Bruce S. Jonas

Negative affect as a prospective risk factor for hypertension.

Objective: The objective of this study was to test the hypothesis that negative affect is a prospective risk factor for hypertension among white and black persons. Methods: A population-based cohort of 3310 initially normotensive and chronic disease–free persons in the NHANES I Epidemiologic Follow-up Study was tracked through four follow-up waves (maximum, 22 years). The association between hypertension and baseline negative affect was analyzed using Cox proportional hazards regression, adjusting for baseline age, sex, race, education, smoking, alcohol use, diastolic and systolic blood pressure, body mass index, and change in body mass index as a time-dependent covariate. Negative affect was based on combined symptoms of depression and anxiety. Hypertension end points included 1) self-reported, 2) treated (prescription of antihypertensive medications), and 3) incident (blood pressure ≥160/95 mm Hg or treated) hypertension. Blood pressure measurements were obtained only at baseline and the first follow-up examination (maximum, 13 years). Results: Increased negative affect was associated with elevated risk for self-reported, treated, and incident hypertension at first follow-up. Through four waves of follow-up, high negative affect was associated with treated hypertension in baseline risk–adjusted models for white women (relative risk [RR] = 1.73, 95% confidence interval [95% CI] = 1.30–2.30), black women (RR = 3.12, 95% CI = 1.24–7.88), and all men (RR = 1.56, 95% CI = 1.08–2.25). Time-dependent covariate models produced similar RRs. Conclusions: Negative affect is predictive of development of hypertension. For treated hypertension, white women and all men with increased negative affect had similarly elevated RRs, whereas black women with increased negative affect had substantially higher RRs.

Prevalence of mood disorders in a national sample of young American adults.

Availability of nationally representative mood disorder prevalence estimates in the United States, based on structured psychiatric interviews is limited. This report estimates overall lifetime prevalence of major depressive episode, dysthymia, and bipolar disorder using the Third National Health and Nutrition Examination Survey (NHANES III) and compares these estimates to the Epidemiologic Catchment Area Study (ECA) conducted 10 years earlier. Additionally, prevalence estimate breakdowns by selected sociodemographic and health characteristics are investigated. NHANES III, conducted from 1988 to 1994, is a large nationally representative cross-sectional sample of the United States. A population-based sample of 8,602 men and women 17–39 years of age were eligible to participate, of whom 7,667 (89.1 %) completed interviews. Mood disorder assessments came from the Diagnostic Interview Schedule (DIS) administered as one component of the NHANES III. Lifetime prevalence estimates were assessed for six mood measures: 1) major depressive episode (MDE) 8.6%, 2) major depressive episode with severity (MDE-s) 7.7%, 3) dysthymia 6.2%, 4) MDE-s with dysthymia 3.4%, 5) any bipolar disorder 1.6%, and 6) any mood disorder 11.5%. All estimates except for MDE and MDE-s were significantly higher than comparable ECA estimates. These data provide recent national prevalence estimates. Based on their overall magnitudes, subgroup excesses, and observed increases compared to the ECA, continued monitoring of these estimates is warranted.

Depression and Bone Mineral Density in Young Adults: Results From NHANES III

Objective: The purpose of this cross-sectional population-based study was to assess the association of major depressive episode (MDE) and dysthymia with bone mineral density (BMD) in young adults. Methods: Data are from a nationally representative sample of 5,171 people aged 20 to 39 years from the Third National Health and Nutrition Examination Survey. Total proximal femoral BMD was measured using dual energy x-ray absorptiometry. MDE and dysthymia were measured using the Diagnostic Interview Schedule. Results: MDE was associated with lower BMD in multivariate models in men (mean BMD = 1.038 vs. 1.068 g/cm2; odds ratio (OR) per 1 SD decline in BMD = 1.65, 95% confidence interval (CI) = 1.08–2.52; p = 0.02) but not in women (mean BMD = 0.982 vs. 0.979 g/cm2; OR = 0.96, 95% CI = 0.71–1.30; p = .79). The same divergence by gender was seen for dysthymia. Conclusion: The relationship between BMD and MDE or dysthymia in young adults varies by gender.

Standardizing the Comparison of Systolic Blood Pressure vs. Pulse Pressure for Predicting Coronary Heart Disease

Whether systolic blood pressure (SBP) or pulse pressure (PP) is more predictive of coronary heart disease remains controversial. The authors analyzed 6032 participants in the first National Health and Nutritional Examination Survey (NHANES I) followed up for an average of 16 years. Blood pressure was measured at baseline and coronary heart disease outcomes were determined from hospital or mortality records. Cox proportional hazard analyses were used to estimate the multivariate‐adjusted relative risk (RR) for increases of 10 mm Hg or 1 SD in SBP and PP, and the RR associated with PP was greater than the RR associated with SBP when using an increase of 10 mm Hg. However, when using an increase of 1 SD, the RR associated with SBP was larger than for PP. Although both are predictors, the authors conclude that SBP has a larger RR than PP for coronary heart disease events.

Psychological and Physical Functioning Difficulties Associated with Complex Activity Limitations among U.S. Adults

BACKGROUND There is limited research that assesses psychological functioning categorically as a predictor of complex activity limitations either alone or in conjunction with physical functioning. OBJECTIVES This paper assesses the impact of psychological and/or physical functioning difficulties as predictors of complex activity limitations among U.S. adults, using data from a national survey. METHODS Data come from the 2006-2010 National Health Interview Survey among U.S. adults 18 or older (n = 124,337). We developed a combined physical/psychological exposure variable with six categories: 1) no/low psychological distress (LPD) and absence of physical functioning difficulties, 2) moderate psychological distress (MPD) only, 3) serious psychological distress (SPD) only, 4) physical functioning difficulty only, 5) MPD and physical functioning difficulties, and 6) SPD and physical functioning difficulties. Selected complex activity limitations include daily living, social and work limitations. RESULTS Compared to adults with LPD and absence of physical functioning difficulties, the results demonstrated a clear and significant gradient of increasing risk of complex activity limitations beginning with MPD only, SPD only, physical functioning difficulty only, both MPD and physical functioning difficulties, and SPD and physical functioning difficulties. CONCLUSIONS The data suggest a stronger risk of complex activity limitations when increasing psychological functioning difficulties coexist with physical functioning difficulties, leading to potential interference with a persons ability to accomplish major life activities measured in this study. The sizeable contribution of psychological distress to the prevalence of basic actions difficulty implies that the mental health component of functional limitations is important in the overall assessment of health and well-being.

Considering disability and health: Reflections on the Healthy People 2020 Midcourse Review

The Healthy People 2020 (HP2020) Midcourse Review (MCR) presents an opportunity for professionals in the disability and health field to contemplate preliminary progress toward achieving specific health objectives. The MCR showed notable progress in access to primary care, appropriate services for complex conditions associated with disability, expansion of health promotion programs focusing on disability, improving mental health, and reducing the unemployment rate among job seekers with disabilities. This commentary presents potential considerations, at least in part, for such progress including increased access to health care, greater awareness of appropriate services for complex conditions, and opportunities for societal participation. Additional considerations are provided to address the lack of progress in employment among this population -- a somewhat different measure than that for unemployment. Continuing to monitor these objectives will help inform programs, policies, and practices that promote the health of people with disabilities as measured by HP2020.