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1.
Stress ; : 1-28, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31939338

RESUMO

The role of cortisol as a premorbid vulnerability factor for trauma sequelae remains unclear. Furthermore, the onset of long-term endocrine changes in response to first time trauma as a function of later psychopathology is not clarified yet. Thus the predictive value of pre- and post-traumatic hair cortisol concentrations (HCC) for psychological trauma sequelae was investigated in response to motor vehicle crash (MVC).A total of N = 62 MVC survivors participated in this study [46 females, mean age (SD): 43.94(12.95)]. Subsequent trauma sequelae were measured with a structured clinical interview and self-report questionnaires to evaluate psychological symptoms (pre-MVC and three months post-MVC). Hair strands were taken immediately after MVC and three months post-MVC, reflecting cumulative cortisol secretion over the three-month period before and after the MVC.A total of 22.6% of the participants developed a trauma sequela with an affective disorder (14.5%) and/or anxiety disorder (16.1%). We observed a significant main effect of group and diagnosis x time interaction with an increase of HCC in those individuals who presented a subsequent psychiatric disorder. Regression analyses revealed that post-MVC increased HCC were significantly predictive of higher levels of subsequent depressiveness, and that pre-MVC increased HCC were predictive of higher levels of subsequent avoidance behavior.Our findings demonstrate that individual differences in long-term cortisol secretion in response to a first-time traumatic event (MVC) contribute to subsequent psychopathology. Specifically, higher long-term cortisol secretion before and after first-time MVC was a risk factor for subsequent development of avoidance behavior and depressiveness, respectively.Lay Summary: Higher cortisol secretion and stress experience before a motor vehicle crash was a risk factor for subsequent development of psychological symptoms.

2.
Psychoneuroendocrinology ; 112: 104519, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31794949

RESUMO

BACKGROUND: Earlier evidence indicated an association between chronotype and the cortisol awakening response (CAR). However, these earlier data were collected without objective control for participant compliance being available, which, following recent guidelines, is considered critical for ensuring data validity. Here, we are seeking to replicate these earlier findings within a well-controlled sleep laboratory set up. METHODS: The sample consisted of 103 young males, including 12 participants defined as 'evening' (MEQ < 41) and 20 participants defined as 'morning type' (MEQ > 59) types. All participants slept for one night in a sleep laboratory and were wakened at 6:30 AM the next morning. Saliva samples for the assessment of the CAR were collected under strict supervision at 0, 15, and 30 min post-awakening. RESULTS: Significant effects of chronotype emerged consistently from both dimensional analyses across the entire sample and from comparisons between morning vs. evening type. Overall, greater morningness was associated with an increased cortisol level upon awakening (S1) as well as with a greater overall cortisol output (AUCG), however, it was not associated with the CAR (AUCI). DISCUSSION: Our data corroborate earlier evidence by showing that, under well-controlled sleep-laboratory conditions, chronotype is related to an altered cortisol secretion over the post-awakening period with no association with the CAR. However, the results have to be replicated since it is only a single day study design.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31837450

RESUMO

CONTEXT: Fatigue is a frequent symptom in patients suffering from chronic diseases. The Multidimensional Fatigue Inventory (MFI-20) is often used to measure fatigue. The aim of this article was to test the scale structure of the questionnaire. METHODS: The MFI-20 data were obtained from seven samples, including general population samples and samples of patients with different diseases (N between 122 and 1993). Five confirmatory factor analysis (CFA) models were tested for each sample. RESULTS: The scale structure postulated by the original test authors could not be confirmed by the CFAs. The inclusion of a method factor which considers the positive versus the negative orientation of the items yielded a better model fit. Cronbach's alpha was acceptable for most of the samples and scales: the total score of the MFI-20 reached alpha coefficients above 0.89. A short form of the MFI-20 which is restricted to the 10 positively oriented items (MFI-10) showed relatively good CFA indices. CONCLUSION: The factorial validity of the MFI-20 is insufficient, an issue which is due, at least in part, to the inclusion of positively and negatively oriented items. Nevertheless, we recommend maintaining the scale structure of the MFI-20 and not searching for alternative structures.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31844975

RESUMO

INTRODUCTION: Up to date, there has been little research about the acute stress load of emergency physicians of the Helicopter Emergency Medical Service (HEMS). Therefore, this study investigates the physiological stress level between an air-rescue day, a clinic day, and a day off (control day). Furthermore, phases of activity and resting were compared to assess the activity of the autonomic nervous system (ANS). METHODS: In this field study (within-subjects design), heart rate variability (HRV) and self-perceived stress levels were monitored on an air-rescue day, a clinic day, and a control day of 20 HEMS EPs [three females, 17 males; age: mean (M) = 44.95, standard deviation (SD) = 4.80]. RESULTS: When comparing the activity phases, significant differences were found for HR and HRV. The highest HR was found on the air-rescue day during the phase of landing at the operation site with M = 107.30 bpm (SD = 22.66 bpm), which was significantly higher than during activity phases of the clinic day (M = 88.28 bpm, SD = 11.81 bpm) and the control day (M = 83.28 bpm, SD = 14.83 bpm). The SDNN is significantly higher on the air-rescue day for the phase before the alarm (M = 72.23 ms, SD = 38.60 ms), the phase of the alarm (M = 77.52 ms, SD = 40.52 ms), and the average of all phases (M = 60.04 ms, SD = 34.07 ms) than on the clinic day (M = 38.42 ms, SD = 15.16 ms) and the control day, where the lowest value was reached (M = 39.11 ms, SD = 17.65 ms). The highest LF/HF was found during activity phases of the clinic day with M = 1281.84% (SD = 587.33%), which was significantly higher than the first five phases of the emergency operations and the average of all phases of the emergency operations of the air-rescue day, where a maximum of M = 896.57 ms (SD = 681.79 ms) during the phase before the alarm and a minimum of M = 764.69 ms (SD = 372.28 ms) during the phase of landing at the operation site. The lowest LF/HF for all testing days was found during the activity phases of the control day with M = 693.74% (SD = 404.73%). Overall, 60 observations were analyzed. In the psychological assessment, on average, the EPs shows lower values than the norm sample. DISCUSSION: In the comparison of the activity phases, significant effects were found on the clinic day and during the phases of the emergency operations of the air-rescue day for the HR and HRV. Hereby, a significant activation of the EPs ANS and an outweigh of the sympathetic nervous system could be shown, whereby the subjective stress load was reported mainly as low. For the resting phases, no significant differences were found between all testing days. We interpret this as a good sign for the ability of regeneration between the phases of high stress load.

5.
PLoS One ; 14(11): e0222277, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738763

RESUMO

The Trier Inventory for Chronic Stress (TICS), consisting of 57 items, is an instrument for measuring chronic stress in nine areas. There is also a short form (SSCS) of the TICS consisting of 12 items. However, this 12-item short form does not include all nine areas of the theoretical model and the long version. Therefore, a short version including all nine scales/areas was investigated. The TICS was taken by a sample of N = 2,473 respondents from the general population, aged 14 to 99, selected by random-route sampling. Confirmatory factor analyses applying robust maximum likelihood estimations (MLM) tested the model fit. The one-factor-model proposed by the original authors was tested, and the SSCS showed an unacceptable model fit. For the development of an economical short version of the TICS, including items of the nine areas of chronic stress, nine items based on the alphamax algorithm were selected. The one-factor-model of this new short version of the TICS of nine items provided a good fit for the latent construct and showed good reliability (α = .88). A new and reliable short version of the TICS consisting of only 9 items representing the 9 scales/areas for the assessment of chronic stress was identified to possess a good model fit and good reliability.

6.
Psychopathology ; 52(3): 184-190, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31401628

RESUMO

BACKGROUND: Different studies have shown that a patient's attachment correlates with the psychotherapy outcome. However, these findings are based on the traditional interview and paper and pencil attachment methods. Latency-based methods like the Implicit Association Test (IAT) have not yet been investigated in clinical attachment research, specifically in therapy outcome research. OBJECTIVES: It can be hypothesized that patients with positive schemas of their mother and their partner may show a better psychotherapeutic outcome than those with less positive schemas of their mother/partner. METHOD: A sample of 103 patients suffering from panic disorder with or without agoraphobia (age 36.73, SD = 10.80), including 56% of patients with affective or other anxiety disorders as comorbidities without a personality disorder, based on the Structured Clinical Interview for DSM-IV (SCID-I/II), were treated with a manualized cognitive-behavioral confrontation therapy. Two IATs (for mother and partner) were implemented before the therapy (t1). The symptom reduction was assessed by the Symptom Checklist-90 (SCL-90) and the Beck Depression Inventory (BDI) with symptoms at t1 and IAT at t1 as predictors of symptoms at t2. RESULTS: The results confirmed a moderate to high therapeutic effect of the confrontation therapy. Furthermore, the mother's IAT at t1 predicted the Global Severity Index (ß = 0.20) as well as the Anxiety subscale (ß = 0.18) at t2 above and beyond the t1 measurement of the criteria. CONCLUSIONS: Implicit attitudes of the mother predicted the symptom reduction and a better therapeutic outcome. Relationship aspects with less impact awareness predicted the therapeutic outcome, even though mostly cognitive-behavioral techniques were used.


Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno de Pânico/psicologia , Psicoterapia/métodos , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento
7.
Artigo em Alemão | MEDLINE | ID: mdl-31420716

RESUMO

BACKGROUND: Tattooing has become very popular in recent years. In this context, socio-demographic information and health orientation is important. OBJECTIVES: The objective of this study was to evaluate the development of the prevalence of tattoos over the last thirteen years and the social and economic background of people with tattoos. Three national representative surveys were compared for this purpose; men and women residing in Germany were included. Additionally, the purpose of the study was to assess socio-demographic information and the health orientation of respondents with tattoos. MATERIALS AND METHODS: Three national, representative surveys were conducted on German participants (2016: n = 2510, 2009: n = 2512, 2003: n = 2043). The number of tattoos and socio-demographic information were investigated. The Health Regulatory Focus Scale (HRFS) assessing the individual's health orientation was used in 2016. RESULTS: Currently, one out of five Germans (≥14 years) has at least one tattoo. In Germany, tattoos are most prevalent among younger adults of both sexes aged 25 to 34 years. People with all levels of education have tattoos, although there were weak correlations with a lower education level and unemployment. Only men with several tattoos showed a significantly lower health orientation than non-tattooed ones. CONCLUSION: The fact that nearly one fifth of the German population has tattoos suggests that this permanent body art is becoming more and more accepted in German society. As a result, a need for better health risk information on the topic for both tattooists and the people getting tattoos appears evident because of the high prevalence of tattoos in younger generations as well as the lower health orientation in men with several tattoos.


Assuntos
Tatuagem/estatística & dados numéricos , Adulto , Distribuição por Idade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Distribuição por Sexo , Fatores Socioeconômicos , Tatuagem/efeitos adversos , Tatuagem/psicologia
8.
Assessment ; : 1073191119860910, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272193

RESUMO

The Hopkins Symptom Checklist-25 (HSCL-25) is a widely applied measure of depression and anxiety. The present study examines two of its short forms-the HSCL-5 and HSCL-10, which have been proposed by previous research-in a representative sample of the German general population. To this end, we conducted exploratory and confirmatory analysis on two subsamples (n = 1,246 and n = 1,216). Our results suggest that, compared with the HSCL-25, both short forms represent economical ways of assessing depression and anxiety. Model fit was good and correlations with established measures demonstrate convergent validity. Both HSCL short forms are strongly invariant across sex, and we found evidence for partial strong invariance across age groups. Further analyses showed that differences in HSCL can be partially explained by sociodemographic variables. Finally, we report normative values for usage by researchers and clinicians. We recommend the HSCL-5 and HSCL-10 for clinical and research-oriented application.

9.
World Neurosurg ; 129: e436-e443, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31150852

RESUMO

BACKGROUND: A large proportion of the population suffers from chronic back pain. For optimal treatment, the question arises which patients would benefit from conservative therapy and for whom lumbar disc surgery is most appropriate. It seems reasonable to analyze the impact of paraclinical parameters on the operation outcome to identify patients who would benefit less from surgery or need special pre-/postoperative medical care. MATERIALS AND METHODS: From March 2012 to July 2014, 32 patients were treated via microscopically supported interlaminar fenestration and discectomy at the Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden. One day before the operation, a cortisol survey was made during the stress response of the Trier Social Stress Test. At the same time, a survey of relevant questionnaires was conducted by which the postoperative symptom experience was made operational and comparable with the evaluation of the same information thirty days afterwards. RESULTS: It could be shown that there is a connection between cortisol reactivity and the pain burden following operations. Patients with a greater cortisol reaction under stress exposition partially experienced more intense postoperative pain than the patients with a lower cortisol reaction. However, this relationship could only be explained by single significant results, whereas further calculations could not produce any significance. CONCLUSIONS: Cortisol reactivity seems to be associated with pain development. The inconsistent findings in empiricism as well as in this investigation are indicative of a complex association of postoperative pain and cortisol reactivity, which needs to be examined further.


Assuntos
Dor nas Costas/cirurgia , Dor Crônica/cirurgia , Discotomia/psicologia , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estresse Psicológico/psicologia , Adulto , Idoso , Dor nas Costas/psicologia , Dor Crônica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Resultado do Tratamento
10.
Psychoneuroendocrinology ; 108: 28-34, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31220690

RESUMO

BACKGROUND: It is assumed that the expression of the cortisol awakening response (CAR) is modulated by light exposure during the peri-awakening period. While initial evidence supports this principal effect, the specific role of the spectral composition of light (brightness and wavelength) is still incompletely understood. METHOD: Two counterbalanced within-subject experiments were conducted in a standardized sleep laboratory setting to investigate the effect of light intensity (study I; two days: dim vs. bright light) and spectral composition (study II; three days: red vs. blue vs. green light) on the CAR. Across studies, light exposure was conducted for one-hour post-awakening and the accuracy of CAR assessments (based on eight saliva samples) was well-controlled in line with recent guidelines. RESULTS: The two studies revealed consistent effects of light exposure on the CAR. Specifically, an increased CAR was found after exposure to bright (vs. dim) light (study I; (F(3.7, 106.4) = 11.93, p < .001, η²p = .29) and following blue and green (vs. red) light exposure (study II; F(4.9, 194.6) = 2.49, p = .037, η²p = .10). CONCLUSION: Our findings illustrate the crucial role of light intensity and wavelength for expression of the CAR, in line with current theoretical knowledge of underlying neurobiological mechanisms.

11.
J Nerv Ment Dis ; 207(6): 423-428, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31045952

RESUMO

Assessments based on reaction time and language-based interviews postulate that unconscious attachment processes be measured. Nevertheless, a possible empirical equivalence of these two approaches has not yet been investigated. To fill this void, the Adult Attachment Interview and the Implicit Association Test were implemented with a group of patients with panic disorder (n = 157, mean age = 29, SD = 2.47) based on the Structured Clinical Interview for DSM-IV, axis I and II disorders and a group of healthy individuals (n = 138). In total, the securely attached individuals showed significantly more positive attitudes toward their mother than the insecurely attached individuals. In the healthy individuals, the secure and disorganized classifications showed significantly more positive attitudes toward the mother in comparison with the insecure attachment classification, as well as the patient group. In summary, implicit attachment patterns based on reaction times are not equivalent to an attachment representation based on language markers. For the disorganized attachment representation, no differences were present between the information processing of the memory/association network and the autobiographic memory function.

12.
Psychol Health Med ; : 1-10, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31046437

RESUMO

Cardiovascular diseases are among the leading causes of death, worldwide. To protect those vulnerable to cardiac arrest, defibrillators performing reanimation by automatic discharge are implanted. Due to the high pain intensity of such a procedure, many patients develop anxiety disorders. To diagnose the fear-relevant symptoms, the English version of the Florida Shock Anxiety Scale (FSAS) is used. The present study investigates the quality of the German version of the FSAS using a confirmatory factor analysis. Therefore, a sample of N = 138 participants (n = 38 female and n = 100 male; age: M = 60.99, SD = 11.58) with implanted or wearable cardioverter defibrillators was examined. Similar to the English version, the most suitable model includes the two factors 'consequence' and 'trigger stimulus'. Although, in our investigation, it is not a second order model but a bi-factorial model which reaches the best fit. Both the internal consistency and the convergent validity were checked and showed sufficiently good values. In summary, the German version of the FSAS may also be recommended for the diagnosis of shock-induced anxiety disorder.

13.
Stress ; 22(6): 664-669, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31062999

RESUMO

Both intense physical activity and potent psychosocial stressors increase blood lactate. Raising lactate levels by infusing the chemical can have an anxiogenic effect. Here, we compare the relationship between changes in lactate and anxiety levels resulting from two standardized stressors. We investigated the effects of the Multiple Wingate All-Out Performance Test (WG), a strong physical stressor, and the Trier Social Stress Test (TSST), a well-documented psychosocial stressor, in 32 healthy young men using a crossover design. Before and after each stressor, venous blood was analyzed for lactate levels and the State-Trait-Anxiety Inventory (STAI) was given. Both stressors raised both lactate and anxiety significantly above their baseline levels. While the rise in lactate was much higher for the WG than for the TSST, the rises in anxiety were nearly equal. Individual fitness did not influence the results for lactate or anxiety. No significant relation between lactate and anxiety changes were found. Thus, our results as well as the literature suggest that lactate is an important variable for understanding the impact of sport participation.

14.
PLoS One ; 14(4): e0213490, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951538

RESUMO

BACKGROUND: The SCL-K-9 is the latest short version of the multidimensional Symptom-Checklist 90-R. Up to now, its psychometric properties have not been clarified sufficiently as the nine items have not yet been presented exclusively in a representative sample. Therefore, psychometric properties, model fit values as well as norm-values were analyzed. METHODS: For the sample, N = 2,507 participants aged 14 to 92, n = 1,379 women and n = 1,128 men, and a mean age of 48.79 (SD = 17.91), were selected from the general population by random-route sampling. Confirmatory factor analyses applying full information maximum likelihood (FIML) tested the model fit. The reliability estimations and effect sizes were reported. RESULTS: The items' discriminative power ranged between .49 to .65, and the Cronbach's Alpha was α = .87, which stands for a good reliability of the SCL-K-9. Norm values as well as gender and age specificities were presented in this section. The CFA with all nine items loading on one latent factor resulted in a good fit. There was evidence of invariance across age and gender groups. SUMMARY: Based on these results, the short screening version SCL-K-9 of the Symptom-Checklist 90-R showed good reliability and good model fit; specific norm values could be determined. Further studies should evaluate the usefulness of the standardization in clinical samples.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Emoções/fisiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/patologia , Braço/fisiologia , Depressão/diagnóstico , Depressão/patologia , Análise Fatorial , Feminino , Alemanha , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/patologia , Saúde Mental/normas , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Psicometria , Inquéritos e Questionários , Adulto Jovem
15.
Psychopathology ; 52(1): 26-32, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30879013

RESUMO

BACKGROUND/AIMS: Little research effort has so far been dedicated to the analysis of the hypothalamic-pituitary-adrenal axis of aetiologically differing subgroups of patients with panic disorder (PD). The current study aimed at a deeper understanding of the cortisol stress response in cannabis-induced PD (CIPD) patients. METHODS: Matched groups of 7 PD patients (mean age ± SD: 32.95 ± 9.04 years), 7 CIPD patients (31.94 ± 8.40 years), and 7 healthy controls (HC) (31.13 ± 8.57 years) were included in the study. The Trier Social Stress Test (TSST) was used for stress induction. Salivary cortisol samples were collected and panic- and depression-related questionnaires were applied. RESULTS: A stress response to the TSST was found in 28.6% of PD patients, in 51.1% of CIPD patients, and in 100% of HC subjects. Statistical analyses revealed a cortisol hyporesponsiveness in PD and CIPD patients. While cortisol values of PD patients and HC participants differed significantly, CIPD patients' cortisol courses balanced between those of PD patients and HC subjects. CONCLUSIONS: Current findings show a distinctive pattern of the stress-induced cortisol reaction in CIPD patients, which is markedly different from the hormonal response in PD patients as well as HC subjects. Previous findings of cortisol hyporesponsiveness in PD patients compared to HC subjects were confirmed.


Assuntos
Cannabis/efeitos adversos , Hidrocortisona/metabolismo , Transtorno de Pânico/induzido quimicamente , Saliva/química , Estresse Psicológico/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias/etiologia , Adulto , Feminino , Humanos , Sistema Hipotálamo-Hipofisário , Masculino , Transtorno de Pânico/patologia , Transtornos Relacionados ao Uso de Substâncias/patologia , Inquéritos e Questionários
16.
Crit Care ; 23(1): 39, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736830

RESUMO

BACKGROUND: Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking. METHODS: The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU. RESULTS: Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients. CONCLUSIONS: Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment. TRIAL REGISTRATION: German Clinical Trials Register No. DRKS00003386 . Registered 13 November 2011.


Assuntos
Estado Terminal/psicologia , Qualidade de Vida/psicologia , Transtornos de Estresse Pós-Traumáticos/complicações , Idoso , Estudos de Coortes , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Parceiros Sexuais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários , Sobreviventes/psicologia
17.
BMC Psychiatry ; 19(1): 57, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717711

RESUMO

BACKGROUND: Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD. METHODS: Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach. RESULTS: Higher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results. CONCLUSION: Our findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008). www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008).


Assuntos
Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/psicologia , Depressão/diagnóstico , Depressão/psicologia , Sintomas Inexplicáveis , Apoio Social , Idoso , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Fatores Socioeconômicos , Resultado do Tratamento
18.
J Nerv Ment Dis ; 207(2): 112-120, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30688832

RESUMO

The neural response to faces of attachment figures compared with unfamiliar faces still remains elusive. In particular, the modulation of the neural response by the organized (secure, insecure) compared with disorganized attachment representation of the subject investigated is unknown. For the present study, 38 healthy participants (age range, 21-71 years) were recruited. Three attachment groups (secure, n = 14; insecure, n = 15; disorganized, n = 9) were assessed using the Adult Attachment Projective. The participants were shown pictures of the faces of attachment figures (romantic partner/parents) and unfamiliar faces in a blocked factorial design, using functional magnetic resonance imaging. Showing pictures of attachment figures activated parts of a neural social judgment network, important for inferring others' affective and cognitive mental states (e.g., inferior parietal lobe/superior temporal gyrus) in securely attached healthy individuals. In contrast, disorganized attached individuals with the experience of unresolved attachment trauma in their biography showed deactivations in these areas.


Assuntos
Córtex Cerebral/fisiologia , Reconhecimento Facial/fisiologia , Relações Interpessoais , Rede Nervosa/fisiologia , Apego ao Objeto , Trauma Psicológico/fisiopatologia , Percepção Social , Adulto , Idoso , Córtex Cerebral/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/diagnóstico por imagem , Pais , Trauma Psicológico/diagnóstico por imagem , Parceiros Sexuais , Cônjuges , Adulto Jovem
19.
Stress ; 22(1): 103-112, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30345865

RESUMO

As a time-efficient training system, high intensity interval training (HIIT) is well known for several beneficial effects. However, the literature on the stress-generating effects of HIIT shows a research deficit. A standardized comparable stressor and different kinds of stress-parameters are needed for quantifying the results. The present study examined the hormonal, autonomic, and psychological stress outcomes of HIIT compared to a standardized psychosocial stressor and tested the cross-stressor-adaptation (CSA) hypothesis which implies a stress-buffering effect at a good fitness level. In a sample of 32 healthy young males (24.31 ± 3.35 years of age) stress was induced with a multiple Wingate (WG), as a HIIT all-out performance test, involving four 30 sec all-out exercise bouts. In addition, the Trier Social Stress Test (TSST), which consists of a mock job interview and mental arithmetic performance, was used for stress induction. Cortisol, heart rate variability (HRV), and stress-related questionnaires were assessed before, during, and after stress induction. Both the Wingate as well as the TSST led to a highly significant change in time and stressor for cortisol and HRV. Furthermore, a significantly higher delta during Wingate was identified. In part, the TSST had a significantly higher impact on the psychological measurements than the WG. In contrast to the literature, this study was not able to confirm the stress-buffering effect of the CSA hypothesis. These findings prove the stressful effect of HIIT. The prevention of negative health effects needs to be taken into consideration in sports training methods and programs as well as in stress-related research Lay summary By using a well-estimated psychosocial stressor for comparison and several stress parameters, this study is able to show the strong stress-generating effect of high intensity interval training (HIIT). Interestingly, subjective stress perception differed from objective stress response. This research is an important step towards understanding stress-related disorders in elite sport and making recommendations for reducing autonomic as well as hormonal stress in high intensity sport.


Assuntos
Estresse Fisiológico/fisiologia , Estresse Psicológico/fisiopatologia , Adolescente , Adulto , Sistema Nervoso Autônomo/fisiopatologia , Teste de Esforço , Frequência Cardíaca/fisiologia , Humanos , Hidrocortisona/sangue , Masculino , Saliva/metabolismo , Estresse Psicológico/sangue , Estresse Psicológico/metabolismo , Inquéritos e Questionários , Adulto Jovem
20.
J Occup Environ Med ; 61(1): 51-60, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30335676

RESUMO

OBJECTIVE: IT managers have received limited attention in health literacy research, although they are subject to special professional demands. The aim of this study was to evaluate a training program designed to promote health literacy among managers. METHODS: A randomized controlled trial with a sample of 171 industry managers from one IT company was conducted. Effects of classroom training on health literacy, psychological well-being, self-rated health, and cortisol awakening response were investigated using pre- (t0), post- (t1), and follow-up (t2) surveys. RESULTS: The intervention effects (time and group) were not significant for the primary outcome of health literacy. At the second measuring point, psychological well-being and self-rated health significantly decreased, and cortisol awakening response significantly increased. CONCLUSION: Our study did not show beneficial intervention effects of a training program on promoting health literacy.

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