An interview to measure vital exhaustion. II. reliability and validity of the interview and correlations of vital exhaustion with personality characteristics

Abstract

In the previous paper (Meesters and Appels, this issue) we described the development of an interview to measure feelings of vital exhaustion (VE). The current paper presents data on the reliability and the validity of the interview, which is labeled the Maastricht Interview for Vital Exhaustion (MIVE). Correlations with the Type A behavior pattern (TABP) and hostility are also discussed in this paper. The data were collected in a case-control study of 81 males with first MI and 168 healthy neighborhood controls. The interview was found to have a good reliability, Cronbach's alpha being .90 in the case group and .86 in the control group. The kappa coefficient was .95 in the case group and .91 in the control group. The validity was tested by computing the estimated relative risk of VE, controlling for angina pectoris and the classic risk factors. The odds ratio was found to be 8.11 (p<.001). This indicates that the interview makes a valid assessment of the mental precursors of MI. The interview correlated significantly with TABP (structured interview) and two self-report measures of hostility (Cook-Medley Hostility Scale and Buss-Durkee Hostility Inventory). Although the absolute magnitude of the observed odds ratios may be affected to some extent because the interviews were not scored blind, these results clearly suggest that the MIVE is a reliable and valid method to assess VE.     

The impact of AIDS/sex education by schools or family doctors on Hong Kong Chinese adolescents

Despite the rapid increases of HIV and sexually transmitted infections (STIs) in East Asia, the sex-related knowledge among Chinese adolescents is limited and the standard of sex education is both variable and inconsistent in Hong Kong. The aim of this study is to review the overall effectiveness of the school-based or doctor-based sexual health education currently provided for Hong Kong adolescents. In 1999 - 2000, a large survey on youth risk behaviours was carried out among 15 - 18-year-old students from 21 secondary schools. Of the 8,039 questionnaires, 377 students (4.7%) admitted sexual experience. Multiple logistic regression showed that students who had received school AIDS education were found to be less likely to have sexual intercourse in the past 3 months (odds ratio, OR 0.5; 95% confidence interval, CI 0.3 - 0.9) or use drugs or alcohol before the previous intercourse (OR 0.5; 95% CI 0.3 - 0.9). They were twice as likely to discuss emotional (95% CI 1.4 - 4.0) or puberty issues (95% CI 1.1 - 3.0). Although not statistically significant, sex education by family doctors showed a similar pattern. This result provides the strongest available evidence that school-based sex education programmes can modify sexual behaviour, which, in turn, reduces risk among Chinese students.     

Prospective cohort study of stress, life satisfaction, self-rated health, insomnia, and suicide death in Japan

The association between many psychosocial factors and risk of suicide was examined. A cohort was conducted over 14 years of follow up among the general population (15,597 people) in Japan. A baseline survey of psychosocial characteristics was conducted by self-administrated questionnaire. The relative risks of occasional emotional stress, difficulty maintaining sleep, and reporting unhealthy as their self-rated health are 3.2 (95% CI: 1.3, 7.6), 2.4 (95% CI: 1.3, 4.3) and 2.6 (95% CI: 1.1, 6.2), respectively. The importance of these observations lie in its potential for improving physician and public awareness of psychosocial factors as an early indication of mental health morbidity.     

Efficacy of physical activity interventions on psychological outcomes in refugee,asylum seeker and migrant populations: A systematic review and meta-analysis

ObjectivesThe role of physical activity (PA) in the promotion of mental wellbeing and prevention of psychological disorders in population groups at increased risk for mental health conditions, such as migrant populations, has never been systematically investigated.MethodsWe conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed, Web of Science, SportDiscus. We included randomized (RCTs), controlled clinical trials (CCT), and pre-post intervention studies, that assessed the efficacy of PA interventions in migrants, compared with any types of controls.ResultsWe included 27 studies (4166 participants) (16 RCTs; 2 CCTs; 9 pre-post design) between 1997 and 2020. Meta-analysis showed a significant beneficial effect of PA over control conditions for general functioning (SMD -0.35, 95% CI -0.83 to −0.16; 400 participants), outcome expectancies (SMD -0.78, 95% CI -1.17 to −0.40; 118 participants), self-efficacy/coping (SMD -0.28, 95% CI -0.52 to −0.03; 269 participants), and psychological symptoms (SMD -0.48, 95% CI -0.88 to −0.08; 6 RCTs; 597 participants). Similar findings were produced by pre-post intervention studies (SMD -0.35, 95% CI -0.60 to −0.10; 7 studies; 302 participants).ConclusionsMigrant populations may benefit from PA interventions to improve psychological outcomes. Uncertainty remains about the best approach to promote PA in this population, and future research should consider the complex factors that characterize the migration experience.     

Violent and disruptive behavior among drug-involved prisoners: relationship with psychiatric symptoms

This study examines the relationship between psychiatric symptoms and violent/disruptive behavior among 192 inmates who participated in prison-based substance abuse treatment. Participants came from two sites able to provide narrative reports of disciplinary actions in the Criminal Justice Drug Abuse Treatment Studies' Co-Occurring Disorders Screening Instrument study. In multivariate logistic models, a lifetime history of thought insertion/control ideation (OR, 11.6; 95% CI, 1.8-75.2), antisocial personality disorder (OR, 3.3; 95% CI, 1.2-8.9), and disciplinary action related to possession of controlled substances or contraband (OR, 4.9; 95% CI, 1.9-12.3) were associated with increased risk for violent or disruptive behavior while in prison, whereas lifetime phobic symptoms (OR, 0.2; 95% CI, 0.1-0.54) and high school graduation (OR, 0.4; 95% CI, 0.2-1.0) were associated with a decreased risk of violence and disruptive behavior in general. We conclude that, among inmates in substance abuse treatment, symptoms that increase risk for violence or disruptive behavior include thought control/insertion ideation and disciplinary infractions related to controlled substances, contraband, or failure to participate in assigned programs, as well a history of antisocial personality disorder.     

Poor motor skills: A risk marker for bully victimization

Children who are clumsy are often bullied. Nevertheless, motor skills have been overlooked in research on bullying victimization. A total of 2,730 Swedish adults (83% females) responded to retrospective questions on bullying, their talents in physical education (i.e., coordination and balls skills) and school academics. Poor talents were used as indicators of poor gross motor skills and poor academic skills. A subset of participants also provided information on educational level in adulthood, childhood obesity, belonging to an ethic minority in school and socioeconomic status relative to schoolmates. A total of 29.4% of adults reported being bullied in school, and 18.4% reported having below average gross motor skills. Of those with below average motor skills, 48.6% were bullied in school. Below average motor skills in childhood were associated with an increased risk (OR 3.01 [95% CI: 1.97–4.60]) of being bullied, even after adjusting for the influence of lower socioeconomic status, poor academic performance, being overweight, and being a bully. Higher odds for bully victimization were also associated with lower socioeconomic status (OR 2.29 [95% CI: 1.45–3.63]), being overweight (OR 1.71 [95% CI: 1.18–2.47]) and being a bully (OR 2.18 [95% CI: 1.53–3.11]). The findings indicate that poor gross motor skills constitute a robust risk‐marker for vulnerability for bully victimization. Aggr. Behav. 39:453–461, 2013. © 2013 The Authors. Aggressive Behavior Published by Wiley‐Blackwell     

Immigration, suicidal ideation and deliberate self-injury in the Boston youth survey 2006

The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By contrast, U.S.-born youth who reported having been discriminated against because of their ancestry had an increased risk of deliberate self-injury (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9) and suicidal ideation (OR = 2.1, 95% CI = 1.2-3.8). The combination of being U.S.-born and experiencing ancestry-based discrimination identifies youth at increased risk for suicidal behavior.     

Cognitive impairment and the 10-year survival probability of a normal 62-year-old population

The predictive value of cognitive impairment together with demographic and health factors on long-term survival was evaluated. The population sample comprised 389 subjects, all 62 years old. Cognitive performances were measured using verbal, visuomotor and memory tests. Cognitive impairment was determined by comparing performances with norms derived from healthy controls. Ten years after testing, the probability of survival was 89% for the cognitively preserved subjects, 80% for those with mild impairment, and 71% for those with moderate impairment (p = 0.009). Relative risk (RR) for shortened survival was 1.7 (95% CI 0.9-3.2) for the mildly, and 2.6 (95% CI 1.4-4.8) for the moderately impaired. Perceived health problems were, as expected, related to reduced survival (p < 0.001, RR 3.6, 95% CI 2.1-6.0), and there was an association between cognitive impairment and impaired perceived health (p = 0.040). Multivariate analyses with Cox's regression models showed that cognitive impairment, in particular, impaired episodic memory had an association with survival, in addition to the expected effects. Thus, memory impairment may reflect very early signs of underlying disease, and so the findings provide predictive validity for the cognitive methods used.     

Associated biological and environmental factors of impaired executive function in preschool-aged children: A population-based study

Executive function (EF) is essential for academic achievement, successful work, and physical and mental health. Although evidence shows that several factors have been linked to EF, these results are mixed. This study aims to identify both biological and environmental variables associated with impaired EF in preschoolers. This study was a population-based cross-sectional study of healthy children aged 2–5 years from public and private schools in Chiang Mai, Thailand. EF was assessed using a parent report of the Behaviour Rating Inventory of Executive Function-Preschool (BRIEF-P). Multivariable logistic regression analysis was used to explore the biological and environmental factors relevant to impaired executive functioning. In a total of 1540 included children, 213 children (13.83%) were defined as impaired EF. We found that biological factors—male (odds ratio [OR], 1.41, 95% confidence interval [CI] [1.04–1.91]), overweight/obesity (OR, 1.59, 95% CI [1.10–2.31]), less physical activity (OR, 1.77, 95% CI [1.10–2.84]), and environmental factors—low maternal education (OR, 1.61, 95% CI [1.13–2.31]), permissive parenting style (OR, 2.75, 95% CI [1.24–6.13]), and excessive screen exposure (OR, 1.66, 95% CI [1.15–2.41])—are associated with an increased risk of impaired EF. Adjusting modifiable factors, such as healthy weight status, positive parenting, appropriate screen time, and adequate physical activities, may be necessary for children to promote EF.     

Associations between substance use among car and van drivers in Norway and fatal injury in road traffic accidents: A case-control study

The aim of this study was to determine the association between alcohol or drug use with fatal injury in road traffic accidents by calculating odds ratios (ORs) using a case-control design. The ‘cases’ were 508 drivers killed in road traffic accidents in the period 2003–2010 from whom blood samples were sent to the Norwegian Institute of Public Health for alcohol and drug testing, and the ‘controls’ were 9261 random drivers in normal traffic. Blood samples from ‘cases’ and oral fluid samples from ‘controls’ were analysed for alcohol, 15 drugs which have legislational concentration limits in Norway, in addition to two other commonly detected psychoactive drugs. The ORs for being killed in a traffic crash with blood alcohol concentration above the legal limit of 0.02 g/dL was 199.5 (95% CI 112.6–353.2). For the use of amphetamines without other substances the OR was 41.6 (95% CI 12.6–137.1), and for use of two or more substances 85.0 (95% CI 46.3–156.1). The OR for general use of only one medicinal drug was 6.0, and no significant ORs were found for the specific use of only zopiclone or THC. The ORs were generally higher for involvement in single-vehicle accidents. It is likely that the observed ORs, particularly for alcohol, are not only related to the risk posed by the substance alone, but a combination with behavioural factors, such as sensation seeking or risk taking behaviour.     

Circulating fibrinogen but not D-dimer level is associated with vital exhaustion in school teachers

Meta-analyses have established elevated fibrinogen and D-dimer levels in the circulation as biological risk factors for the development and progression of coronary artery disease (CAD). Here, we investigated whether vital exhaustion (VE), a known psychosocial risk factor for CAD, is associated with fibrinogen and D-dimer levels in a sample of apparently healthy school teachers. The teaching profession has been proposed as a potentially high stressful occupation due to enhanced psychosocial stress at the workplace. Plasma fibrinogen and D-dimer levels were measured in 150 middle-aged male and female teachers derived from the first year of the Trier-Teacher-Stress-Study. Log-transformed levels were analyzed using linear regression. Results yielded a significant association between VE and fibrinogen (p = 0.02) but not D-dimer controlling for relevant covariates. Further investigation of possible interaction effects resulted in a significant association between fibrinogen and the interaction term "VE x gender" (p = 0.05). In a secondary analysis, we reran linear regression models for males and females separately. Gender-specific results revealed that the association between fibrinogen and VE remained significant in males but not females. In sum, the present data support the notion that fibrinogen levels are positively related to VE. Elevated fibrinogen might be one biological pathway by which chronic work stress may impact on teachers' cardiovascular health in the long run.     

Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality

The influence of complicated grief (CG) on suicidality among bereaved adults was examined. The Yale Evaluation of Suicidality scale and the Inventory of Complicated Grief-Revised were administered to 309 bereaved adults in face-to-face interviews conducted at baseline (6.2 months post-loss) and at follow-up (10.8 months post-loss). Cross-sectionally, CG was associated with a 6.58 (95% CI: 1.74-18.0) times greater likelihood of "high suicidality" at baseline, and an 11.30 (95% CI: 3.33-38.10) times greater risk of high suicidality at follow-up, after controlling for gender, race, major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and social support. Longitudinally, CG at baseline was associated with an 8.21 (95% CI: 2.49-27.0) times greater likelihood of high suicidality at follow-up, controlling for the above confounders. The study results indicate that CG substantially heightened the risk of suicidality after controlling for important confounders such as MDD and PTSD, suggesting that CG poses an independent psychiatric risk for suicidal thoughts and actions.     

A systematic review and meta‐analysis of tertiary interventions in clinical burnout

Clinical burnout is one of the leading causes of work absenteeism in high‐ and middle‐income countries. There is hence a great need for the identification of effective intervention strategies to increase return‐to‐work (RTW) in this population. This review aimed to assess the effectiveness of tertiary interventions for individuals with clinically significant burnout on RTW and psychological symptoms of exhaustion, depression and anxiety. Four electronic databases (Ovid MEDLINE, PsychINFO, PubMed and CINAHL Plus) were searched in April 2016 for randomized and non‐randomized controlled trials of tertiary interventions in clinical burnout. Article screening and data extraction were conducted independently by two reviewers. Pooled odds ratios (ORs) and hazard ratios (HRs) were estimated with random‐effects meta‐analyses. Eight articles met the inclusion criteria. There was some evidence of publication bias. Included trials were of variable methodological quality. A significant effect of tertiary interventions compared with treatment as usual or wait‐list controls on time until RTW was found, HR = 4.5, 95% confidence interval (CI) = 2.15–9.45; however, considerable heterogeneity was detected. The effect of tertiary interventions on full RTW was not significant, OR = 1.33, 95% CI = 0.59–2.98. No significant effects on psychological symptoms of exhaustion, depression or anxiety were observed. In conclusion, tertiary interventions for individuals with clinically significant burnout may be effective in facilitating RTW. Successful interventions incorporated advice from labor experts and enabled patients to initiate a workplace dialogue with their employers.     

Short‐term cognitive‐behavioral treatment in multicultural primary care of patients with longstanding backache

The efficacy of cognitive‐behavioral therapy in multi‐cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly‐treatment given by primary care physicians regarding pain‐related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain‐related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain‐related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain‐related worry and depression were both significantly lower after treatment (pain‐related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain‐related worry (OR 2.1; 95% CI 1.1–4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6‐5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1–4.6) in the 38–45 year old age group. To conclude, a focus on pain ideas reduced pain‐related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.     

A Nationwide Panel Study on Religious Involvement and Depression in South Africa: Evidence from the South African National Income Dynamics Study

Panel data from the South African National Income Dynamics Study, a nationally representative sample of households (years 2008, 2010 and 2012), were used to examine the longitudinal association between religious involvement and depression risk. Approximately 89.6–91.8% identified themselves as religiously affiliated, while 88.0–90.3% perceived religion to be important in South Africa during the observed study periods. A short-term association between religious involvement and significant depressive symptomatology was not detected, but logistic regression models that accounted for the clustering of repeated observations within participants indicated that, over time, those with religious affiliations (aOR 0.85, 95% CI 0.76–0.96) were at a lower risk than those not affiliated. Furthermore, individuals who reported religious activity as being important (aOR 0.81; 95% CI 0.73–0.91) were at less risk of significant depressive symptomatology over time than those rating religious activity as not important. Our study points to the potentially important role of religious involvement as an emerging area of investigation toward improving mental health at a population level in resource-limited settings.     

sleep complaints,behavioral characteristics and vital exhaustion in myocardial infarction cases

Abstract

Prodromal symptoms of vital exhaustion and sleep complaints are increasingly being recognized as important risk indicators for myocardial infarction (MI). In this study, the relationships between vital exhaustion, behavioral characteristics, and MI, and between several sleep complaints and MI were investigated. The subjects were 133 male cases with first MI, 192 male hospital controls, and 133 male neighborhood controls. The instruments used were the Maastricht Questionnaire (vital exhaustion), the Life Styles Questionnaire (sleep complaints, coffee consumption, and current smoking), and the Structured Interview (Type A behavior). All sleep complaints, vital exhaustion, Type A behavior, excessive coffee consumption, and current smoking occurred significantly more often in MI-cases. After controlling for these potential confounders, and age, most sleep complaints retained significant associations with MI, in particular often taking naps during the day and waking up in the morning feeling tired and exhausted.     

Mediators of physical activity behavior change: a multivariate approach

OBJECTIVE: Using a multivariate extension of the Baron and Kenny (1986) mediation framework, we examined the simultaneous effect of variables hypothesized to mediate the relationship between a motivationally tailored physical activity intervention, and 6-month physical activity behavior in 239 healthy, underactive adults (M age = 47.5; 82% women). DESIGN: Participants were randomly assigned to (a) print-based feedback; (b) telephone-based feedback; or (c) contact control. MAIN OUTCOME MEASURES: Psychosocial variables, including self-efficacy, decisional balance, and processes of change. RESULTS: All mediation criteria were satisfied for both intervention arms. A moderate indirect effect of print (0.39, 95% CI = 0.21, 0.57) was found due to increases in behavioral processes (0.54, 95% CI = 0.29, 0.80) being attenuated by decreases due to cognitive processes (-0.17, 95%CI = 0.31,-.03). A moderate indirect effect was observed for telephone (0.47, 95% CI = 0.28, 0.66), with increases due to behavioral processes (0.61, 95% CI = 0.34, 0.87) attenuated by decreases due to cognitive processes (0.15, 95% CI = -0.27, -0.02); self-efficacy and decisional balance mediational paths did not attain statistical significance. CONCLUSIONS: These findings highlight the importance of studies that deconstruct the theoretical components of interventions to determine which combination produces the greatest behavior changes at the lowest cost.     

Medical Conditions and Nearly Lethal Suicide Attempts

P hysical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population‐based, case‐control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case‐ and 513 control‐subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random‐digit‐dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12–4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87–12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI‐0.62–4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.     

Systemic lupus erythematosus is associated with negatively variable impacts on domains of sleep disturbances: a systematic review and meta-analysis

Sleep disturbances are common in systemic lupus erythematosus (SLE), but the features of sleep disturbances are not well understood. The aim of this study was to identify the impact of SLE on specific sleep quality domains and to determine its prevalence and associations. We performed a systematic review and meta-analysis to compare the sleep outcomes of individuals with SLE and healthy controls. PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science CNKI, VIP, CNKI and Wanfang database were searched to find the published literatures (from these databases established to May 2017). Studies were screened according to inclusion and exclusion criteria and the qualities of included studies were evaluated. The data was analyzed using Revman5.3 software. Score of the Pittsburgh Sleep Quality Index (PSQI) scoring system was used as the outcome measurement, and mean differences (MD) with 95% confidence intervals (CI) were calculated. Five studies were included, including 350 SLE and 1396 healthy controls. A total of 5 studies including 827 patients were eligible for inclusion in the systematic review and meta-analysis. In this meta-analysis, each domain of the PSQI score: subjective sleep quality (MD, .58; 95% CI, .26, .89), sleep latency(MD, .47; 95% CI, .21, .73), sleep duration (MD, .36; 95% CI, .13, .58), habitual sleep efficiency (MD, .58; 95% CI, .32, .84),sleep disorders (MD, .56; 95% CI, .34, .77), use of sleep medication (MD, .56; 95% CI, .33, .80), daytime dysfunction (MD, .57; 95% CI, .11, 1.04) and the global score (MD, 3.59; 95% CI, 1.37, 5.80) were higher in SLE women than healthy controls. Furthermore, subjective sleep quality and habitual sleep efficiency were most severely affected especially. It demonstrated that targeted interventions should be done to improve their sleep quality. Early recognition and appropriate intervention are essential to reduce the negative impact of sleep disturbances on the patient’s sleep quality and outcome of their disease.