Socioeconomic Differences in Psychosocial Factors Contributing to Coronary Heart Disease: A Review

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.     

Attentional bias and anxiety in individuals with coronary heart disease

This study examined whether in an emotional Stroop task, individuals with coronary heart disease (CHD) would show greater attention towards the threatening words related to their disease than healthy persons, and if such an attentional bias is associated with anxiety. An emotional Stroop task with threatening words related to CHD as well as positive, negative and neutral words was administered to 35 individuals with CHD and 35 healthy controls. Additionally, the original Stroop task, the Beck anxiety inventory and the state-trait anxiety inventory were administered. The results indicated an attentional bias towards threatening words related to CHD in the individuals with CHD. They experienced higher interference than healthy participants from threatening words related to CHD but not from positive or negative words. Moreover, the level of interference was associated with their level of anxiety, and a vicious circle may exist in this association. In addition, results indicated a possible deficit of executive functioning among individuals with CHD. Attentional bias, as well as its association with anxiety, and an indication of deficit in executive functioning among individuals with CHD might be the risk factors for these individuals’ quality of life and for further development of their disease.     

Lifestyle effects of group health education for patients with coronary heart disease

Abstract

In the present study, effects of a health education (INFO) and a PsychoEducational Prevention (INFO + PEP) Programme were Investigated in three hospitals. These programmes were offered to groups of coronary heart disease (CHD) patients and their partners alter discharge from hospital. The INFO was offered to 127 CHD patients in addition to FIT (i.e. standard medical care and physical training). The PEP was offered to 90 Patients in, addition to the INFO and FIT. A control group of 122 patients received only FIT. The INFO and the PEP consisted of four weekly two-hour group sessions each. In addition, the PEP was followed by seven telephone follow-up contacts.

On average, patients improved their lifestyles during the first three months. Between three and twelve months an extra improvement was found for eating habits, whereas there was a relapse for smoking and a sedentary lifestyle. In the short term, angina pectoris and a longer period of heart complaints were parallelled with a decrease in the risk of maintaining unhealthy eating habits, whereas in the long term a longer period of heart complaints a younger age and unemployment predicted a lower risk of maintaining unhealthy eating habits In the short term living with a partner and in the long term female gender were predictive of continued smoking behaviour In the short term, older age, a first CABG and a specific hospital setting decreased the risk of a continued sedentary lifestyle.

The FIT + INFO + PEP had a favourable short-term effect on eating habits. For smoking and a sedentary lifestyle, however, there were negative effects. In the short term patients in the FIT +INFO and those in the FIT +INFO+PEP had significantly more problems in quitting a sedentary lifestyle than those in the FIT intervention in the long term, patients in the FIT + INFO had significantly more problems in stopping smoking compared to these in the FIT.     

Cognition and the development of temperament from late childhood to early adolescence

Temperament is related to cognition, but it is unclear whether reciprocal associations exist with early developmental trajectories. Children from the Longitudinal Study of Australian Children (N = 8,677) were assessed over four waves on verbal ability at ages 8/9, nonverbal ability at ages 8/9 and 10/11, and parent-rated temperament every two years from ages 8/9 to 14/15. Latent difference score analyses indicated correlated changes between ages 8/9 and 10/11. Increased nonverbal ability over the first two years was associated with declined reactivity and increased persistence. Latent growth curve models further indicated that nonverbal and verbal ability at baseline were associated with declined reactivity and increased persistence over the six years. These findings suggest bidirectional associations between childhood cognitive ability and temperament development.     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗。现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述。     

Childhood parental warmth and heart rate variability in midlife: Implications for health

The current study investigated high‐frequency heart rate variability (HF‐HRV) as a potential mediator between childhood parental warmth and later health and mortality outcomes. Participants were 1,255 adults (56.9% female). Childhood parental warmth was reported retrospectively at mean age 46; resting HF‐HRV was measured at mean age 57; cardiovascular health and self‐evaluated health were assessed at mean ages 57 and 63, and mortality records extracted at mean age 63. Results revealed a positive association between childhood parental warmth and resting HF‐HRV, as well as associations between higher HF‐HRV and reduced risk of having a later cardiovascular health problem and of mortality by age 63. Mediation analyses revealed a small significant indirect effect of parental warmth, through HF‐HRV, on cardiovascular health.     

Resilience is associated with better recovery in Chinese people diagnosed with coronary heart disease

This study investigated the impact of personal resilience (a composite measure of optimism, perceived control and self-esteem) on outcome measures in 67 Chinese coronary heart disease patients in response to an 8-week rehabilitation programme. The effect of personal resilience on posttraumatic growth attributed to the onset of heart disease was also examined. Results indicated that coronary heart disease patients high in personal resilience achieved better outcomes than those low in personal resilience, as indicated by higher physical and mental summary measures in SF-36, lower cholesterol levels and better performance on the 6?min walk test. Moreover, personal resilience was demonstrated to be a significant predictor of the level of posttraumatic growth although the rehabilitation programme exerted a weak mediating effect on the link between personal resilience and posttraumatic growth. Findings were discussed in relation to clinical implications of the construct of personal resilience and the intervention programme.     

Vital exhaustion measures and their associations with coronary heart disease risk factors in a sample of spanish-speakers

Abstract

The main purpose of this research was to study the reliability and conceptual validity of two Spanish language measures of Vital Exhaustion (VE), a short-term risk factor for coronary artery disease (CAD). The English version of the Maastricht Questionnaire for Vital Exhaustion was used to make a Spanish language questionnaire (VEQ) and a Spanish language interview (VEI) whose scoring systems were equal to the original version. These instruments were administered to a sample of healthy working men (n = 100) and women (n = 130) in Caracas, Venezuela. Participants also completed questionnaires designed to measure anger-expression and social support and were assessed by means of the Structured Interview to measure Type A Behaviour Pattern (TABP). Information about other CAD-risk factors, such as age, smoking behavior, and health habits, were collected.

High reliability coefficients, .85 and .91, were found for the VEI and VEQ, respectively. Principal component analysis provided one-factor solutions for each instrument. The pattern of correlations between VE, assessed by the VEI, and other personality characteristics was rather similar to the pattern observed in other cultures. In general significant, but modest, correlations were observed between VE and TABP, anger expression, a negative self-concept, and low social support. We conclude that VE appears to be a meaningful construct in this particular cultural context.     

Causal attributions for heart disease: A systematic review

Abstract

The aims of this systematic literature review are to describe the pattern of attributions made for the causes of heart disease, and to determine how this pattern varies with the method by which attributions are elicited, and the respondent group.

A search yielded 47 papers and reports, containing 54 datasets. Lifestyle factors and chronic stress were the most common causes cited across all datasets. Attributions to stressors and fate or luck were more likely to be reported in studies that used interval rating scales than in studies that used dichotomous ratings. Cardiac patients were more likely to mention stressors and fate or luck as causes of heart disease; non-patients rated being overweight and hypertensive as more important

The differences observed between the responses of patients and non-patients may be due to actor - observer differences, or to a methodological difference: patients are often asked to report their own experiences whereas non-patients are asked about the general case.     

The link between involuntary non-regular employment and poor mental health: A cross-sectional study of Japanese workers

Involuntary non-regular employment is a severe inequity problem worldwide, and it may significantly affect the mental health of employees. The present study aimed to examine the relationship between employment type and mental health. Additionally, the characteristics of involuntary non-regularly employed workers were explored. An online-based cross-sectional study was conducted in Japan, and 1566 participants were included in the data analysis. The eligible participants were divided into four categories: regularly employed (n = 1092), voluntary (n = 134), average (n = 233) and involuntary (n = 107) non-regularly employed individuals, respectively. Involuntary non-regular employment was associated with greater lack of vigour, anger-irritability, fatigue, anxiety, and depression. It was higher among women, those who were single or had no childcare, and those who had lower personal income or shorter working hours, or who tended not to practice relaxation activities. Lower personal income was associated with a risk of anxiety and depressive symptoms. Those individuals experiencing involuntary non-regular employment had a higher risk of poor mental health; subgroup analysis showed that this was particularly true among men. Both encouragement of employment stability via policy reform and workplace mental health support for involuntary non-regularly employed individuals are urgent health concerns.     

Cognitive performance in older adults with stable heart failure: Longitudinal evidence for stability and improvement

Cognitive impairment is prevalent in heart failure (HF), though substantial variability in the pattern of cognitive impairment is found across studies. To clarify the nature of cognitive impairment in HF, we examined longitudinal trajectories across multiple domains of cognition in HF patients using latent growth class modeling. 115 HF patients completed a neuropsychological battery at baseline, 3-months and 12-months. Participants also completed the Beck Depression Inventory-II (BDI-II). Latent class growth analyses revealed a three-class model for attention/executive function, four-class model for memory, and a three-class model for language. The slope for attention/executive function and language remained stable, while improvements were noted in memory performance. Education and BDI-II significantly predicted the intercept for attention/executive function and language abilities. The BDI-II also predicted baseline memory. The current findings suggest that multiple performance-based classes of neuropsychological test performance exist within cognitive domains, though case-controlled prospective studies with extended follow-ups are needed to fully elucidate changes and predictors of cognitive function in HF.     

Congenital heart disease: A primer for the pediatric neuropsychologist

Congenital heart disease (CHD) affects millions of people worldwide, including over one million children in the United States. Approximately 25% of children born with CHD require intensive surgical intervention within the first year of life. Despite improved rates of survival into adulthood – rates that exceed 90% in the modern era – children and adolescents with CHD remain at risk for neurological injury and a range of neurobehavioral and psychosocial challenges that pose a threat to quality of life across the lifespan. Consequently, as experts in both clinical psychology and brain development, neuropsychologists are becoming increasingly involved in cardiac follow-up and monitoring to promote optimal developmental outcomes. The primary objective of this paper is to provide an evidence-based, clinically-oriented primer on CHD for pediatric neuropsychologists working with this growing population of survivors. Following an introduction to current standard-of-care guidelines for managing children and adolescents with CHD, we present an overview of brain development within the context of CHD, review neuropsychological outcomes, examine factors influencing variability in outcomes, and discuss implications and strategies for clinical assessment.     

The Pathways Between Socioeconomic Status and Adolescent Outcomes: A Systematic Review

Socioeconomic status (SES) is a significant risk factor for negative adolescent development outcomes. Identifying the pathways between SES and these outcomes may inform interventions for adolescents from this demographic. We conducted a systematic literature review of eight databases for studies investigating pathways between SES and adolescent psychosocial outcomes. A total of 59 articles met inclusion criteria. Significant risk factors identified include economic stress, chaos in the home, and violence in the community. These risk factors appear to be mediated through parent depression, conflict between parents, parenting practices, and adolescent resilience. Interventions focusing on the identified risk factors are recommended.     

Neurological subtle signs and cognitive development: A study in late childhood and adolescence

Introduction and Aim: Neurological subtle signs (NSS) are often observed during the neurological examination of children and tend to disappear with age. Their persistence into late adolescence or young adulthood has been related to psychiatric and neurocognitive disorders. To provide a better understanding of their functional basis, a longitudinal correlational study with neurocognitive measurements was performed.

Method: We conducted multiple regression and correlation analyses of NSS with demographic and cognitive measures on a subset of 341 healthy children (56% males), taking part in a longitudinal dental study. Participants, whose ages ranged between 11–15 years, at first evaluation, undertook yearly, during 5 years, a 6-item NSS exam (producing a total score ranging between 0–18) and a comprehensive battery of neurocognitive tests. Effects of age, gender, IQ, and 7 neurocognitive factors on NSS were analyzed.

Results: Over the years, NSS scores correlated consistently with selective attention (Stroop test), motor speed (finger tapping), and visuomotor speed (pegboard speed).

Discussion: These results suggest that the disappearance of NSS in late childhood and adolescence occurs primarily in parallel with the development of motor and visuomotor functions and secondarily in relation to higher order functions such as selective attention (Stroop) and executive control (B-A Trails difference).     

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.     

Posttraumatic stress and depression: potential pathways to disease burden among heart failure patients

Background and Objectives: Posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) are associated with high disease burden. Pathways by which PTSD and MDD contribute to disease burden are not understood. Design: Path analysis was used to examine pathways between PTSD symptoms, MDD symptoms, and disease burden among 251 low-income heart failure patients. Methods: In Model 1, we explored the independent relationship between PTSD and MDD symptoms on disease burden. In Model 2, we examined the association of PTSD symptoms and disease burden on MDD symptoms. We also examined indirect associations of PTSD symptoms on MDD symptoms, mediated by disease burden, and of PTSD symptoms on disease burden mediated by MDD symptoms. Results: Disease burden correlated with PTSD symptoms (r = .41; p < .001) and MDD symptoms (r = .43; p < .001) symptoms. Both models fit the data well and displayed comparable fit. MDD symptoms did not mediate the association of PTSD symptoms with disease burden. Disease burden did mediate the relationship between PTSD symptoms and MDD symptoms. Conclusions: Results support the importance of detection of PTSD in individuals with disease. Results also provide preliminary models for testing longitudinal data in future studies.     

Inhibitory control and the onset of combustible cigarette,e-cigarette,and hookah use in early adolescence: The moderating role of socioeconomic status

The purpose of the study was to test the moderating influence of socioeconomic status (SES) on the associations between inhibitory control and the onset of combustible cigarette, electronic (e-) cigarette, and hookah use in early adolescence. A total of 407 adolescents self-reported nicotine use, inhibitory control, and SES. The hypothesis that inhibitory control would be significantly associated with nicotine use onset (i.e., combustible cigarettes, e-cigarettes, and hookah) only under the condition of low SES was tested. Direct associations were found for inhibitory control on “ever use” of all three nicotine use variables. A moderating effect was also found whereby low inhibitory control was significantly associated with nicotine use onset when participants were from low, but not high, SES families. Findings illustrate one contextual condition under which inhibitory control is associated with early onset of nicotine use.     

Childhood intelligence and adult health: The mediating roles of education and socioeconomic status

The longitudinal relation between childhood intelligence and various health outcomes in adulthood is now well-established. One mediational model that accounts for this relation proposes that intelligence has cumulative indirect effects on adult health via subsequent educational attainment and adult socioeconomic status (SES). The aim of the present study was to examine whether and the extent to which educational attainment and SES mediate the impact of childhood intelligence on three dimensions of adult health in Luxembourg, a country with high-quality universal public health care. We used data from 745 participants in the Luxembourgish MAGRIP study. At the age of 12, participants completed a comprehensive intelligence test. At the age of 52, they reported their educational careers, SES, and functional, subjective, and physical health status. Using structural equation modeling, we investigated the direct and indirect effects (via educational attainment and adult SES) of childhood intelligence on adult health. We found that higher childhood intelligence predicted better functional, subjective, and physical health in adulthood. These effects were entirely mediated via educational attainment and SES. The mediational processes differed depending on the health dimension under investigation: Whereas SES was crucial in mediating the effect of intelligence on functional and subjective health, educational attainment was crucial in mediating the effect on physical health. These findings held up when considering adult intelligence and were similar for women and men. Our results suggest that even excellent public health care cannot fully offset the cumulative effects of childhood intelligence on adult health. Further studies are needed to investigate the relative importance of different mediators in the intelligence–health relation while including a broader set of objective health measures.     

The relationships between television viewing in midlife and the development of Alzheimer's disease in a case-control study

The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer's disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive measures against cognitive decline, it is important to examine the effects of less stimulating but common activities. Data are from 135 Alzheimer's disease cases and 331 healthy controls. Demographic characteristics and life history questionnaire responses on the number of hours spent on 26 leisure activities during middle-adulthood (ages 40-59) were analyzed. Logistic regression was used to examine the effects of middle-adulthood leisure activities on case vs. control status. Results indicate that for each additional daily hour of middle-adulthood television viewing the associated risk of AD development, controlling for year of birth, gender, income, and education, increased 1.3 times. Participation in intellectually stimulating activities and social activities reduced the associated risk of developing AD. Findings are consistent with the view that participation in non-intellectually stimulating activities is associated with increased risk of developing AD, and suggest television viewing may be a marker of reduced participation in intellectually stimulating activities.