Depressive symptoms in outpatients with heart failure: Importance of inflammatory biomarkers,disease severity and personality

Objective: Depressive symptoms are highly prevalent in heart failure (HF) patients, however the underlying etiology of depression in HF patients remains yet unclear. Hence, the goal is to examine the relative importance of inflammation, disease severity and personality as predictors of depression in HF patients. Design: Depressive symptoms (Hospital Anxiety and Depression Scale, depression subscale) were assessed at baseline and one-year follow-up in 268 HF patients (75.6% men; mean age?=?66.7?±?8.7). Markers of inflammation (TNFα, sTNFr1, sTNFr2, IL-6 and IL-10), disease severity (e.g. New York Heart Association (NYHA) classification) and personality (Type D personality, loneliness) were assessed at baseline. Results: At baseline, NYHA class, body mass index, educational level, Type D personality and loneliness were significantly associated with depression. Higher NYHA class (B?=?2.25; SE?=?.83), higher educational level (B?=?1.41; SE?=?.48), Type D personality (B?=?2.56; SE?=?.60) and loneliness (B?=?.19; SE?=?.05) were also independently associated with higher depression levels at one-year follow-up (all p-values?<?.005). Inflammation, brain natriuretic peptide and left ventricular ejection fraction were not related to depression over time. Conclusions: Personality factors, but not inflammation, were independent concomitants of depressive symptoms in patients with HF. Gaining more insight into the etiology of depression in HF patients is important in order to identify potential targets for novel interventions.     

Internet-delivered cognitive behavior therapy for anxiety and insomnia in a higher education context

Background and Objectives: Anxiety and insomnia can be treated with internet-delivered Cognitive Behavioral Therapy (iCBT). iCBT may be well-suited to students who are known to be poor help-seekers and suffer these symptoms. iCBT can offer easy access to treatment and increase service availability. The aim of this study was to evaluate the efficacy of anxiety and insomnia iCBT programs in students. Design: A randomized, controlled study. Methods: Students were randomly allocated to intervention (“Anxiety Relief”: n?=?43; “Insomnia Relief”: n?=?48; control: n?=?47). Interventions lasted six weeks. Outcome measures were the State-Trait Anxiety Inventory and the Pittsburgh Sleep Quality Index. Results: Significant within-group reductions in anxiety (t(31)?=?2.00, p?=?.03) with moderate between-groups (compared to control) effect size (d?=?.64) and increases in sleep quality (t(31)?=?3.46, p?=?.002) with a moderate between-groups effect size (d?=?.55) were found for completers of the anxiety program from pre- to post-intervention. Significant within-group increases in sleep quality were found for completers of the insomnia program from pre- to post-intervention (t(35)?=?4.28, p?>?.001) with a moderate between-groups effect size (d?=?.51). Conclusions: Findings support the use of iCBT for anxiety and insomnia in students, and indicate that further research is needed.     

Difficulties in emotion regulation differentiate depressive and obsessive–compulsive symptoms and their co-occurrence

Background and Objectives: Depressive and obsessive–compulsive (OC) symptoms are frequently comorbid, and the combination of these may result in additional impairment compared to the difficulties of experiencing one of these symptom groups. Emotion regulation difficulties underlie many forms of psychopathology symptoms, and this study examined whether aspects of emotion regulation could differentiate clinical levels of depressive and OC symptoms, and their co-occurrence. Design and Method: College students (N?=?199; M_age?=?19.47 years; 59.8% female) were grouped based on the presence of clinical levels of OC and depressive symptoms. Using a multinomial logistic regression approach, differences in odds ratios for emotion regulation difficulties were examined. Results: The co-occurring clinical-symptom group was differentiated from the single clinical-symptom groups on several aspects of emotion regulation. Impulse-control difficulties and limited access to emotion regulation strategies differentiated clinical levels of depressive from OC symptoms. Conclusions: This study highlights the importance of conducting a nuanced emotion assessment to best inform prevention and treatment of depressive and OC symptoms, and their comorbidity.     

Insomnia Symptoms,Nightmares, and Suicide Risk: Duration of Sleep Disturbance Matters

Duration of insomnia symptoms or nightmares was investigated to see if it was related to suicide risk independent of current insomnia symptoms, nightmares, anxiety symptoms, depressive symptoms, and posttraumatic symptoms. The cross‐sectional study involved analyses of survey responses from undergraduate students who endorsed either insomnia symptoms (n = 660) or nightmares (n = 312). Both insomnia symptom and nightmare duration were significantly associated with suicide risk independent of current insomnia symptoms or nightmares, respectively. Relations were also significant after controlling for anxiety symptoms, depressive symptoms, and posttraumatic symptoms. Results suggest that duration of sleep disturbance is relevant when assessing suicide risk.     

Event centrality prospectively predicts PTSD symptoms

Background: Recent evidence suggests that event centrality has a prominent association with post-traumatic stress disorder (PTSD) symptoms. However, evidence for this notion thus far has been mostly correlational. We report two studies that prospectively examined the relationship between event centrality and PTSD symptoms. Study 1 Methods: Participants (N?=?1438) reported their most stressful event (“prior event”), along with event centrality, PTSD symptoms, and neuroticism. At Time 2 participants reported their most stressful event since Time 1 (“critical event”), along with measures of event centrality and PTSD symptoms. Study 1 Results: Event centrality for the critical event predicted PTSD symptoms, after controlling for event centrality and PTSD symptoms of the prior event and neuroticism. Study 2 Methods: In the second study (N?=?161) we examined changes in event centrality and PTSD symptoms over a month. Study 2 Results: Using a cross-lagged panel design, results revealed event centrality at Time 1 significantly predicted PTSD symptoms at Time 2, but the reverse was not significant. Conclusions: In two studies, a prospective association between event centrality and PTSD symptoms, but not the reverse, emerged. This evidence implicates event centrality in the pathogenesis and/or maintenance of PTSD symptoms.     

Exploring correlations between positive psychological resources and symptoms of psychological distress among hematological cancer patients: a cross-sectional study

Hematological cancer patients experience high levels of psychological distress during diagnoses and intensive treatments. The aim of the present study is to explore the effects of positive psychological resources on depressive and anxiety symptoms in hematological cancer patients. This survey was conducted in a hospital during the period from July 2013 to April 2014. A total of 300 inpatients were recruited and finally 227 of them completed the questionnaires. Questionnaires included demographic and clinical variables, the Center for Epidemiologic Studies Depression Scale, the Self-Rating Anxiety Scale, the Life Orientation Scale-Revised, the General Perceived Self-Efficacy Scale, and the Resilience Scale-14. Results showed that the prevalence of depressive and anxiety symptoms was 66.1 and 45.8%, respectively. Both optimism (β = ?.479, p < .001) and resilience (β = ?.174, p < .05) were negatively associated with depressive symptoms, and optimism (β = ?.393, p < .001) was negatively associated with anxiety symptoms. However, resilience (β = ?.133, p > .05) was not significantly associated with anxiety symptoms, and self-efficacy was not significantly associated with depressive (β = ?.032, p > .05) or anxiety symptoms (β = ?.055, p > .05). The results suggest that hematological cancer patients who possess high levels of positive psychological resources may have fewer symptoms of psychological distress. The findings indicate that enhancing positive psychological resources can be considered in developing intervention strategies for decreasing depressive and anxiety symptoms.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms

Background: Many women experience childbirth as traumatic and 2% develop post-traumatic stress disorder. This study examined the role of health practitioner support and personal control during birth as predictors of post-traumatic stress (PTS) symptoms, adjusting for vulnerability factors of prior trauma, depression, control beliefs and birth intervention. It also investigated interactions between support, prior trauma and birth intervention and their association with PTS symptoms.

Methods: A prospective longitudinal survey of 138 women recruited from UK NHS maternity clinics. Measures were taken in pregnancy, 3 weeks and 3 months after the birth.

Results: Support and control during birth were not predictive of postnatal PTS symptoms. However, support was predictive of PTS symptoms in a subset of women with prior trauma (β?=??0.41, R ²?=?16%) at both 3-weeks and 3-months postpartum. The interaction of birth intervention and support was associated with PTS symptoms 3 months after birth, the relationship between support and PTS symptoms was stronger in women experiencing more intervention.

Conclusions: Low support from health practitioners is predictive of postnatal PTS symptoms in women who have a history of trauma. Longer term effects of low support on postnatal PTS symptoms are also found in women who had more intervention during birth.     

Associations of ethnic discrimination with symptoms of anxiety and depression among Hispanic emerging adults: a moderated mediation model

Background and Objectives: Emerging adulthood is often marked with elevated symptoms of anxiety and depression. Hispanic emerging adults may face cultural stressors such as ethnic discrimination that further increase levels of anxiety and depression symptoms. The study aims were to examine if (a) self-esteem mediated effects of ethnic discrimination on symptoms of anxiety and depression, and (b) if gender moderated the indirect effects of discrimination. Design: The study design was cross-sectional self-report. Method: Two moderated mediation models were tested, with 1084 Hispanic emerging adults (ages 18–25) enrolled in institutions of post-secondary in the United States. Results: Results indicated that (a) higher ethnic discrimination was associated with higher anxiety symptoms (β?=?.05, p?=?.04), higher depression symptoms (β?=?.06, p?=?.02), and lower self-esteem (β?=??.30, p?Conclusions: Findings suggest that the mediating effects of self-esteem linking ethnic discrimination with symptoms of anxiety and depression vary between genders.     

The shared and unique genetic relationship between mental well-being,depression and anxiety symptoms and cognitive function in healthy twins

Alterations to cognitive function are often reported with depression and anxiety symptoms, yet few studies have examined the same associations with mental well-being. This study examined the association between mental well-being, depression and anxiety symptoms and cognitive function in 1502 healthy adult monozygotic (MZ) and dizygotic (DZ) twins, and the shared/unique contribution of genetic (G) and environmental (E) variance. Using linear mixed models, mental well-being was positively associated (p?β?=?0.127), inhibition (β?=?0.096), cognitive flexibility (β?=?0.149), motor coordination (β?=?0.114) and working memory (β?=?0.156), whereas depression and anxiety symptoms were associated (p?β?=??0.134), inhibition (β?=??0.139), cognitive flexibility (β?=??0.116) and executive function (β?=??0.139). Bivariate twin modelling showed well-being shared a small environmental correlation with motor coordination and a small genetic correlation with working memory. Trivariate twin modelling showed well-being shared a small genetic correlation with inhibition, whereas depression and anxiety symptoms shared a small environmental correlation with inhibition. The remaining variance was mostly driven by unique G and/or E variance. Overall, well-being and depression and anxiety symptoms show both independent and shared relationships with cognitive functions but this is largely attributable to unique G or E variance and small shared G/E variance between pairs of variables.     

Keep your eyes open: dispositional vigilance moderates the relationship between operational police stress and stress symptoms

Background: Vigilant coping is characterized by a deep processing of threat-related information. In many cases, vigilant coping increases stress symptoms, whereas avoidant coping decreases negative affect. However, vigilance may be beneficial when stress-eliciting situations involve a risk of injury or escalation as is usually the case in police operations. Design: We investigated the roles of vigilance and cognitive avoidance in police operations in a cross-sectional survey. Methods: The participants were 137 students (104?men, M_age?=?28.54, SD?=?8.04) from the Federal University of Applied Administrative Sciences; 76 of them were already police officers (work experience: M?=?12.59?years), and 61 were police officer candidates who had completed a 3- to 6-month police internship. Participants completed a paper-and-pencil survey and reported their operational stress, dispositional vigilance and cognitive avoidance in police operations, and stress symptoms. Results: We found that vigilance was negatively associated with stress symptoms and moderated the relationship between operational stress and stress symptoms. Cognitive avoidance, on the other hand, just missed the level of statistical significance in our test of whether it was positively associated with stress symptoms. Conclusions: Our findings demonstrate that vigilance may protect against the negative consequences of stress in police operations.     

Personality,life events and the course of anxiety and depression

Using data from the Netherlands Study of Depression and Anxiety, we examined among 1322 participants with a DSM‐IV diagnosis of depression or anxiety: (i) whether positive and negative life events influence 1‐year course of anxiety and depressive symptoms; (ii) whether personality traits (neuroticism and extraversion) predict symptom course and moderate the impact of life events on symptom course; and (iii) whether life events mediate relationships of neuroticism and extraversion with symptom course. Negative life events were predictive of both anxiety and depressive symptoms, while positive life events predicted the course of depressive symptoms only. Personality traits had significant predictive and moderating effects on symptom course, though these effects were rather small. Copyright © 2011 John Wiley & Sons, Ltd.     

A latent profile analysis of coping responses to individuals’ most traumatic event: associations with adaptive and maladaptive mental health outcomes

ABSTRACT

Background & Objectives: This study explores how empirically-derived coping response patterns influence mental health.

Design: Emerging adults, currently enrolled in college and aged 18–24 (N?=?432; M_age?=?19.66; SD?=?1.65), completed self-report measures of trauma exposure, coping responses to self-selected most traumatic event (MTE), resilience, posttraumatic growth (PTG), depressive symptoms, and posttraumatic stress symptoms (PTSS).

Methods: Eight coping subscales were included as indicators in a latent profile analysis. Then, associations between established profiles and mental health outcomes were examined, covarying for demographic and trauma-related variables.

Results: Considering fit statistics, class size, profile patterns, and theory, the four-class model was deemed most appropriate: High Overall Coping (HCOPE; n?=?146, 34%), Low Overall Coping (LCOPE; n?=?92, 22%), High Engagement Coping (HENG; n?=?115, 27%), and High Disengagement Coping (HDIS; n?=?73, 17%). HENG participants endorsed above-average resilience and PTG, coupled with below-average depressive symptoms and PTSS. Compared to the sample average, HDIS participants endorsed lower resilience and PTG, coupled with higher depressive symptoms and PTSS. LCOPE participants endorsed low levels of all outcomes. HCOPE participants endorsed high levels of all outcomes.

Conclusions: Findings suggest that clinicians who promote engagement coping and discourage disengagement coping among trauma-exposed individuals may engender the most desirable constellation of mental health outcomes.     

Neuroticism,Life Events and Negative Thoughts in the Development of Depression in Adolescent Girls

Theories of depression suggest that cognitive and environmental factors may explain the relationship between personality and depression. This study tested such a model in early adolescence, incorporating neuroticism, stress-generation and negative automatic thoughts in the development of depressive symptoms. Participants (896 girls, mean age 12.3 years) completed measures of personality and depressive symptoms, and 12 months later completed measures of depressive symptoms, recent stressors and negative automatic thoughts. Path analysis supported a model in which neuroticism serves as a distal vulnerability for depression, conferring a risk of experiencing dependent negative events and negative automatic thoughts, which fully mediate the effect of neuroticism on later depression. A second path supported a maintenance model for depression in adolescence, with initial levels of depression predicting dependent negative events, negative automatic thoughts and subsequent depressive symptoms. Unexpectedly, initial depression was also associated with later independent life events. This study establishes potential mechanisms through which personality contributes to the development of depression in adolescent girls.     

A pathway from neuroticism to depression: examining the role of emotion regulation

We examined whether the relation between neuroticism and the severity of depressive symptoms is mediated by emotion regulation. At the same time, we examined whether the type of emotion regulation strategy (maladaptive vs. adaptive) moderates the effects of neuroticism on depression severity. Community participants (N =?533; 235 women and 298 men) completed a set of questionnaires over the Internet. We used structural equation modeling to examine the mediational role of emotion regulation in linking neuroticism and the levels of depressive symptoms. The well-documented relation between neuroticism and depression is mediated by individual differences in the use of different emotion regulation strategies. More specifically, the use of maladaptive forms of emotion regulation, but not reappraisal, fully mediated the association between neuroticism and the severity of depressive symptoms.     

Long-term adherence to a physical activity intervention: The role of telephone-assisted vs. self-administered coping plans and strategy use

Objective: This study investigated the role of coping plans and the use of selection, optimisation and compensation (SOC) strategies within an experimental evaluation of a 26-week physical exercise intervention.

Methods: Older women (N?=?86, M _age?=?73.7 years) were randomly assigned to a telephone-assisted or a self-administered coping planning intervention after 6 weeks’ participation in an exercise programme. The number of different coping plans formulated, exercise-specific SOC strategy use and their interaction were used to predict objectively measured long-term adherence to the intervention.

Results: The number of coping plans formulated (β?=?0.28) and goal-pursuit strategies reported (sum score of optimisation and compensation strategies, β?=?0.39) predicted adherence to the exercise programme over 20 weeks. The predictive strength of coping plans increased with decreasing numbers of goal-pursuit strategies (β?=??0.21). Women supported via telephone reported significantly more coping plans than did women in the self-administered coping planning group, F(1,80)?=?9.47, p?=?0.003.

Conclusion: Coping plans have a buffering effect on adherence levels when use of SOC strategies is low. Older women's adherence to physical activities may be improved if they are given direct support in generating coping plans involving strategies of selection, optimisation and compensation.     

The Role of Family Routines in the Intergenerational Transmission of Depressive Symptoms between Parents and their Adolescent Children

Whereas previous research on environmental factors implicated in the intergenerational transmission of depression has tended to focus on the role of parenting quality (e.g., harshness), the current study sought to assess whether structural aspects of families may contribute to depression-relevant affective and immune processes in youths. Specifically, the present study examined the role of family routines in linking parental depressive symptoms to youth emotion regulation, a depression-relevant marker of low-grade inflammation, and depressive symptoms in youths. 261 parent-adolescent dyads reported on their own depressive symptoms, family routines, and youths’ emotion regulation abilities. In addition, peripheral blood was drawn from youths to assess levels of the proinflammatory cytokine interleukin 6 (IL-6). Path analyses provided support for a model in which parental depressive symptoms related to fewer family routines, which in turn were associated with higher IL-6 and depressive symptoms in youths as well as marginally associated with worse youth emotion regulation. Moreover, family routines were found to statistically account for part of the association between parent- and youth- depressive symptoms. Together, these results suggest that family routines may represent an additional facet of the family environment that can potentially contribute to the intergenerational transmission of depressive symptoms.     

Social anxiety and interpersonal stress generation: the moderating role of interpersonal distress

Background and Objectives: Existing models of social anxiety scarcely account for interpersonal stress generation. These models also seldom include interpersonal factors that compound the effects of social anxiety. Given recent findings that two forms of interpersonal distress, perceived burdensomeness and thwarted belongingness, intensify social anxiety and cause interpersonal stress generation, these two constructs may be especially relevant to examining social anxiety and interpersonal stress generation together.

Design: The current study extended prior research by examining the role of social anxiety in the occurrence of negative and positive interpersonal events and evaluated whether interpersonal distress moderated these associations.

Methods: Undergraduate students (N?=?243; M?=?20.46 years; 83% female) completed self-report measures of social anxiety, perceived burdensomeness, and thwarted belongingness, as well as a self-report measure and clinician-rated interview assessing negative and positive interpersonal events that occurred over the past six weeks.

Results: Higher levels of social anxiety were associated only with a higher occurrence of negative interpersonal dependent events, after controlling for depressive symptoms. This relationship was stronger among individuals who also reported higher levels of perceived burdensomeness, but not thwarted belongingness.

Conclusions: It may be important to more strongly consider interpersonal stress generation in models of social anxiety.     

Specificity of peer difficulties to social anxiety in early adolescence: categorical and dimensional analyses with clinical and community samples

Background and Objectives: We investigated the specificity of social difficulties to social anxiety by testing associations of social anxiety and other anxiety presentations with peer acceptance and victimization in community and treatment-seeking samples of adolescents aged 12–14 years.

Design: Cross-sectional, quantitative survey.

Methods: Adolescents from the community (n?=?116) and a clinical setting (n?=?154) completed ratings of anxiety symptoms, perceived social acceptance, and peer victimization. Their parents also completed ratings of the adolescents’ anxiety and social acceptance.

Results: Social acceptance was lowest among adolescents with social anxiety disorder (SAD) and lower among adolescents with other anxiety disorders than in the community sample. Anxiety symptoms were negatively correlated with social acceptance, but these associations were not unique to social anxiety symptoms. Girls in the community sample reported more overt victimization than girls with SAD and with other anxiety diagnoses. Relational victimization was associated with social and nonsocial anxiety symptoms only in the community sample.

Conclusions: Our findings supplement recent laboratory-based observational studies on social functioning among adolescents with SAD and other anxiety disorders. Although social anxiety may be associated with unique social skill deficits and impairment, concerns about peer relations should also be considered among adolescents with other anxiety symptoms.     

The role of the Five Factor Model of personality in the perceptions of negative and positive forms of work–nonwork spillover: A meta-analytic review

The present meta-analysis examines the relationships between the Five Factor Model (FFM) of personality and negative and positive forms of work–nonwork spillover (e.g., work-family conflict and facilitation). Results, based on aggregated correlations drawn from 66 studies and 72 independent samples (Total N = 28,127), reveal that the FFM is predictive of work–nonwork spillover. More specifically, meta-analytic structural equation modeling indicated that extraversion (β = −.08), agreeableness (β = −.06), conscientiousness (β = −.13), and neuroticism (β = .29) are related to negative work–nonwork spillover, while extraversion (β = .27), agreeableness (β = .11), conscientiousness (β = .12), and openness to experience (β = .20) are related to positive work–nonwork spillover. FFM personality variables were equally predictive of both directions of spillover (i.e., work-to-nonwork and nonwork-to-work). Collectively these results suggest a moderate amount of variance in negative (R² = .15) and positive (R² = .18) work–nonwork spillover is accounted for by personality.