.25) in both men and women, and even more distinctly associated with participants with the following characteristics: lower education status, married, overweight, smokers, anxiety and depressive symptomatology, and unhealthy dietary habits. Especially, participants with increased irrational beliefs and low adherence to the Mediterranean diet were 37% more likely to develop type 2 diabetes than those with the reverse status (hazard ratio: 3.70; 95% CI: 2.32-5.88). CONCLUSIONS: These data support the need for lifestyle changes towards healthier nutrition which can be achieved by educating people so that they are equipped to recognize false and unhelpful thoughts and thus to prevent negative psychological and clinical outcomes such as mental health disorders and type 2 diabetes.

Irrational beliefs trigger depression and anxiety symptoms, and associated with increased inflammation and oxidative stress markers in the 10-year diabetes mellitus risk: the ATTICA epidemiological study.

PURPOSE: To investigate the combined role of irrational beliefs, anxiety and depression in the 10-year incidence of type 2 diabetes, and the underlying effect of biochemical, and socio-behavioural factors. METHODS: Within the context of the ATTICA cohort study (2002-2012), 853 participants without evidence of CVD [453 men (45 ± 13 years) and 400 women (44 ± 18 years)] underwent psychological evaluation through the Irrational Beliefs Inventory (IBI) (range 0-88), the Zung Self-Rating-Depression-Scale (ZDRS) and the State-Trait-Anxiety-Inventory (STAI). Diagnosis of diabetes at follow-up examination was based on the criteria of the American Diabetes Association (ADA). RESULTS: Mean IBI score was 53 ± 10 in men and 51 ± 11 in women (p = 0.68). Participants with high irrational beliefs who also had anxiety symptoms had a 93% excess risk of developing diabetes during the 10-year follow-up (Hazard Ratio 1.93; 95%CI 1.34, 2.78) as compared to those without anxiety. Moreover, diabetes risk was 73% higher among individuals with high levels of irrational beliefs and depression as compared to those where depression was absent (1.73; 1.21, 2.46). Lower education status, family history of diabetes, hypercholesterolemia, high BMI, as well as tumor necrosis factor and total antioxidant capacity were revealed as mediating risk factors related to the tested associations. CONCLUSION: Irrational beliefs among apparently healthy adults trigger depression and anxiety symptomatology, and through the increased inflammation and oxidative stress profile, were associated with increased diabetes risk. This observation moves psychological research a step forward in supporting and guiding primary prevention of mental health and metabolic conditions.