The Semmelweis Study: a longitudinal occupational cohort study within the framework of the Semmelweis Caring University Model Program for supporting healthy aging.

The Semmelweis Study is a prospective occupational cohort study that seeks to enroll all employees of Semmelweis University (Budapest, Hungary) aged 25 years and older, with a population of 8866 people, 70.5% of whom are women. The study builds on the successful experiences of the Whitehall II study and aims to investigate the complex relationships between lifestyle, environmental, and occupational risk factors, and the development and progression of chronic age-associated diseases. An important goal of the Semmelweis Study is to identify groups of people who are aging unsuccessfully and therefore have an increased risk of developing age-associated diseases. To achieve this, the study takes a multidisciplinary approach, collecting economic, social, psychological, cognitive, health, and biological data. The Semmelweis Study comprises a baseline data collection with open healthcare data linkage, followed by repeated data collection waves every 5 years. Data are collected through computer-assisted self-completed questionnaires, followed by a physical health examination, physiological measurements, and the assessment of biomarkers. This article provides a comprehensive overview of the Semmelweis Study, including its origin, context, objectives, design, relevance, and expected contributions.

Quality of life and related constructs in a group of infertile Hungarian women: a validation study of the FertiQoL.

Quality-of-life measurement is a basic prerequisite for psychologically sensitive fertility care and the FertiQoL is a psychometrically sound outcome measure in this field. The aim of the present research was to investigate the reliability and validity of the Hungarian Core FertiQoL. Two independent samples of infertile women were merged (n = 320). While the model fit of the four-factor Confirmatory Factor Analysis was under the level of acceptability (χ2(246) = 626.36, p < 0.001, RMSEA = 0.070 [CI90 = 0.063-0.076], CFI = 0.878, SRMR = 0.071), the four-factor Exploratory Structural Equation Model showed much improved model fit (χ2(186) = 395.63, p < 0.001, RMSEA = 0.059 [CI90 = 0.051-0.067], CFI = 0.933, SRMR = 0.035). Good internal consistency (Cronbach's Alphas 0.77-0.92) and construct reliability (0.75-0.95) were found for both factor structures. Depression correlated negatively with fertility-specific quality of life. Almost a quarter of the sample suffered from moderate-to-severe depression. Multivariate analysis of variance indicated that Beck Depression Inventory categories (mild, moderate etc.) co-occurred with significantly distinct FertiQoL score ranges, leading to a possible, clinically meaningful threshold on the Core FertiQoL. Pearson coefficients showed secondary infertility, rural residency and pre-treatment status to be associated with better fertility quality of life.

Depression among predictors of intermittent claudication: A cross-sectional study.

PURPOSE: The aim of the present cross-sectional study was to investigate the relationship between depression and intermittent claudication (IC), independently of traditional risk factors. MAIN METHODS: The sample consisted of 300 individuals (M age = 65.3 ± 8.7 years, 61.0% female) recruited from the offices of 33 general practitioners. Participants' medical history and the presence of major cardiovascular risk factors were recorded. Participants completed the Edinburgh Claudication Questionnaire. The role of depression (assessed by a shortened version of the Beck Depression Inventory) in predicting IC was examined using a binary logistic regression analysis - controlled for sex, age, hypertonia, diabetes, smoking, hypercholesterinemia, hazardous drinking, and body mass index (BMI). RESULTS: The descriptive data indicated that the prevalence of depression was 57.9% in the IC subgroup and 16.1% in those free of IC. The bivariate analyses indicated that hypercholesterinemia, smoking, hazardous drinking, BMI, and depression were significantly associated with IC. Male sex and age showed a trend toward being a significant correlate of IC. Results of the multivariate analyses indicated that depressive symptomatology was significant in predicting IC (OR: 1.08 (1.05-1.11)), even after controlling for lifestyle and traditional risk factors such as smoking, hazardous drinking, and BMI. Among traditional risk factors, smoking (OR: 2.44 (1.26-4.74)), hazardous drinking (OR: 1.19 (1.02-1.40)), and hypercholesterinemia (OR: 2.17 (1.26-3.75)) showed a significant, positive relationship with IC. CONCLUSIONS: These results underscore the importance of a multidisciplinary approach that focuses on supporting health-related behavioral changes and managing mental health symptoms when providing care for patients with IC.

Depressive symptomatology and personality traits in patients with symptomatic and asymptomatic peripheral arterial disease.

BACKGROUND: The aim of this study was to examine the relationship of depressive symptomatology and personality traits with peripheral arterial disease (PAD). METHODS: The sample of this cross-sectional study comprised of 300 individuals (Mage = 65.3 ± 8.7 years, 61.0% female) recruited from the offices of 33 general practitioners. Based on at-rest ankle-brachial index (ABI) values and claudication symptoms, four subsamples were formed: clear PAD-positive, clear PAD-negative, ABI-negative but symptomatic, and a non-compressible-artery group. The concurrent role of depression (assessed by a shortened version of the Beck Depression Inventory) and personality traits (measured by the Big Five Inventory) in predicting PAD status was examined using multinomial logistic regression - controlled for sex, age, hypertonia, diabetes, smoking, hazardous drinking, and body mass index. RESULTS: Depressive symptomatology was significant in predicting peripheral arterial disease status even after controlling for both traditional risk factors and personality traits. Among the Big Five personality traits, neuroticism showed a significant, positive relationship with PAD - independently of depression. CONCLUSIONS: Patients with PAD - even those with asymptomatic forms of the disease - are at higher risk for suffering from depression compared to individuals without PAD, independently of neuroticism, other Big Five personality dimensions or traditional risk factors for cardiovascular diseases.

Social relations in late adolescence and incident coronary heart disease: a 38-year follow-up of the Swedish 1969-1970 Conscription Cohort.

OBJECTIVES: Increasing evidence suggests that low social support is associated with an elevated risk of coronary heart disease (CHD). Earlier studies in this field were conducted in predominantly middle-aged or older samples; thus, the associations reported previously may have been confounded by subclinical manifestations of the disease. We investigated whether social relationships in late adolescence, that is, well before symptoms of subclinical disease manifest, are associated with CHD during a 38-year follow-up. SETTING: Sweden. PARTICIPANTS: Men born 1949-1951 and conscripted for military service in Sweden during 1969-1970 (n=49 321). At conscription, participants completed questionnaires about social relationships, lifestyle and health-related factors and underwent a medical examination. PRIMARY AND SECONDARY OUTCOME MEASURES: CHD, acute myocardial infarction (AMI). RESULTS: We found no relationship between having no confidant and frequency of confidential discussions with friends and the risk of CHD or AMI in the first 30 years of follow-up. However, after 30 years, men with no confidant at baseline had increased CHD and AMI risks relative to those having a confidant; the childhood socioeconomic status-adjusted HR and 95% CIs (CI) were 1.25 (1.10 to 1.41) and 1.27 (1.08 to 1.49), respectively. The frequency of confidential discussions with friends had an inverse U-shaped relationship with the outcomes after 30 years; the HR (95% CI) for 'sometimes' versus 'quite often' was 1.16 (1.04 to 1.29) for CHD and 1.16 (1.01 to 1.33) for AMI. These associations persisted after adjusting for mental ill-health, lifestyle factors and systolic blood pressure. A low number of friends in late adolescence was not related to an increased CHD or AMI risk. CONCLUSIONS: Not having a confidant in late adolescence was associated positively, while the frequency of confidential discussions with friends had an inverse U-shaped relationship with CHD and AMI after 30 years of follow-up, suggesting that these associations are not due to subclinical disease manifestations.

The role of vital exhaustion in predicting the recurrence of vascular events: A longitudinal study.

BACKGROUND/OBJECTIVE: The aim of this study was to examine the role of vital exhaustion in predicting the recurrence of vascular events. METHOD: The sample comprised of 816 individuals (65.3% female, M age  = 43.2 years, SD = 14.7 years), 395 (48.4%) of whom reported treatment for the reoccurrence of a vascular event during the four-year follow-up period. Concurrent effects of baseline vital exhaustion (measured by a shortened version of the Maastricht Questionnaire), depression (assessed by a shortened version of the BDI), anxiety (assessed by the HADS), and hostility (assessed by a shortened version of the Cook-Medley Hostility Scale) in predicting the recurrence of T2 vascular events were examined. The analyses were also controlled for traditional risk factors, such as age, education, body mass index, smoking, alcohol use, and lack of physical activity. RESULTS: The regression analyses showed that vital exhaustion scores significantly predicted the reoccurrence of vascular events even after controlling for all covariates. None of the other psychological predictors (depression, anxiety, and hostility) was significant in the final model. CONCLUSIONS: These results suggest that despite the partial conceptual overlap with several similar constructs, vital exhaustion is a distinct phenomenon that deserves consideration when planning and implementing interventions to reduce the risk of vascular diseases.

ANTECEDENTES/OBJETIVO: El objetivo de este estudio fue examinar el papel del agotamiento vital en la predicción de la recurrencia de eventos vasculares. MÉTODO: La muestra estaba compuesta por 816 sujetos (65,3% mujeres, M edad = 43,20 años; DT = 14,70 años), 395 (48,40%) de los cuales tuvieron tratamiento para la reincidencia de evento vascular durante los cuatro años de seguimiento. Se examinaron los efectos concurrentes del agotamiento vital inicial (medido por una versión abreviada del Maastricht Questionnaire), depresión (evaluada por una versión abreviada del BDI), ansiedad (evaluada por el HADS) y hostilidad (evaluada por una versión reducida de la Cook-Medley Hostility Scale) en la predicción de la recurrencia de eventos vasculares T2. Los análisis también fueron controlados por factores de riesgo (edad, educación, índice de masa corporal, tabaquismo, consumo de alcohol y falta de actividad física). RESULTADOS: Las puntuaciones de agotamiento vital predijeron la recurrencia de eventos vasculares, incluso después de controlar todas las covariables. Ninguno de los otros predictores psicológicos fue significativo en el modelo final. CONCLUSIONES: A pesar de la superposición conceptual parcial con varios constructos similares, el agotamiento vital es un fenómeno distinto que merece ser considerado al planificar e implementar intervenciones para reducir el riesgo de enfermedades vasculares.

The role of vital exhaustion in predicting the recurrence of vascular events: A longitudinal study / El papel del agotamiento vital en la predicción de la recurrencia de eventos vasculares: un estudio longitudinal

Background/objective: The aim of this study was to examine the role of vital exhaustion in predicting the recurrence of vascular events. Method: The sample comprised of 816 individuals (65.3% female, Mage = 43.2 years, SD = 14.7 years), 395 (48.4%) of whom reported treatment for the reoccurrence of a vascular event during the four-year follow-up period. Concurrent effects of baseline vital exhaustion (measured by a shortened version of the Maastricht Questionnaire), depression (assessed by a shortened version of the BDI), anxiety (assessed by the HADS), and hostility (assessed by a shortened version of the Cook-Medley Hostility Scale) in predicting the recurrence of T2 vascular events were examined. The analyses were also controlled for traditional risk factors, such as age, education, body mass index, smoking, alcohol use, and lack of physical activity. Results: The regression analyses showed that vital exhaustion scores significantly predicted the reoccurrence of vascular events even after controlling for all covariates. None of the other psychological predictors (depression, anxiety, and hostility) was significant in the final model. Conclusions: These results suggest that despite the partial conceptual overlap with several similar constructs, vital exhaustion is a distinct phenomenon that deserves consideration when planning and implementing interventions to reduce the risk of vascular diseases

Antecedentes/objetivo: El objetivo de este estudio fue examinar el papel del agotamiento vital en la predicción de la recurrencia de eventos vasculares. Método: La muestra estaba compuesta por 816 sujetos (65,3% mujeres, Medad = 43,20 años; DT = 14,70 años), 395 (48,40%) de los cuales tuvieron tratamiento para la reincidencia de evento vascular durante los cuatro años de seguimiento. Se examinaron los efectos concurrentes del agotamiento vital inicial (medido por una versión abreviada del Maastricht Questionnaire), depresión (evaluada por una versión abreviada del BDI), ansiedad (evaluada por el HADS) y hostilidad (evaluada por una versión reducida de la Cook-Medley Hostility Scale) en la predicción de la recurrencia de eventos vasculares T2. Los análisis también fueron controlados por factores de riesgo (edad, educación, índice de masa corporal, tabaquismo, consumo de alcohol y falta de actividad física). Resultados: Las puntuaciones de agotamiento vital predijeron la recurrencia de eventos vasculares, incluso después de controlar todas las covariables. Ninguno de los otros predictores psicológicos fue significativo en el modelo final. Conclusiones: A pesar de la superposición conceptual parcial con varios constructos similares, el agotamiento vital es un fenómeno distinto que merece ser considerado al planificar e implementar intervenciones para reducir el riesgo de enfermedades vasculares

[Negative emotions associated with cardiovascular diseases]. / A negatív érzelmek és a szív- és érrendszeri betegségek összefüggései.

With regard to cardiovascular health, the role of negative emotions, particularly that of depression, anxiety, vital exhaustion and hostility has been studied the most widely. Mainly the somatic symptoms of depression and, out of anxiety disorders, generalised anxiety and panic disorder have been linked to cardiovascular diseases. Based on an analysis of interviews of patients having suffered myocardial infarction, it was found that vital exhaustion (a combination of loss of energy, increased irritability, and general demoralization) is a precursor of infarction. Vital exhaustion has proven to contribute to the development of coronary heart diseases, being one of the most important risk factors in both sexes. With regard to hostility, studies show that anger suppression and destructive anger expression (blaming others) are closely linked to a higher incidence of coronary heart diseases. Evidence shows that the relationship between negative emotions and cardiovascular diseases is one of a two-way causality, that is, the presence of a cardiovascular disease may also enhance negative emotions, low heart rate variability playing a crucial role in both diseases. This study also presents interview questions suggested by the European Guidelines (2016) to estimate negative emotions related to coronary heart diseases. Orv Hetil. 2018; 159(48): 2005-2010.

Anxiety and depression among infertile women: a cross-sectional survey from Hungary.

BACKGROUND: Infertility is often associated with a chronic state of stress which may manifest itself in anxiety-related and depressive symptoms. The aim of our study is to assess the psychological state of women with and without fertility problems, and to investigate the background factors of anxiety-related and depressive symptoms in women struggling with infertility. METHODS: Our study was conducted with the participation of 225 (134 primary infertile and 91 fertile) women, recruited in a clinical setting and online. We used the following questionnaires: Spielberger Trait Anxiety Inventory (STAI-T), Shortened Beck Depression Inventory (BDI) and Fertility Problem Inventory (FPI). We also interviewed our subjects on the presence of other sources of stress (the quality of the relationship with their mother, financial and illness-related stress), and we described sociodemographic and fertility-specific characteristics. We tested our hypotheses using independent-samples t-tests (M ± SD) and multiple linear regression modelling (ß). RESULTS: Infertile women were younger (33.30 ± 4.85 vs. 35.74 ± 5.73, p = .001), but had significantly worse psychological well-being (BDI = 14.94 ± 12.90 vs. 8.95 ± 10.49, p < .0001; STAI-T = 48.76 ± 10.96 vs. 41.18 ± 11.26, p < .0001) than fertile subjects. Depressive symptoms and anxiety in infertile women were associated with age, social concern, sexual concern and maternal relationship stress. Trait anxiety was also associated with financial stress. Our model was able to account for 58% of the variance of depressive symptoms and 62% of the variance of trait anxiety. CONCLUSIONS: Depressive and anxiety-related symptoms of infertile women are more prominent than those of fertile females. The measurement of these indicators and the mitigation of underlying distress by adequate psychosocial interventions should be encouraged.

Are vital exhaustion and depression independent risk factors for cardiovascular disease morbidity?

OBJECTIVE: The aim of this study was to examine the concurrent effects of vital exhaustion and depression on the development of cardiovascular disease (CVD) morbidity. METHOD: The sample of this representative, 4-year longitudinal study comprised 2,725 participants (43.56% male, Mage = 58.39 years, SDage = 14.39 years). Individuals being treated for hypertension (n = 277) and cardio- and/or cerebrovascular incidents (n = 131) for the first time during the follow-up period were compared with participants never treated for CVD (n = 2,317). Joint principal component analysis was conducted on the items of the vital exhaustion (shortened Maastricht Questionnaire) and depression (shortened Beck Depression Inventory) measures simultaneously resulting in 3 components representing depression, vital exhaustion, and sleep difficulties. The role of these 3 components in predicting the incidence of CVD morbidity was examined using logistic regression-controlling for traditional risk factors such as sex, age, education, body mass index, smoking, alcohol use, and physical inactivity. RESULTS: In the multivariate analyses, vital exhaustion (OR = 1.20, CI = 1.03-1.39, p = .021) and sleep-related problem (OR = 1.16, CI = 1.00-1.33, p = .044) scores proved to be independent predictors of treatment initiation for hypertension, while sleep-related difficulties predicted CVD event incidence (OR = 1.27, CI = 1.06-1.52, p = .009). However, depressive symptomatology factor scores were not associated with either cardiovascular outcome in the regression analyses. CONCLUSIONS: Vital exhaustion and depressive symptomatology showed a different pattern in their relationship with CVD incidence, with vital exhaustion being the more robust predictor. These results suggest that the 2 constructs are not identical and that vital exhaustion deserves consideration when planning and implementing interventions to reduce CVD risk. (PsycINFO Database Record

[Anxiety, depression, health-related control beliefs, and their association with health behavior in patients with ischemic heart disease]. / Szorongás, depresszió, egészségkontrollhit és az egészség-magatartással való kapcsolatuk ischaemiás szívbetegek körében.

INTRODUCTION: Psychological and lifestyle factors affect the development and outcome of heart disease considerably. AIM: The aims of the authors were to examine health control, level of anxiety and depression and to analyse their relationship with health behaviour in patients with ischemic heart disease. METHOD: The present cross-sectional study involved 116 patients who took part in residential cardiac rehabilitation (56.9% men, mean age: 57.65±8.22 years). RESULTS: 30.9% of the patients reported elevated anxiety and 21.9% increased depressive symptomatology. Social-external control belief was the strongest among respondents. Further, anxiety and depression were negatively associated with healthy diet and the frequency of exercise. Patients with stronger social-external control beliefs were more likely to seek medical attention if they suspected a disease. CONCLUSIONS: It is important to assess psychological risk factors linked to cardiovascular diseases in cardiac rehabilitation departments and to initiate psychological interventions if indicated.

[Relationships between psychological well-being, lifestyle factors and fertility]. / A pszichés jóllét, az életmód és a termékenység összefüggései.

INTRODUCTION: 10 to 15% of the Hungarian fertile age population struggles with reproductivity problems. Previous researches have shown that psychological well-being and lifestyle factors play a pivotal role in overall health status, which is closely related to fertility. AIM: The aim of the study was to examine fertility-related psychological and lifestyle factors in a Hungarian sample. METHOD: 194 women (115 infertile and 79 fertile) took part in the study. Standardized, validated questionnaires were used for the assessment of psychological factors and self-administered questions were used for exploring lifestyle factors. RESULTS: The results show that infertile women are younger (33.98±4.89 vs. 36.43±5.81 years, p<0.005) and their psychological status is significantly worse compared to their fertile counterparts. The number of their depressive (BDI 14.00±12.21 vs. 7.79±9.17, p<0.005) and anxiety symptoms is higher (STAI-T 48.53±10.56 vs. 40.25±10.65, p<0.005) compared to fertile women. Findings related to lifestyle factors show that lower level of fluid consumption (1.71±0.67 vs. 1.95±0.68, p<0.05) and diet (31.30% vs. 18.42%, p<0.05) is significantly related to infertility. In this sample higher level of fluid consumption was associated with the fertile group (OR = 1.65, CI = 2.58-1.06), independently of body mass index and age. CONCLUSIONS: The results confirm the findings of international researches showing that women struggling with infertility are in worse psychological condition than their fertile counterparts. The authors conclude that the findings demand further investigations and follow-up studies in order to more specifically determine the relationship between fluid consumption and fertility.

Self-rated health is associated with the length of stay at the intensive care unit and hospital following cardiac surgery.

BACKGROUND: Recently, a considerable amount of evidence suggested that anxiety, depression and other psychosocial variables might influence the outcomes of cardiac surgery. This study investigated the relationship between length of stay at the intensive care unit (ICU) and hospital after surgery and different psychosocial variables (e.g. depression, anxiety, self rated health, happiness, satisfaction). METHODS: We enrolled prospective patients who were waiting for elective cardiac surgery (N = 267) and consented to take part in the study. We collected data of sociodemographic, medical and perioperative factors as well as psychosocial questionnaires completed 1.56 days (standard deviation [SD] = 0.7) before surgery. The primary clinical endpoint was an ICU stay of at least 3 days and the secondary was hospital stay of at least 10 days. RESULTS: Two hundred sixty-seven patients participated in this study. Four patients (1.5%) died in the hospital and 38 patients (14.5%) spent more than 3 days in the ICU and 62 patients (23.2%) spent more than 10 days in the hospital. After controlling for medical and sociodemographic factors, lower self rated health (Adjusted Odds Ratio [AOR]: 0.51, 95% confidence interval [CI]: 0.28-0.95; p = 0.03), lower rate of happiness (AOR: 0.76, 95% CI: 0.59-0.97, p = 0.03), postoperative cardiac failure (AOR: 7.09, 95% CI:1.21-41.54; p = 0.03) and postoperative complications (AOR: 9.52, 95% CI: 3.76-24.11; p < 0.001) were associated with longer ICU stay. More than 10 days of hospital stay was associated with higher occurrence of COPD (AOR 4.56, CI: 1.95-10.67, p < 0.001), NYHA stage (AOR 6.76, CI: 2.57-17.79, p < 0.001), operation time (AOR 1.45, CI: 1.19-1.76, p < 0.001), female gender (AOR 2.16, CI: 1.06-4.40, p = 0.034) and lower self-rated health (AOR 0.63, CI: 0.41-0.99, p = 0.044). CONCLUSIONS: Lower happiness and self-rated health may influence the outcome of cardiac surgery. Therefore, these variables should be assessed in patients.

Vital exhaustion and anxiety are related to subjective quality of life in patients with acute myocardial infarct before cardiac rehabilitation.

AIMS AND OBJECTIVES: To examine psychological risk factors and somatic factors in patients after myocardial infarction. To study the relationship between somatic and psychological factors, their influence on subjective quality of life (well-being) and also to examine possible gender differences. BACKGROUND: There has been a growing body of evidence that psychosocial factors are risk factors for incident and recurrent myocardial infarction. DESIGN: Descriptive correlational and cross-sectional survey design. METHODS: In patients (n = 97, 67 men), the level of depression and anxiety, vital exhaustion, sleep disturbances and well-being were assessed. Left ventricular ejection fraction, left ventricular diastolic diameter, body mass index, metabolic equivalents and the number of diseased vessels were retrieved from medical records. RESULTS: Anxiety, vital exhaustion and sleep disturbances were significantly higher in women than in men. Well-being showed a significant linear correlation with body mass index, anxiety, depression, vital exhaustion and sleep disturbances scores. After adjustment for psychological risk factors and somatic parameters, only vital exhaustion and anxiety correlated significantly with well-being. However, there were gender differences in predictive variables of well-being. Anxiety in men and vital exhaustion in women showed a linear correlation with the subjective quality of life. CONCLUSION: Our study revealed that only vital exhaustion and anxiety showed a significant correlation with well-being in patients. RELEVANCE TO CLINICAL PRACTICE: During cardiac rehabilitation, it is important to detect and treat not only depression but also vital exhaustion and anxiety, because by reducing these psychological conditions, we can improve well-being.

A bifactor model of the Posttraumatic Growth Inventory.

Purpose: The Posttraumatic Growth Inventory (PTGI) is a self-administered measurement instrument designed to provide information concerning positive psychological changes after a traumatic life event. The aim of the present study was to examine the psychometric properties of the PTGI in a Hungarian sample. By examining a bifactor model of the instrument, we also wanted to contribute to the establishment of an evidence-based practice concerning the use of different score types (total score versus subscale scores). Methods: Altogether, 691 Hungarian respondents (82.2% female; Mage = 33.0 ± 13.4 years), who experienced some kind of trauma or loss, participated in this study. Results: A series of confirmatory factor analyses revealed that among the tested first- and second-order models, a bifactor model provided the best-fit to our data (χ2/df = 4.32, Comparative Fit Index = .91, root mean square error of approximation = .07, standardized root mean square residual = .04). Further, the Hungarian version of the PTGI showed high internal consistency (Cronbach's alpha = .93, omega total = .95, omega hierarchical = .87) and test-retest reliability (r = .90; p < .01) coefficients. However, omega hierarchical coefficients (.14-.40) and explained variance values (.05-.10) for the subscales were low. Conclusions: The present study provided empirical support for the psychometric adequacy of the Hungarian adaptation of the PTGI and suggests that only the total and not the subscale scores of the inventory should be used.

The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery.

BACKGROUND: Psychosocial factors have shown independent predictive value in the development of cardiovascular diseases. Although there is strong evidence to support the role of psychosocial factors in cardiovascular mortality, there is a scarcity of knowledge about how these factors are related. Therefore, we investigated the relationship between depression, anxiety, education, social isolation and mortality 7.5 years after cardiac surgery. METHODS: After informed consent, 180 patients undergoing cardiac surgery between July 2000 and May 2001 were prospectively enrolled and followed for ten years. During the follow-up period, the patients were contacted annually by mail. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI) and the number and reason for rehospitalizations were assessed each year. Those patients who did not respond were contacted by telephone, and national registries were searched for deaths. RESULTS: During a median follow-up of 7.6 years (25th to 75th percentile, 7.4 to 8.1 years), the mortality rate was 23.6% (95% confidence interval [CI] 17.3-29.9; 42 deaths). In a Cox regression model, the risk factors associated with an increased risk of mortality were a higher EUROSCORE (points; Adjusted Hazard Ratio (AHR):1.30, 95%CI:1.07-1.58)), a higher preoperative STAI-T score (points; AHR:1.06, 95%CI 1.02-1.09), lower education level (school years; AHR:0.86, 95%CI:0.74-0.98), and the occurrence of major adverse cardiac and cerebral events during follow up (AHR:7.24, 95%CI:2.65-19.7). In the postdischarge model, the same risk factors remained. CONCLUSIONS: Our results suggest that the assessment of psychosocial factors, particularly anxiety and education may help identify patients at an increased risk for long-term mortality after cardiac surgery.

Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery.

Our aim was to prospectively examine the association of psychosocial factors with adverse outcome after cardiac surgery. One hundred and eighty cardiac surgery patients were enrolled and contacted annually by mail. Depression [Beck depression inventory (BDI)], anxiety [state anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-S) and trait anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-T)] were investigated annually, social support, negative affectivity, social inhibition (SI), illness intrusiveness, self-rated health and sleeping disorders were investigated by standardized tests at the second and fifth year. The end-point was the major adverse cardiac and cerebrovascular event (MACCE) including death. Twenty-eight (15.5%) patients died by the end of the fifth year. At the end of the second and fifth years, 146 (81.1%) and 118 (65.5%) patients fulfilled the tests, respectively. At the end of the second year after adjustment for medical and perioperative factors worse self-rated health [adjusted hazard ratio (AHR): 0.67, P=0.006], sleeping disorders (AHR: 1.14, P=0.001), higher illness intrusiveness (AHR: 1.03, P=0.018), higher BDI (AHR: 1.12, P=0.001), STAI-S (AHR: 1.09, P=0.001) and higher STAI-T scores (AHR: 1.08, P=0.002) showed higher risk for MACCE. Significant individual elevation in scores of sleeping disorders, illness intrusiveness and SI were observed over the three-year period in the MACCE group. Assessment of psychosocial factors could help in identifying patients at high-risk for MACCE after cardiac surgery.

Measures of stress in epidemiological research.

A comprehensive assessment of psychosocial stress often poses significant challenges due to diversity in conceptualization of stress. Consequently, a number of instruments that measure psychosocial stress, its stressors, and its impact at the individual, organizational, and societal levels have been developed. This article aims to provide a brief review of such instruments, focusing on established questionnaire and interview measures in line with the environmentalist and psychological conceptualizations of stress. This includes measures of major life events; work, marital, and social stress; the individual's coping abilities; and psychological and somatic outcomes of stress. We provide a general description of selected instruments and discuss their administration, scoring, and psychometric properties. Appropriate application of these instruments in epidemiological and clinical research, as well as in inpatient care, can aid the detection of psychosocial stress, support thorough assessment and management of the individual's illness, and ensure accurate identification of individuals who would benefit from specific behavioral (psychotherapeutic) interventions.

Worldwide stress: different problems, similar solutions? Cultural adaptation and evaluation of a standardized stress management program in Hungary.

BACKGROUND: Chronic stress is an important risk factor for morbidity and premature mortality at the individual and societal level. PURPOSE: Our aim was to describe the process of adapting and testing the effectiveness of a structured stress management skills training program in a culture different from the one in which it was first developed. METHOD: We translated an internationally used standardized behavioral intervention program into Hungarian and adapted it for use in a Hungarian cultural setting. We evaluated the changes in stress level and stress-related symptom scores among distressed voluntary participants on the basis of self-reported questionnaires completed before, immediately after, and 4 to 6 months after the 12-h intervention. The following measures were included: PSS-10, STAI-T, BDI-S, PHQ-15, and WBI-5. For statistical analyses, paired sample t test and Cohen's d value for effect size were used. RESULTS: In a sample of 107 distressed individuals, after the training, stress level, psychological and somatic symptoms decreased and well-being increased (p < 0.0001). These positive changes were maintained at follow-up in a subsample of 42 persons tested 4-6 months later. CONCLUSION: These results confirm the long-term positive effects of this standardized behavioral intervention in a different cultural context and in real-world settings, which encourages further dissemination of the program in various community settings.

[Psychosocial factors determining life expectancy of patients undergoing open heart surgery]. / Nyitott szívmutéten átesett betegek életkilátásait meghatározó pszichoszociális tényezok.

Not only the physical status of the patient and the clinical variables determine the outcome and recovery following open heart surgery. Psychosocial and socioeconomic factors have growing importance regarding this field. During the last decades, in the assessment of the results of revascularization the self-perceived health related quality of life of the patient has come into the limelight. Evidence suggests that self-perceived health related quality of life, depressive symptoms and anxiety together influence short and long term recovery following coronary bypass surgery. There is also a higher risk for morbidity and mortality among the lonely and the socially isolated. Lower education and poor social background may play a role in the higher mortality rates. In our review we summarize the psychosocial factors determining the outcome of heart surgery.