Epigenetic mechanisms have been implicated in the pathogenesis of psychiatric disorders. The serotonin transporter gene (SLC6A4) is a key candidate gene for depression. We examined the association between SLC6A4 promoter methylation variation and depressive symptoms using 84 monozygotic twin pairs.
DNA methylation level in the SLC6A4 promoter region was quantified by bisulfite pyrosequencing using genomic DNA isolated from peripheral blood leukocytes. The number of current depressive symptoms was assessed using the Beck Depressive Inventory II (BDI-II). The association between methylation variation and depressive symptoms was examined using matched twin-pair analyses, adjusting for body mass index, smoking, physical activity, and alcohol consumption. Multiple testing was controlled by adjusted false discovery rate (q value).
Intrapair difference in DNA methylation variation at 10 of the 20 studied CpG sites is significantly correlated with intrapair difference in BDI scores. Linear regression using intrapair differences demonstrates that intrapair difference in BDI score was significantly associated with intrapair differences in DNA methylation variation after adjusting for potential confounders and correction for multiple testing. On average, a 10% increase in the difference in mean DNA methylation level was associated with 4.4 increase in the difference in BDI score (95% confidence interval = 0.9–7.9, p = .01).
This study provides evidence that variation in methylation level within the promoter region of the serotonin transporter gene is associated with variation in depressive symptoms in a large sample of monozygotic twin pairs. This relationship is not confounded by genetic and shared environment. The 5-HTTLPR genotype also does not modulate this association.
DNA methylation; SLC6A4; depressive symptoms; monozygotic twins
Depression and inflammation are common among cancer patients. Data suggest that inflammation can contribute to depressive symptoms, while the converse remains untested. We experimentally test whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients, and further, we test one mechanism for the intervention effects.
As part of a randomized clinical trial, newly diagnosed breast cancer patients (N=45) with clinically significant depressive symptoms were evaluated and randomized to Psychological Intervention with assessment or Assessment only study arms. The intervention spanned 12 months, with assessments at baseline, 4, 8, and 12, months. Mixed effects modeling tested the hypothesis that the intervention reduced self reported depressive symptoms (Center for Epidemiological Studies Depression scale, Profile of Mood States Depression and Fatigue subscales, and SF-36 Bodily Pain subscale) and immune cell numbers that are elevated in the presence of inflammation (white blood cell [WBC] count, neutrophil count, and helper:suppressor ratio). Mediation analyses tested whether change in depressive symptoms, pain, or fatigue predicted change in WBC count, neutrophil count, or the helper:suppressor ratio.
The intervention significantly reduced depressive symptoms, pain, fatigue, and inflammation markers. Moreover, the intervention effect on inflammation was mediated by its effect on depressive symptoms.
This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation. Data show that the intervention directly reduced depressive symptoms and indirectly reduced inflammation. Psychological treatment may effectively treat depressive symptoms, pain, and fatigue among cancer patients.
psychological intervention; cancer; depression; white blood cell count; inflammation
Convergent neuroimaging and neuropsychological research demonstrates disrupted attention and heightened threat sensitivity in PTSD. This might be linked to aberrations in large-scale networks subserving detection of salient stimuli, i.e. the salience network (SN), and stimulus-independent, internally-focused thought, i.e. the default mode network (DMN).
Resting state brain activity was measured in returning veterans who served in Iraq or Afghanistan with (n=15) and without PTSD (n=15) and in healthy community controls (n=15). Correlation coefficients were calculated between the time course of seed regions in key SN and DMN regions (posterior cingulate, ventromedial prefrontal cortex, and bilateral anterior insula) and all other voxels of the brain.
Compared to control groups, PTSD participants showed reduced functional connectivity within DMN (between DMN seeds and other DMN regions), including rostral ACC/vmPFC (Z=3.31; p=.005, corrected) and hippocampus (Z=2.58; p=.005), and increased connectivity within SN (between insula seeds and other SN regions), including amygdala (Z=3.03; p=.01, corrected). PTSD participants also demonstrated increased cross-network connectivity. DMN seeds exhibited elevated connectivity with SN regions, including insula (Z=3.06; p=.03, corrected), putamen, and supplementary motor area (Z=4.14; Z=4.08; p<.001), and SN seeds exhibited elevated connectivity with DMN regions, including hippocampus (Z=3.10; p=.048, corrected).
During resting state scanning, PTSD participants showed reduced coupling within DMN, greater coupling within SN, and increased coupling between DMN and SN. Our findings suggest a relative dominance of threat-sensitive circuitry in PTSD, even in task-free conditions. Disequilibrium between large-scale networks subserving salience detection versus internally focused thought may be associated with PTSD pathophysiology.
PTSD; default mode network; salience network; functional connectivity; resting-state; fMRI
The primary purpose of this manuscript is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The manuscript begins with a general introduction to multilevel modeling. Multilevel regression modeling at two-levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated datasets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including: communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive behavioral stress management intervention in prostate cancer.
mixed regression models; random coefficient models; hierarchical linear models; centering; power; missing data
Treatment recommendation and guidelines for patients with heart failure (HF) can be complex, and past work has shown HF patients to demonstrate low rates of adherence to recommended health behaviors. While previous work has identified several medical, demographic, and psychosocial predictors of HF persons’ capacity to adhere to treatment recommendations, little is known about the contribution of cognitive impairment to reported treatment adherence in this population.
149 persons with HF (68.08 years; SD = 10.74) completed a brief fitness assessment and neuropsychological testing. Treatment adherence was assessed using the Heart Failure Compliance Questionnaire, a brief measure that asks participants to report their adherence to a variety of recommended health behaviors (i.e., medication management, diet, exercise, among others).
16.1% of participants reported poor overall adherence, with particularly high rates of non-adherence to dietary and exercise recommendations. Hierarchical regression analyses adjusting for possible confounds revealed reduced performance on attention (β = .26, p = .01), executive function (β = .18, p = .04), and language (β = .22, p = .01) were associated with poorer overall adherence. Follow-up analyses showed these cognitive domains were associated with behaviors such as keeping doctor appointments, medication management, and dietary recommendations (p < .05 for all).
The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF. Prospective studies that objectively measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population.
attention; executive function; heart failure; treatment adherence; cognitive impairment
Empirical findings on racial discrimination and hypertension risk have been inconsistent. Some studies have found no association between self-reported experiences of discrimination and cardiovascular health outcomes while others have found moderated or curvilinear relationships. The current cross-sectional study examined whether the association between racial discrimination and hypertension is moderated by implicit racial bias among African American midlife men.
This study examined data on 91 African American men between 30-50 years of age. Primary variables were self-reported experiences of racial discrimination; and unconscious racial bias as measured by the Black-White Implicit Association Test. Modified Poisson regression models were specified examining hypertension, defined as mean resting systolic ≥ 140 mm Hg or diastolic ≥ 90 mm Hg; or self-reported history of cardiovascular medication use with a physician diagnosis of hypertension.
No main effects for discrimination or implicit racial bias were found, but the interaction of the two variables was significantly related to hypertension (χ2 = 4.89, 1 df, p < 0.05). Among participants with an implicit anti-Black bias, more frequent reports of discrimination were associated with a higher probability of hypertension, while among those with an implicit pro-Black bias, it was associated with lower risk.
The combination of experiencing racial discrimination and holding an anti-Black bias may have particularly detrimental consequences for hypertension among African American midlife men, while holding an implicit pro-Black bias may buffer the effects of racial discrimination. Efforts to address both internalized racial bias and racial discrimination may lower cardiovascular risk in this population.
African American men; hypertension; racial discrimination; implicit racial bias
Posttraumatic stress disorder (PTSD) is associated with altered neuropsychological function, possibly including complex visual information processing. Grapheme-color synesthesia refers to the phenomenon that a particular letter or number elicits the visual perception of a specific color. The study objective was to assess if grapheme-color synesthesia was associated with PTSD among US veterans.
We surveyed 700 veterans who were outpatients in a multi-hospital system in Pennsylvania. All veterans had served at least one warzone deployment. PTSD and grapheme-color synesthesia were assessed using a validated research instruments.
The mean age of veterans was 59 and 96% were men. The prevalence of current PTSD was 7% (95% C.I. = 5.1–8.8) and current partial PTSD was 11% (95% C.I. = 9.3–14.0). The prevalence of current depression was 6% (95% C.I. = 4.7–8.3). Altogether, 6% (95% C.I. = 4.8–8.5) of veterans screened positive for grapheme-color synesthesia. Bivariate analyses suggested that grapheme-color synesthesia was associated with current PTSD (odds ratio [OR] = 3.4, p = 0.004) and current partial PTSD (OR = 2.4, p = 0.013), but not current depression (OR = 1.1, p = 0.91). Multivariate logistic regression results, adjusting for age, gender, marital status, level of education, current psychotropic medication use, and concussion history, confirmed these results.
Grapheme-color synesthesia appears to be associated with PTSD among veterans who had been deployed. This finding may have implications for PTSD diagnostic screening and treatment. Research is recommended to confirm this finding and to determine if synesthesia is a risk indicator for PTSD among nonveterans.
Posttraumatic stress disorder; Depression; Synesthesia; Veterans; Risk factors; Trauma exposure
To examine the association between Five Factor Model personality traits (Neuroticism, Extraversion, Openness to experience, Agreeableness, Conscientiousness) and physician-quantified aggregate morbidity in a sample of older adults in primary care.
A total of 449 primary care patients, ranging in age from 65 to 97 years (75 ± 6.9 (mean ± standard deviation)), completed the Neo-Five Factor Inventory (NEO-FFI) and extensive interviews. A physician-investigator completed the Cumulative Illness Rating Scale (CIRS), a well-validated measure of aggregate morbidity based on a review of medical records.
Bivariate analyses demonstrated that all five domains of the NEO-FFI were associated with CIRS scores. Multivariate regression controlling for age, gender, education, depression, smoking, hypertension, total cholesterol, alcohol or substance misuse, and other personality traits showed that greater Conscientiousness was independently associated with lower CIRS scores (β = −0.10, t(435) = −1.96, p = .05). Other independent predictors of less morbidity were younger age, absence of hypertension, and lower levels of depression.
Our results point toward the necessity of considering Conscientiousness and other personality traits in studies of risk factors for aggregate morbidity. More detailed characterization of at-risk populations will increase the likelihood of constructing informed and effective prevention, intervention, and policy initiatives.
personality; older adults; medical illnesses; primary care
Depression and sleep apnea (SA) are common among patients after acute myocardial infarction (AMI), and both are associated with increased risk for adverse outcomes. We tested the hypothesis that there is an interaction between depression and SA in relation to prognosis in post-AMI patients.
Participants were 337 depressed and 379 nondepressed post-AMI patients who participated in a substudy of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. SA was identified from Holter ECG at the entry by an algorithm that detects cyclic variation of heart rate.
During a median follow-up of 25 months, 43 (6.0%) of patients died and 83 (11.6%) either died or experienced a recurrent AMI. Among 94 patients with both depression and SA, these endpoints occurred in 20 (21.3%) and 25 (26.6%), the prevalence that was 6.9 and 3.9 times higher than predicted probabilities by ENRICHD clinical risk scores (P <.001 for both). In the patients with depression alone, SA alone, or neither, the frequencies did not differ significantly from the predicted probability. Although both depression and SA predicted death and the combined endpoint, we observed depression by SA interactions (P = .03 and .02). SA independently predicted these endpoints in depressed (P <.001 and P = .001), but not in nondepressed patients (P = .73 and .84). Similarly, depression independently predicted these endpoints in SA (P <.001 for both), but not in non-SA patients (P = .61 and .12).
The combination of depression and SA estimated by CVHR is associated with long-term adverse clinical outcomes after AMI.
Depression; Sleep apnea; Myocardial infarction; Mortality
We previously reported a unique hypothalamic-pituitary-thyroid (HPT) axis profile in women with a menstrually related mood disorder (MRMD) who also had a history of sexual abuse (SA). In the present study, we sought to extend that work by examining the association of a SA history with HPT-axis disturbance in both MRMD and non-MRMD women.
Fifty-seven women met prospective criteria for MRMD (23 with a SA history) and 52 women were non-MRMD (18 with a SA history). Thyroid stimulating hormone (TSH), T4, (total and free) and T3 (total and free) were evaluated in serum together with thyroid hormone ratios reflecting T4 to T3 conversion.
MRMD women, compared with non-MRMD women, had elevated T3/T4 ratios (ps≤0.01; reflecting increased conversion of T4 to T3) and lower free and total T4 concentrations (ps=0.01). Higher T3/T4 ratios and lower T4 concentrations predicted more severe premenstrual symptomatology in all women. A SA history, irrespective of MRMD status, was associated with elevated TSH concentrations (p=0.03). However, in MRMD women, a SA history was associated with elevated T3 concentrations (p=0.049), whereas in non-MRMD women, a SA history was associated with decreased T3 concentrations (p=0.02).
A MRMD and a SA history are associated with independent as well as interactive effects on the HPT-axis. The evidence that a MRMD moderates the influence of SA on T3 concentrations contributes to a growing body of work suggesting that a SA history may identify a distinct subgroup of women with MRMD.
Menstrually related mood disorders; sexual abuse; thyroid hormones
Set-shifting difficulties are observed among adults with bulimia nervosa (BN). This study aimed to assess whether adolescents with BN and BN-spectrum eating disorder (EDs) exhibit set-shifting problems relative to healthy controls.
Neurocognitive data from 23 adolescents with BN were compared to 31 adolescents with BN-type ED Not Otherwise Specified (EDNOS-BN); and 22 healthy controls (HC) on various measures of set-shifting (Trail Making Task [shift task], Color-Word Interference, Wisconsin Card Sorting Test, and Brixton Spatial Anticipation Task).
No significant differences were found among groups on set-shifting tasks (p values >.35), and effect sizes were small (Cohen’s f <0.17).
Cognitive inflexibility may develop over time as a result of the ED, though it is possible that there is a subset of individuals for whom early neurocognitive difficulty may result in longer illness trajectory. Future research should investigate the existence of neurocognitive taxons amongst larger samples, as well as employ longitudinal designs to fully explore biomarkers and illness effects.
Bulimia Nervosa; Set-shifting; Neurocognition; Eating Disorders; Cognitive inflexibility
To determine whether obstructive sleep apnea mediates the relationship between posttraumatic stress disorder (PTSD) and psychosomatic and somatic disorders and its implications for self-rated health (SRH) among Iraqi immigrants in the United States.
A random sample of immigrants who had left Iraq before the 1991 Gulf War (n = 145) or after (n = 205) and are residing in metropolitan Detroit responded to a structured interview covering questions on sociodemographics, premigration trauma, SRH, physician-diagnosed and -treated obstructive sleep apnea, somatic disorders, and psychosomatic disorders. Structural equation modeling was used to evaluate the relationship between premigration trauma scores and health, as well as to explore mediating pathways between PTSD, obstructive sleep apnea, and health.
The prevalence of obstructive sleep apnea among post-Gulf War immigrants (30.2%) was significantly higher than among pre-Gulf War immigrants (0.7%; p < .001). Premigration trauma scores were positively associated with depression and PTSD. Structural equation modeling supported a model in which obstructive sleep apnea mediated the relationship between PTSD and psychosomatic and somatic disorders. Premigration trauma also related directly to SRH.
Part of the PTSD-associated adverse health effects observed in Iraqi immigrants is mediated by obstructive sleep apnea. Because sleep apnea in the current study is based on medical history and current treatment, there is a need for future confirmatory polysomnographic studies.
stress; Gulf War; PTSD; obstructive sleep apnea; health; psychosomatic disorder
To determine whether the relationship between interleukin (IL)-6 and depressive symptoms is moderated by participation in moderate-intensity physical activity in a sample of primary care patients. Elevated inflammation has been associated with a number of poor health outcomes. Depressive symptoms may be related to higher levels of the inflammatory marker IL-6; however, previous findings are inconsistent, possibly due to unidentified moderating factors.
A total of 107 participants, aged ≥40 years, were recruited in Rochester, New York, in 2006 to 2007. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale-Revised, participation in moderate-intensity physical activity was measured using a modified version of the Community Health Activities Model Program for Seniors Activity Questionnaire for Older Adults, and serum IL-6 concentrations were determined using standard enzyme-linked immunosorbent assay protocols and high-sensitivity, anti-cytokine antibody pairs. A hierarchical multiple regression analysis was conducted.
The correlation between IL-6 and depressive symptoms was nonsignificant (r = .086, p = .40). The association between IL-6 and depressive symptoms was moderated by participation in moderate-intensity physical activity (p = .02). Among those who did not engage in moderate-intensity physical activity, higher levels of depressive symptoms were significantly associated with higher levels of IL-6 (r = .28, p = .05), whereas this association was not significant among those who did participate in moderate-intensity physical activity (r = −.13, p = .38).
Participation in moderate-intensity physical activity may buffer the risk of higher inflammation often associated with higher levels of depressive symptoms.
exercise; depressive symptoms; interleukin-6; inflammation; physical activity; depression
To examine sex differences in the relation of childhood socioeconomic status (CSES) to systolic (SBP) and diastolic (DBP) blood pressure trajectories during 15-years spanning young (30 ± 3 years) and middle (45±3 years) adulthood, independent of adult SES.
4077 adult participants reported father’s and mother’s educational attainments at study enrollment (Year 0), and own educational attainment at enrollment and at all follow-up exams. Resting BP also was measured at all exams. Data from exam Years 5 (when participant mean age=30± 3 years), 7, 10, 15, and 20 are examined here. Associations of own adult [Year 5], mother’s, and father’s educations with 15-year BP trajectories were examined in separate multilevel models. Fully controlled models included time-invariant covariates (age, sex, race, recruitment center), and time-varying covariates that were measured at each exam (marital status, body mass, cholesterol, oral contraceptives/hormones, antihypertensives). Parental education analyses controlled for own education.
When examined without covariates, higher education -- own (SBP γ=−0.03, DBP γ= −0.03), mother’s (SBP γ= −0.02, DBP γ= −0.02), and father’s (SBP γ= −0.02, DBP γ= −0.01) -- were associated with attenuated 15-year increases in BP (p<0.001). Associations of own (but not either parent’s) education with BP trajectories remained independent of standard controls. Sex moderated the apparent null effects of parental education, such that higher parental education–especially mother’s, predicted attenuated BP trajectories independent of standard covariates among women (SBP γ= −.02, p=.02; DBP γ= −.01, p=0.04) but not men (SBP γ=0.02, p=0.06; DBP γ=0.005, p=0.47; p-interaction SBP<0.001, p-interaction DBP=0.01).
CSES may influence women’s health independent of their own adult status.
blood pressure; childhood socioeconomic status; multilevel modeling; sex differences
Elevated body mass index (BMI) at midlife is associated with increased risk of cognitive decline in later life. The goal of the current study was to assess mechanisms of early brain vulnerability by examining if higher BMI at midlife has an effect on current cognitive performance through alterations in cerebral neurochemistry.
Fifty-five participants, aged 40–60 years, underwent neuropsychological testing, health screen, and proton magnetic resonance spectroscopy (1H MRS) examining N-acetyl-aspartate (NAA), creatine (Cr), myo-inositol (mI), choline (Cho), and glutamate (Glu) concentrations in occipitoparietal grey matter. Concentrations of NAA, Cho, mI, and Glu were calculated as a ratio over Cr and examined in relation to BMI using multivariate regression analyses. Structural equation modeling was used to determine if BMI had an indirect effect on cognition through cerebral metabolite levels.
Higher BMI was associated with elevations in mI/Cr (F(5,45)= 3.843, p=0.006, β=0.444, p=0.002), independent of age, sex, fasting glucose levels, and systolic blood pressure. Moreover, a chi-square difference test of the direct and indirect structural equation models revealed that BMI had an indirect effect on global cognitive performance (ΔX2(df=2) =19.939, p<0.001). Subsequent follow-up analyses revealed that this effect was specific to memory (ΔX2(df=2) = 22.027, p<0.001).
Higher BMI was associated with elevations in mI/Cr concentrations in the occipitoparietal grey matter and indirectly related to poorer memory performance through mI/Cr, potentially implicating plasma hypertonicity and neuroinflammation as mechanisms underlying obesity-related brain vulnerability.
BMI; obesity; proton magnetic resonance spectroscopy; myo-inositol
This study investigated the effects of acculturation on cortisol, a biological correlate of maternal psychological distress, and perinatal infant outcomes, specifically gestational age at birth and birth weight.
Fifty-five pregnant women of Mexican descent were recruited from a community hospital and collected saliva samples at home over 3 days during pregnancy at 15–18 (early), 26–2 (mid), and 32+ (late) weeks gestation and once in the postpartum period (4–12 weeks). These values were used to determine the diurnal cortisol slope at each phase of pregnancy. Mothers also completed an acculturation survey and gave permission for a medical chart review to obtain neonate information.
Multiple regression analyses determined that greater acculturation levels significantly predicted earlier infant gestational age at birth (R2=0.09, p=0.03). T-tests revealed that mothers of low birth weight infants weight (<2500g) had significantly higher acculturation scores than mothers of infants with birth weight >2500g (t=−2.95, p=0.005). A blunted maternal cortisol slope during pregnancy was also correlated with low birth weight (r=−0.29, p=0.05), but not gestational age (r=−0.08, p=0.59). In addition, more acculturated women had a flatter diurnal cortisol slope late in pregnancy (R2=0.21, p=0.01). Finally diurnal maternal cortisol rhythms were identified as a potential mediator between increased acculturation and birth weight.
This study associated increased acculturation with perinatal outcomes in the US Mexican population. This relationship may be mediated by prenatal maternal diurnal cortisol, which can program the health of the fetus leading to several adverse perinatal outcomes.
perinatal; hypothalamic-pituitary-adrenal axis; mother; immigrant; gestational age; birth weight
Research demonstrates a negative impact of sleep disturbance on mood and affect; however, the biological mechanisms mediating these links are poorly understood. Amygdala reactivity to negative stimuli has emerged as one potential pathway. Here, we investigate the influence of self-reported sleep quality on associations between threat-related amygdala reactivity and measures of negative affect and perceived stress.
Analyses on data from 299 participants (125 men, 50.5% white, mean [standard deviation] age = 19.6 [1.3] years) who completed the Duke Neurogenetics Study were conducted. Participants completed several self-report measures of negative affect and perceived stress. Threat-related (i.e., angry and fearful facial expressions) amygdala reactivity was assayed using blood oxygen level–dependent functional magnetic resonance imaging. Global sleep quality was assessed using the Pittsburgh Sleep Quality Index.
Amygdala reactivity to fearful facial expressions predicted greater depressive symptoms and higher perceived stress in poor (β values = 0.18–1.86, p values < .05) but not good sleepers (β values = −0.13 to −0.01, p values > .05). In sex-specific analyses, men reporting poorer global sleep quality showed a significant association between amygdala reactivity and levels of depression and perceived stress (β values = 0.29–0.44, p values < .05). In contrast, no significant associations were observed in men reporting good global sleep quality or in women, irrespective of sleep quality.
This study provides novel evidence that self-reported sleep quality moderates the relationships between amygdala reactivity, negative affect, and perceived stress, particularly among men.
sleep; amygdala; stress; depression; negative affect
To determine if parenthood predicts host resistance to the common cold among healthy volunteers experimentally exposed to a common cold virus.
Subjects were 795 healthy participants (age range 18–55) enrolled in one of 3 viral-challenge studies conducted from 1993–2004. After reporting parenthood status, participants were quarantined, administered nasal drops containing one of four common cold viruses, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5–6 days after exposure. All analyses included controls for immunity to the experimental virus (pre-challenge specific antibody titers), viral strain, season, age, sex, race/ethnicity, marital status, body mass, study, employment status and education.
Parents were less likely to develop colds than non-parents (OR=0.48; 95% CI, 0.31–0.73). This was true for both parents with 1–2 children (OR=0.52; 95% CI, 0.33–0.83) and 3 or more children (OR=0.39; 95% CI, 0.22–0.70). Parenthood was associated with a decreased risk of colds for both those with at least one child living at home (OR=0.46; 95% CI, 0.24–0.87), and those whose children all lived away from home (OR=0.27; 95% CI, 0.12–0.60). The relationship between parenthood and colds was not observed in parents ages 18–24, but was pronounced among older parents.
Parenthood was associated with greater host resistance to common cold viruses.
parenthood; influenza; rhinovirus; disease susceptibility; common cold
To extend findings that African American women report greater stress during pregnancy, have higher blood pressure (BP), and are twice as likely to have low birthweight infants relative to white women. This study examines a) racial differences in associations between stress and BP during pregnancy, and b) the combined effects of stress and BP on infant birthweight in a sample of 170 African American and white women.
A prospective, longitudinal study of pregnant women was conducted in which measures of BP, stress, and other relevant variables were collected. Multiple measures of systolic and diastolic BP were taken at each of three points during pregnancy (18–20, 24–26, and 30–32 weeks gestation).
Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with stress in pregnant African American women and not in pregnant white women. In analyses of birthweight, there were no main effects of BP or stress. However, a significant interaction demonstrated that, when stress was high, DBP was negatively associated with birthweight and a combination of high stress and high DBP predicted the lowest birthweight in the sample. Furthermore, African American women were twice as likely as white women to have a combination of high stress and high DBP.
Racial differences in relationships between stress and BP, and the interactive effect of stress and DBP on birthweight together suggest that a high stress-high BP profile may pose a risk for lower birthweight among African American women, in particular, and possibly for all pregnant women.
pregnancy; birthweight; African American; blood pressure; stress
Treatments of female sexual dysfunction have been largely unsuccessful because they do not address the psychological factors that underlie female sexuality. Negative self-evaluative processes interfere with the ability to attend and register physiological changes (interoceptive awareness). This study explores the effect of mindfulness meditation training on interoceptive awareness and the three categories of known barriers to healthy sexual functioning: attention, self-judgment, and clinical symptoms.
Forty-four college students (30 women) participated in either a 12-week course containing a “meditation laboratory” or an active control course with similar content or laboratory format. Interoceptive awareness was measured by reaction time in rating physiological response to sexual stimuli. Psychological barriers were assessed with self-reported measures of mindfulness and psychological well-being.
Women who participated in the meditation training became significantly faster at registering their physiological responses (interoceptive awareness) to sexual stimuli compared with active controls (F(1,28) = 5.45, p = .03, ηp2 = 0.15). Female meditators also improved their scores on attention (t = 4.42, df = 11, p = .001), self-judgment, (t = 3.1, df = 11, p = .01), and symptoms of anxiety (t = −3.17, df = 11, p = .009) and depression (t = −2.13, df = 11, p < .05). Improvements in interoceptive awareness were correlated with improvements in the psychological barriers to healthy sexual functioning (r = −0.44 for attention, r = −0.42 for self-judgment, and r = 0.49 for anxiety; all p < .05).
Mindfulness-based improvements in interoceptive awareness highlight the potential of mindfulness training as a treatment of female sexual dysfunction.
mindfulness; meditation; interoceptive awareness; self-evaluation; female sexuality; arousal
To investigate the relationship between a measure of cumulative physiologic dysfunction and specific domains of cognitive function.
We examined a summary score measuring physiological dysfunction, a multisystem measure of the body’s ability to effectively adapt to physical and psychological demands, in relation to cognitive function deficits in a population of 4511 adults aged 20 to 59 who participated in the third National Health and Nutrition Examination Survey (1988–1994). Measures of cognitive function comprised three domains: working memory, visuomotor speed, and perceptual-motor speed. ‘Physiologic dysfunction’ scores summarizing measures of cardiovascular, immunologic, kidney, and liver function were explored. We used multiple linear regression models to estimate associations between cognitive function measures and physiological dysfunction scores, adjusting for socioeconomic factors, test conditions, and self-reported health factors.
We noted a dose-response relationship between physiologic dysfunction and working memory (coefficient = 0.207, 95% CI = (0.066, 0.348), p < 0.0001) that persisted after adjustment for all covariates (p = 0.03). We did not observe any significant relationships between dysfunction scores and visuomotor (p = 0.37) or perceptual-motor ability (p = 0.33).
Our findings suggest that multisystem physiologic dysfunction is associated with working memory. Future longitudinal studies are needed to clarify the underlying mechanisms and explore the persistency of this association into later life. We suggest that such studies should incorporate physiologic data, neuroendocrine parameters, and a wide range of specific cognitive domains.
Allostatic Load; Cognition; Epidemiology; Cross-Sectional Analysis
There is a bidirectional association between depression and cardiovascular disease. The neurobiological mechanisms underlying this association may involve an inability to cope with disrupted social bonds. This study investigated in an animal model the integration of depressive behaviors and cardiac dysfunction following a disrupted social bond and during an operational measure of depression, relative to the protective effects of intact social bonds.
Depressive behaviors in the forced swim test and continuous electrocardiographic parameters were measured in 14 adult, female socially monogamous prairie voles (rodents), following 4 weeks of social pairing or isolation.
Following social isolation, animals exhibited (all values are mean ± standard error of the mean, isolated vs. paired respectively) increased heart rate (416±14bpm vs. 370±14bpm, P<0.05) and reduced heart rate variability [3.3±0.2ln(ms2) vs. 3.9±0.2ln(ms2)]. During the forced swim test, isolated animals exhibited greater helpless behavior (immobility, 106±11sec vs. 63±11sec, P<0.05), increased heart rate (530±22bpm vs. 447±15bpm, P<0.05), reduced heart rate variability [1.8±0.4ln(ms2) vs. 2.7±0.2ln(ms2), P<0.05), and increased arrhythmias (arrhythmic burden score, 181±46 vs. 28±12, P<0.05).
The display of depressive behaviors during an operational measure of depression is coupled with increased heart rate, reduced heart rate variability, and increased arrhythmias, indicative of dysfunctional behavioral and physiological stress-coping abilities as a function of social isolation. In contrast, social pairing with a sibling is behaviorally- and cardioprotective. The present results can provide insight into a possible social mechanism underlying the association of depression and cardiovascular disease in humans.
Autonomic nervous system; Forced swim test; Heart rate variability; Helplessness; Isolation; Prairie vole
To determine the predictors of pain improvement among patients being treated for cancer-related pain over 12 months.
A secondary analysis of the Indiana Cancer Pain and Depression (INCPAD) trial was performed. Patients participating in this telephone care management pain and depression intervention trial (N=274, mean age=58.1±10.5 years, 66.1% women) were interviewed at baseline, and 1, 3, 6, and 12 months. Pain improvement outcomes included both a continuous measure (Brief Pain Inventory score) and a categorical measure (pain improved vs. pain not improved). Predictor variables included change in depression, age, gender, race, marital status, socioeconomic disadvantage, medical comorbidity, type of cancer, and phase of cancer. Multivariable repeated measures were conducted adjusting for intervention group assignment, baseline pain severity, and time in months since baseline assessment.
Factors predicting both continuous and categorical pain improvement included participating in the intervention group (beta=−.92, p<.001; OR=2.53, CI=1.65–3.89), greater improvement in depression (beta=−.31, p=.003; OR=1.84, CI=1.35–2.51), higher socioeconomic status (Socioeconomic Disadvantage Index; beta=.25, p=.034; OR=.73, CI=.56–.94), and fewer comorbid conditions (beta=.20, p=.002; OR=.84, CI=.73–.96). Conversely, patients with more severe pain at baseline or with recurrent or progressive cancer were less likely to experience continuous or categorical pain improvement, respectively.
Effective management of depression and comorbid conditions along with improvement of social services could be critical components of a comprehensive pain management plan. Also, patients with more severe pain or with recurrent or progressive cancers may require closer monitoring and adequate treatment of pain.
Clinical Trial Registration Number
Cancer-related pain; pain improvement; predictors; longitudinal study
To evaluate the immediate and longer-term effectiveness of Mindfulness-based Stress Reduction (MBSR) among treatment adherents on CD4+ T Lymphocyte Count (CD4 count) and medical and psychological symptoms among HIV+ patients in Tehran, Iran.
Using a randomized controlled trial design, data were analyzed from 173 HIV+ patients (CD4 Count > 250) not yet receiving antiretroviral therapy who participated in either an 8-week MBSR (n=87) or a brief education and support condition (ESC) (n=86) at the Imam Khomeini Hospital. Assessments included CD4 count, Symptom Checklist-90-Revised (SCL-90R), and Medical Symptom Checklist (MSCL) at baseline, immediate post-test, and 3, 6, 9 and 12-month follow-up periods.
The treatment adherent sample had a mean age of 35.1(SD = 6.5) years and 69% were male. Linear mixed model estimates indicated mean CD4 count increased from baseline up to 9 months post-treatment, then returned to baseline level at 12 months. Improvements in mean SCL-90R (up to 6 months) and MSCL (up to 12 months) scores were observed for the MBSR condition while ESC scores remained the same over time; however, only MSCL improvements significantly differed between groups and these changes lasted up to the final assessment.
Findings suggest that among treatment adherent Iranian HIV+ patients not yet receiving antiretroviral drug treatment, MBSR appears to have the strongest potential to improve self-reported physical symptomatology.
Iranian Registry of Clinical Trials IRCT201106084076N2.
mindfulness-based; meditation; HIV/AIDS; CD4 count; mind-body; psychoneuroimmunology; medical symptoms