Anna C. Phillips

Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study.

Objective: To examine whether the 1-year prevalence of major depressive disorder (MDD), generalized anxiety disorder (GAD), and their comorbidity were associated with subsequent all-cause and cardiovascular disease (CVD) mortality during 15 years in Vietnam veterans. Methods: Participants (N = 4256) were from the Vietnam Experience Study. Service, sociodemographic, and health data were collected from service files, telephone interviews, and a medical examination. One-year prevalence of MDD and GAD was determined through a diagnostic interview schedule based on the Diagnostic and Statistical Manual of Mental Disorders (version IV) criteria. Mortality over the subsequent 15 years was gathered from US army records. Results: MDD and GAD were positively and significantly associated with all-cause and CVD mortality. The relationships between MDD and GAD and CVD mortality were no longer significant after adjustment for sociodemograhics, health status at entry, health behaviors, and other risk markers. Income was the covariate with the strongest impact on this association. In analyses comparing comorbidity and GAD and MDD alone, with neither diagnosis, comorbidity proved to be the strongest predictor of both all-cause and CVD mortality. Conclusion: GAD and MDD predict all-cause mortality in a veteran population after adjusting for a range of covariates. However, those with both GAD and MDD were at greatest risk of subsequent death, and it would seem that these disorders may interact synergistically to affect mortality. Future research on mental disorders and health outcomes, as well as future clinical interventions, should pay more attention to comorbidity. GAD = generalized anxiety disorder; MDD = major depressive disorder; PTSD = posttraumatic stress disorder; HR = hazard ratio; CVD = cardiovascular disease; SBP = systolic blood pressure; DBP = diastolic blood pressure; BMI = body mass index; IQ = intelligence quotient.

The age-related increase in low-grade systemic inflammation (Inflammaging) is not driven by cytomegalovirus infection

Aging is accompanied by the development of low‐grade systemic inflammation, termed ‘inflammaging’, characterized by raised serum C‐reactive protein (CRP) and pro‐inflammatory cytokines. Importantly, inflammaging is implicated in the pathogenesis of several of the major age‐related diseases including cardiovascular disease, type 2 diabetes, and dementia and is associated with increased mortality. The incidence of infection with the persistent herpes virus cytomegalovirus (CMV) also increases with age. Cross‐sectional studies have proposed CMV infection as a significant driver of inflammaging, but a definitive case for CMV as a causative agent in inflammaging has not yet been made. We studied longitudinally 249 subjects (153 men, 96 women) who participated in the Hertfordshire Ageing Study at baseline (1993/5, mean age 67·5 years) and at 10 year follow‐up. At both times, anthropometric measurements were made and subjects provided blood samples for analysis of inflammatory status and CMV seropositivity. In the cohort as a whole, serum CRP (P < 0·02) and pro‐inflammatory cytokines TNFα (P < 0·001) and IL‐6 (P < 0·001) were increased between baseline and follow‐up sampling whereas levels of the anti‐inflammatory cytokine IL‐10 were decreased (P < 0·001). These changes to cytokine status over time occurred equally in the 60% of subjects who were seropositive for CMV at baseline and follow‐up, the 8% who were CMV negative at baseline but who became CMV positive by the 10 year follow‐up, and also in the 32% who were CMV seronegative throughout. We conclude that CMV infection is not a primary causative factor in the age‐related increase in systemic inflammation.

Symptoms of depression and cardiovascular reactions to acute psychological stress: Evidence from a population study

Depression and exaggerated cardiovascular reactivity are considered risk factors for cardiovascular disease, possibly as a result of common antecedents, such as altered autonomic nervous system function. We examined the association between depressive symptomatology and cardiovascular reactions to psychological stress in 1608 adults (875 women) comprising 3 distinct age cohorts: 24-, 44-, and 63-year olds. Depression was assessed using the Hospital Anxiety and Depression Scale. Blood pressure and heart rate were measured at baseline and during the paced auditory serial arithmetic test. Depression scores were negatively associated with systolic blood pressure and heart rate reactions, after adjustment for likely confounders such as sex, cohort, occupational status, body mass index, stress task performance score, baseline cardiovascular activity, antidepressant, and antihypertensive medication. The direction of association was opposite to that which would be expected if excessive reactivity were to mediate the association between depression and cardiovascular disease outcomes or if they shared common antecedents.

Body mass index, abdominal adiposity, obesity, and cardiovascular reactions to psychological stress in a large community sample.

Objective: To examine the association between adiposity and the magnitude of cardiovascular reactions to acute psychological stress cross-sectionally and prospectively in a large community sample. Methods: Blood pressure and heart rate (HR) were measured at rest and in response to a brief time-pressured mental arithmetic stress in 1647 adults. At the same session and 5 years later, height, weight, waist and hip circumference were measured and body mass index (BMI) and waist-hip ratio were computed. Obesity was defined as a body mass index of ≥30kg/m2. Results: Contrary to expectations, the most robust and consistent results to emerge from cross-sectional analyses were negative associations between all three measures of adiposity and HR reactivity; those with greater BMI and waist-hip ratios and those categorized as obese displayed smaller HR reactions to stress. In prospective analyses, high HR reactivity was associated with a reduced likelihood of becoming obese in the subsequent 5 years. Conclusions: Our analyses suggest that it is low, not high, HR reactivity that is related to adiposity. Low HR reactivity, probably by reflecting generally blunted sympathetic nervous system reactions to challenge, may be a risk marker for developing obesity. SBP = systolic blood pressure; BMI = body mass index; CI = confidence interval; DBP = diastolic blood pressure; HR = heart rate; OR = odds ratio; PASAT = paced auditory serial addition test.

Predictors of Psychological Morbidity in Parents of Children with Intellectual Disabilities

OBJECTIVE This study examined predictors of excess psychological morbidity in parents of children with intellectual disabilities. METHODS Thirty-two parents of children with intellectual disabilities and 29 parents of typically developing children completed the Hospital Depression and Anxiety Scale, and measures of social support, child problem behaviors, sleep quality, and perceived caregiver burden. RESULTS Parents of children with intellectual disabilities registered high depression and anxiety scores, and the majority met the criteria for possible clinical depression and/or anxiety. The strongest predictor of psychological morbidity was caregiver burden. Analyses of its component dimensions indicated that feelings of guilt held the greatest consequence for depression and anxiety. CONCLUSIONS Caregiver burden, in general, and its guilt component, in particular, predicted symptoms of depression and anxiety in parents of children with intellectual disabilities. Assisting such parents to resolve their feelings of guilt should benefit their psychological status.

The other side of the coin: Blunted cardiovascular and cortisol reactivity are associated with negative health outcomes

A cornerstone for research into the link between stress and health has been the reactivity hypothesis; cardiovascular reactivity to psychological stressors, if prolonged or exaggerated, can promote the development of cardiovascular disease. However, it has recently been argued that low or blunted reactivity is also associated with negative health outcomes. As such, in this special issue we present further evidence implicating that cardiovascular and stress hormone responses to acute stress at the other end of the response spectrum can also be considered a pathway to ill health. In this introductory article, we explore and review the origins of and potential mechanisms underlying blunted responses to acute stress. In so doing, we aim to highlight: what is currently known regarding this new conceptualization of the reactivity hypothesis; the potential explanations for blunted reactivity; the pathways underlying associations with health outcomes; and where this field is headed in terms of developing our understanding of the link between reactivity and health.

Generalized Anxiety Disorder Is Associated with Metabolic Syndrome in the Vietnam Experience Study

BACKGROUND Few studies have explored the relationship between major mental health disorders and metabolic syndrome (MetS), although both have been linked to cardiovascular disease. The present study examined the cross-sectional associations of major depressive disorder (MDD) and generalized anxiety disorder (GAD) with MetS in a large study of male US veterans. METHODS The analyses were cross-sectional. Participants (n = 4256) were drawn from the Vietnam Experience Study. From military service files, telephone interviews, and a medical examination, occupational, socio-demographic, and health data were collected. One-year prevalence of MDD and GAD was determined with DSM-III criteria. Metabolic syndrome was ascertained from data on: body mass index, fasting blood glucose or a diagnosis of diabetes, blood pressure, high-density lipoprotein cholesterol, and triglyceride levels. RESULTS In models that adjusted for age (p = .01) and additionally for place of service, ethnicity, marital status, smoking, alcohol consumption, IQ at enlistment, household income in midlife, and education grade achieved (p = .02), GAD was positively associated with MetS. Major depressive disorder was not related to MetS. CONCLUSIONS Depression has very much been the focal condition for studies on mental health and physical health outcomes. The current data suggest that future research should perhaps pay equal attention to GAD.

Blunted cardiovascular reactivity relates to depression, obesity, and self-reported health

The reactivity hypothesis implicates exaggerated cardiovascular reactions to acute psychological stress in the development of hypertension and other cardiovascular disease outcomes. However, cardiovascular reactivity has also been suggested as a mediator between a variety of psychosocial and behavioural risk factors and cardiovascular disease. Data from various analyses of the West of Scotland Twenty-07 study are discussed together, and caution against over-stretching the original reactivity hypothesis. Blood pressure and heart rate were assessed at rest and during an acute mental arithmetic stress task. First, depression, though a putative risk factor for cardiovascular disease, does not appear to confer this risk via exaggerated reactivity, as it was negatively related to reactivity. Second, obesity, another risk factor, was also associated with blunted rather than heightened reactivity. Finally, lower reactivity was related to poorer self-reported health. Similar associations emerged from both cross-sectional and prospective analyses. These seemingly paradoxical results are discussed in terms of implications for the reactivity hypothesis.

Generalized anxiety and major depressive disorders, their comorbidity and hypertension in middle-aged men

Objective: To examine the cross-sectional associations between generalized anxiety disorder (GAD) and major depressive disorder (MDD), their comorbidity, and hypertension. Methods: Participants (n = 4180) were drawn from a cohort of men who were members of the U.S. army during the Vietnam war era. Occupational, sociodemographic, and health data were collected from military service files, telephone interviews, and medical examinations. Hypertension status was defined by the presence of one of the following: self-reports at interview of either a physician-diagnosis or taking antihypertensive medication; or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg at the medical examination. One-year prevalence of GAD and MDD was determined, using Diagnostic and Statistical Manual of Mental Disorders, Third Edition criteria. Results: In separate regression models adjusting for age and then additionally for place of service, ethnicity, marital status, alcohol consumption, smoking, body mass index, household income, and education grade, both GAD and MDD were related positively to hypertension. In age-adjusted and fully adjusted models comparing comorbid GAD/MDD, GAD alone, MDD alone, and neither condition, comorbidity showed the strongest relationship with hypertension. Conclusion: Depression has been the main focus for research on mental health and physical health outcomes. The present results suggest that future research should pay equal attention to GAD and, in particular, the comorbidity of GAD and MDD. BMI = body mass index; GAD = generalized anxiety disorder; MDD = major depressive disorder.

Parental caregivers of children with developmental disabilities mount a poor antibody response to pneumococcal vaccination

In older populations, caregiving for a spouse with dementia has been associated with a poor antibody response to vaccination. The present study examined whether younger caregivers, specifically the parents of children with developmental disabilities, would also show a diminished antibody response to vaccination. At baseline assessment, 30 parents of children with developmental disabilities and 29 parents of typically developing children completed standard measures of depression, perceived stress, social support, caregiver burden, and child problem behaviours. They also provided a blood sample and were then vaccinated with a pneumococcal polysaccharide vaccine. Further blood samples were taken at 1- and 6-month follow-ups. Caregivers mounted a poorer antibody response to vaccination than control parents at both follow-ups. This effect withstood adjustment for a number of possible confounders and appeared to be, at least in part, mediated by child problem behaviours. The negative impact of caregiving on antibody response to vaccination is not restricted to older spousal caregivers, but is also evident in younger parents caring for children with developmental disabilities. The behavioural characteristics of the care recipients may be a key consideration in whether or not immunity is compromised in this context.