Ari Haukkala

Emotional eating, depressive symptoms and self-reported food consumption. A population-based study.

We examined the associations of emotional eating and depressive symptoms with the consumption of sweet and non-sweet energy-dense foods and vegetables/fruit, also focusing on the possible interplay between emotional eating and depressive symptoms. The participants were 25-64-year-old Finnish men (n=1679) and women (n=2035) from the FINRISK 2007 Study (DILGOM substudy). The Three-Factor Eating Questionnaire-R18, Center for Epidemiological Studies Depression Scale, and a 132-item Food Frequency Questionnaire were used. Emotional eating and depressive symptoms correlated positively (r=0.31 among men and women), and both were related to a higher body mass. Emotional eating was related to a higher consumption of sweet foods in both genders and non-sweet foods in men independently of depressive symptoms and restrained eating. The positive associations of depressive symptoms with sweet foods became non-significant after adjustment for emotional eating, but this was not the case for non-sweet foods. Depressive symptoms, but not emotional eating, were related to a lower consumption of vegetables/fruit. These findings suggest that emotional eating and depressive symptoms both affect unhealthy food choices. Emotional eating could be one factor explaining the association between depressive symptoms and consumption of sweet foods, while other factors may be more important with respect to non-sweet foods and vegetables/fruit.

Psychological consequences of predictive genetic testing for hereditary non-polyposis colorectal cancer (HNPCC): A prospective follow-up study

Predictive genetic testing for cancer allows identification of those with the mutation (mutation positive) who should undergo cancer surveillance aiming at early detection of cancer and those without the mutation (mutation negative), whose unnecessary worry can be alleviated and who need not undergo frequent surveillance. However, there is a risk that predictive testing might have a harmful emotional impact on an individual. In the course of a predictive genetic testing protocol, we assessed general anxiety (by the State‐Trait Anxiety Inventory [STAI]), fear of cancer and death, satisfaction with life and attitude to the future using a questionnaire survey in 271 individuals tested for hereditary non‐polyposis colorectal cancer (HNPCC). Measurements were made before the first counseling (baseline), at the test disclosure session (STAI only) and 1 and 12 months after disclosure. Although at every measurement, the mutation‐positive individuals were more afraid of cancer than those who were mutation negative, in both groups fear of cancer decreased significantly from baseline after disclosure. The mutation‐positive subjects were more anxious than their counterparts immediately after the test disclosure, but the differences had disappeared at the follow‐ups. In other variables, neither differences between the groups defined by mutation status nor changes with time were detected. Our findings suggest that counseling and testing relieve fear of cancer; no harmful emotional impact was detectable at the 1‐year follow‐up. To confirm these findings, however, the impact of testing should be studied after a longer interval. Furthermore, to evaluate the ultimate interpretation of these results, studies are needed to investigate the impact of fear of cancer on surveillance behavior among the mutation‐positive subjects.

Depression and smoking cessation: The role of motivation and self-efficacy

The aim of this paper is to examine whether depression, assessed using the Beck Depression Inventory, is related to smoking cessation motivation and self-efficacy. In a population sample of 1,547 Finnish men and 1,856 Finnish women, aged between 25-64 years, there were 34% male and 21% female current smokers. The current smokers had higher mean depression scores than former or never smokers. The higher depression scores were related to greater motivation to quit smoking among female smokers [OR = 1.51 (1.15-1.97)]. In addition, higher depression scores were related to lower smoking cessation self-efficacy, especially among male smokers [OR = .63 (.45-.90)]. Depression scores were not related to whether a smoker had had previous cessation attempts. Our results suggest that depression is related to lower smoking cessation self-efficacy while smokers with higher depression scores seem to be more motivated to quit smoking.

Eating styles, self-control and obesity indicators. The moderating role of obesity status and dieting history on restrained eating.

We examined whether obesity status and dieting history affected the associations of eating styles with measured obesity indicators and self-control among Finnish men (n = 2325) and women (n = 2699) aged 25-75 years. Uncontrolled and emotional eating were positively associated with obesity and reversely with self-control. Among obese subjects and current/past dieters, higher restrained eating was related to lower adiposity, uncontrolled and emotional eating, and higher self-control while these associations were opposite among normal weight subjects and never dieters. These results suggest that restrained eating may be related to better weight control among those who need and/or are motivated to lose weight while among others it may indicate problems with eating.

Emotional eating and physical activity self-efficacy as pathways in the association between depressive symptoms and adiposity indicators

BACKGROUND There is increasing evidence that depressive symptoms and obesity are positively related, but the mechanisms that explain the association between them are unclear. OBJECTIVE We examined direct and indirect associations between depressive symptoms, emotional eating, physical activity (PA) self-efficacy (ie, an individuals confidence in his or her ability to overcome barriers to maintain PA behaviors), and adiposity indicators. DESIGN Structural equation modeling was used to test the hypothesized mediation model in Finnish men (n = 2312) and women (n = 2674) aged 25-74 y from the National Cardiovascular Risk Factor Survey conducted in 2007. The Center for Epidemiologic Studies-Depression Scale, the Three-Factor Eating Questionnaire-R18, and a PA barriers self-efficacy scale were used. Body mass index (BMI), waist circumference (WC), and percentage body fat of participants were measured in a health examination. RESULTS Depressive symptoms and emotional eating had positive correlations and PA self-efficacy had negative correlations with BMI, WC, and percentage body fat. Elevated depressive symptoms were related to higher emotional eating (β = 0.38 for men and 0.31 for women) and lower PA self-efficacy (β = -0.41 for men and -0.31 for women), whereas emotional eating and PA self-efficacy were inversely correlated (r = -0.12 and -0.18, respectively). The positive bivariate associations between depressive symptoms and adiposity indicators became nonsignificant in models that included emotional eating and PA self-efficacy, and both of these factors significantly mediated the effects of depressive symptoms on adiposity indicators. CONCLUSIONS Psychological factors related to both eating and PA may be relevant in explaining the positive relation between depressive symptoms and adiposity. Interventions that target obesity should take into account the effects of these factors on weight regulation.

Comparing sense of coherence, depressive symptoms and anxiety, and their relationships with health in a population-based study.

The strong negative correlations observed between the sense of coherence (SOC) scale and measures of depression and anxiety raise the question of whether the SOC scale inversely measures the other constructs. The main aim of the present study was to examine the discriminant validity of the three measures by comparing their associations with health indicators and behaviours. The participants were 25 to 74-year-old Finnish men (n=2351) and women (n=2291) from the National Cardiovascular Risk Factor Survey conducted in 1997. The SOC scale had high inverse correlations with both depression (r=-0.62 among both men and women) and anxiety measures (r=-0.57 among the men and r=-0.54 among the women). Although confirmatory factor analyses suggested that it was possible to differentiate between SOC, cognitive depressive symptoms and anxiety, the estimated correlations were even higher than those mentioned above. Education was related only to SOC, but the associations of SOC, cognitive depressive symptoms and anxiety with self-reported and clinically measured health indicators (body mass index, blood pressure, cholesterol) and health behaviours were almost identical. The variation in the lowest SOC tertile was more strongly associated with health variables than in the highest tertile. To conclude, the size of the overlap between the SOC and depression scales was the same as between depression and anxiety measures. This indicates that future studies should examine the discriminant validity of different psychosocial scales more closely, and should compare them in health research in order to bring parallel concepts into the same scientific discussion.

Socio-economic disparities in the consumption of vegetables, fruit and energy-dense foods: the role of motive priorities

OBJECTIVE A low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake. DESIGN We analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participants rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ. SETTING A population-based survey in Finland. SUBJECTS Men (n 1691) and women (n 2059) aged 25-64 years. RESULTS Higher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = -0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items. CONCLUSIONS Individual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet.

Hostility, Anger Control, and Anger Expression as Predictors of Cardiovascular Disease

Objective: To examine in a prospective setting whether different hostility measures, including Cynical Distrust, Trait Anger, Anger Out, Anger In, and Anger Control, are related to cardiovascular disease (CVD) and ischemic heart disease (IHD). Methods: Participants comprised 25- to 74-year-old men (n = 3850) and women (n = 4083), followed up for 10 to 15 years. Trait Anger, Anger Out, Anger In, and Anger Control were assessed with the Spielberger State-Trait Anger Expression Inventory and Cynical Hostility with the Cynical Distrust Scale. Incident CVD and IHD were derived from hospital records/death certificates. Subjects with a history of CVD or IHD at baseline were excluded. Results: Subjects in the lowest Anger Control tertile had a higher risk of first nonfatal and fatal CVD incidence (relative risk [RR], 1.35; 95% confidence interval [CI], 1.06-1.73) than subjects in the highest tertile after adjustment for age, gender, education, marital status, smoking, body mass index, blood pressure, cholesterol, alcohol consumption, and depressive symptoms. Higher Cynical Distrust scores predicted nonfatal and fatal CVD (RR, 1.31; 95% CI, 1.09-1.56) and IHD (RR, 1.37; 95% CI, 1.08-1.74) events after adjustment for age, but these associations disappeared after further adjustment for gender, education, and marital status. Other hostility measures, i.e., Trait Anger, Anger Out, or Anger In, were not related to CVD or IHD outcomes. Conclusions: This is the first study to show that compared with four other hostility dimensions, low Anger Control predicts CVD events. Further studies should examine whether Anger Control is specific to anger or reflects more general psychosocial factors. BDI = Beck Depression Inventory; BMI = body mass index; CAD = coronary artery disease; CHD = coronary heart disease; CI = confidence interval; CVD = cardiovascular disease; ICD = International Classification of Diseases and Related Health Problems; IHD = ischemic heart disease; IMT = intima medial thickness; MI = myocardial infarction; RR = relative risk.

Morningness–eveningness, depressive symptoms, and emotional eating: A population-based study

The aim of this study was to increase understanding of the associations between different dimensions of morningness–eveningness, depressive symptoms, and emotional eating in the general population. The participants were 25-to-74-year-old Finnish men (n = 2325) and women (n = 2699) from the National FINRISK Study conducted in 2007. The Center for Epidemiological Studies – Depression Scale and the Three-Factor Eating Questionnaire-R18 were used to measure depressive symptoms and emotional eating. Chronotype was assessed with a shortened version of Horne and Östberg’s Morningness–Eveningness Questionnaire (MEQ). Structural equation modeling was used as an analytical approach. Confirmatory factor analysis indicated a two-factor structure for the six-item MEQ with separate factors for morning alertness and circadian preference for daily activities (r = 0.65). Higher alertness in the morning and preference for morning hours were both related to lower depressive symptoms (βtotal effect = −0.36 and −0.11, respectively) and emotional eating (βtotal effect = −0.20 and −0.09; βindirect effect through depressive symptoms = −0.12 and −0.04, respectively), even though the relationships with morning alertness were stronger. However, the associations of circadian preference with depressive symptoms and emotional eating were reversed after adjustment for morning alertness. Finally, among participants who rarely or never experienced sleeping sufficiently, those in the lowest (i.e. eveningness) and higher (i.e. morningness) circadian preference/morning alertness quartiles had the highest depressive symptom scores. In conclusion, the findings emphasize the importance of separating between different dimensions of chronotype when examining its relationships with psychological factors such as depressive symptoms and overeating tendencies.

Direct contact in inviting high-risk members of hereditary colon cancer families to genetic counselling and DNA testing

Background: Identification of hereditary predisposition to cancer has limited significance if not followed by efficient cancer prevention in the family. Probands are traditionally left to inform their relatives about the increased risk, but distant relatives may remain uninformed. An approach to contacting directly at-risk persons assumed to be unaware of their increased cancer risk was taken. With cancer prevention as the ultimate goal, the study was aimed at investigating attitudes towards and psychosocial consequences of this novel strategy. Methods: In families with hereditary non-polyposis colorectal cancer (Lynch syndrome), 286 healthy adult relatives with a 50% risk of a predisposing mutation were contacted by letter. Of these, 112 participated in counselling and predictive testing. Baseline information and information obtained 1 month after the test for 73 respondents were compared with 299 corresponding subjects, approached via the proband (family-mediated approach in our previous study) in these families. Results: After the contact letter, 51% consented to the study. Of these, 92% approved of the direct contact and 33% had tried to seek information. In 34% of the mutation carriers, neoplasia was identified in the first post-test colonoscopy. Although post-test fear of cancer increased among the mutation carriers and decreased among noncarriers, almost all participants were satisfied with their decision to participate, independently of their test results, parallel to the family-mediated approach. Conclusion: In this large-scale study, relatives in cancer families were actively contacted to inform them of the condition and genetic counselling. Their attitudes were encouraging, and the psychosocial consequences were similar to the family-mediated approach. Our results suggest the appropriateness of direct contact as an alternative method of contact in cases of life-threatening treatable disease.