Christopher Ring

Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety.

Objective The purpose of this study was to determine the impact of symptoms of depression and anxiety on mortality and quality of life in patients hospitalized for acute myocardial infarction (MI). Methods The Beck Depression Inventory and the State-Trait Anxiety Inventory were completed by 288 patients hospitalized for MI. Twelve-month survival status was ascertained, and quality of life among survivors was assessed at 12 months using the Dartmouth COOP charts. Results Thirty-one (10.8%) patients died, 27 of cardiac causes, during the 12-month follow-up. Symptoms of depression and anxiety predicted neither cardiac nor all-cause mortality. Severity of infarction and evidence of heart failure predicted both cardiac and all-cause mortality. The same findings emerged from supplementary analyses of data from patients who died after discharge from the hospital. Symptoms of depression and anxiety, measured at entry, predicted 12-month quality of life among survivors, as did gender, partner status, employment status, living alone, previous frequency of exercise, and indices of disease severity (Killip class and Peel Index). In a multiple regression model in which all of these variables were entered, initial depression scores provided the best independent prediction of quality of life, although living alone, severity of infarction, and state anxiety also entered the model. Conclusions Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality after MI, but they did predict quality of life among those who lived to 12 months.

Stress and secretory immunity.

Publisher Summary This chapter focuses on the relationship between stress and saliva secretory immunity in humans. Salivary gland function is largely under autonomic control; the parasympathetic nerves mainly govern salivary fluid secretion, whereas the sympathetic nerves regulate protein secretion. The primary salivary centers in the brain stem receive inhibitory and excitatory inputs from neural structures in the forebrain and brain stem. As well as governing typical salivary functions, these structures are also involved in generating bodily changes associated with stress. It is, therefore, reasonable to assume that salivary changes during stress are an integral part of a centrally coordinated stress response that encompasses many other bodily functions. The autonomic receptors in the salivary glands can be divided into two main groups: the classic autonomic receptor types, which respond to either noradrenaline or acetylcholine, and the nonadrenergic–noncholinergic (NANC) receptors that respond to other autonomic messenger substances, such as peptides, nitric oxide, and purines. Differential activation of these receptor types can cause additive, synergistic, or antagonistic intracellular responses, ultimately resulting in a protein release that is capable of being differentially regulated among glands.

Predictors of attendance at cardiac rehabilitation after myocardial infarction

OBJECTIVE The purpose of this study was to determine predictors of attendance at cardiac rehabilitation after myocardial infarction (MI). METHODS Various demographic, behavioural, and clinical variables were measured during hospitalisation in 288 MI patients. Of these, 263 were available to attend outpatient-based cardiac rehabilitation: 108 actually attended. RESULTS Multiple logistic regression analyses indicated that nonattenders lived in more deprived areas and were less likely to have paid employment. Nonattenders also registered more symptoms of depression and anxiety and exercised less frequently prior to their MI, although only the last of these variables were predicted in a multivariate model. In terms of clinical status, whether patients had been thrombolysed or not was the strongest predictor of attendance. CONCLUSIONS Attendance at cardiac rehabilitation is not an arbitrary matter. Strategies should be developed for encouraging greater attendance among those not in paid employment, those from deprived areas, and those who exercise infrequently.

The prevalence and persistence of depression and anxiety following myocardial infarction

OBJECTIVES: This study was designed to assess the prevalence and persistence of symptoms of depression and anxiety during the first 12 months following acute myocardial infarction (MI). DESIGN AND METHODS: In a prospective study, 288 MI patients were assessed for symptoms of depression and anxiety using the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) in hospital, 2-15 days following MI, and 4 and 12 months subsequently. RESULTS: During hospitalization, 89 (30.9%) and 75 (26.1%) patients registered elevated BDI scores (>/=10) and state anxiety scores (>/=40), respectively. The 4 and 12 month prevalence rates were 37.7% and 37.2% for depressive symptoms, and 41.8% and 40.0% for anxious symptoms, respectively. Depression and anxiety were highly co-morbid, with 51% of patients experiencing significant levels of depressive and anxious symptoms at baseline. More than half the patients with complete BDI and state anxiety data experienced either elevated symptoms of anxiety or depression throughout the first year following MI. CONCLUSIONS: Symptoms of depression and anxiety are prevalent, persistent problems during the first year following MI. This study highlights the importance of routine psychological assessment for MI patients both in hospital and after discharge.

Blood pressure reactions to stress and the prediction of future blood pressure: effects of sex, age, and socioeconomic position.

Objective This epidemiological study examined whether the magnitude of blood pressure reactions to mental stress was associated with future blood pressure and whether the strength of association was affected by sex, age, and socioeconomic position. Materials and Methods Resting blood pressure was recorded at initial baseline and in response to mental stress. Five-year follow-up resting blood pressure data were available for 990 (68%) of the participants; 333 were 23 years old at the time of stress testing, 427 were 43, and 230 were 63. There were 541 women and 449 men; 440 came from manual and 550 from nonmanual occupation households. Results Systolic blood pressure reactions to stress correlated positively with follow-up systolic blood pressure; no association was found for diastolic blood pressure reactions and follow-up diastolic blood pressure. In multivariate tests, systolic reactivity remained predictive of follow-up systolic blood pressure and accounted for 2.3% of the variance not explained by age, body mass index, and initial baseline systolic blood pressure. Systolic and diastolic reactivity predicted 5-year upward drift in systolic and diastolic blood pressure respectively, accounting for an additional 3.6% and 2.9% of variance, respectively, in multivariate models. The predictive value of reactivity was greater for participants from manual occupation households and tended to be greater for men. Conclusions The results of this study indicate that blood reactions to mental stress predict future blood pressure status and the increase in resting blood pressure over time. The magnitude of the prediction appears to vary with socioeconomic position and sex.

Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction

OBJECTIVE The purpose of this study was to determine the impact of depression and anxiety on mortality and quality-of-life in patients hospitalized for an acute myocardial infarction (MI). METHODS Questionnaire measures of depression and anxiety were completed during hospitalization by 288 MI patients. The main outcomes were mortality and quality-of-life, assessed by the Dartmouth COOP charts, at 4 months. RESULTS A total of 25 patients died, 22 from cardiac causes, during the 4-month follow-up. Symptoms of depression and anxiety did not predict either cardiac or all-cause mortality. Severity of infarction, extent of heart failure, and a longer stay in hospital predicted mortality. Symptoms of depression and anxiety predicted 4-month quality-of-life among survivors, as did gender, partner status, occupational status, living alone, previous exercise behaviour, length of hospital admission, and Peel Index scores. In a multiple regression model, depression emerged as the strongest predictor of quality-of-life. State anxiety, severity of infarction, and partner status also entered the model. CONCLUSION Neither depression nor anxiety predicted mortality 4 months after MI. Both depression and anxiety predicted quality-of-life at 4 months among survivors.

Secretory immunoglobulin A and cardiovascular reactions to mental arithmetic, cold pressor, and exercise: Effects of beta‐adrenergic blockade

We investigated the influence of sympathetic nervous system processes on mucosal immunity by comparing the effects of beta-adrenoceptor blockade with 40 mg propranolol and placebo on secretory immunoglobulin A (sIgA) at rest and during paced serial arithmetic, cold pressor, and submaximal cycling. These tasks produced patterns of cardiovascular activity indicative of combined alpha- and beta-adrenergic, alpha-adrenergic, and beta-adrenergic activation, respectively. The effectiveness of the beta blockade was confirmed by the attenuation under propranolol of the shortening of the cardiac preejection period and the tachycardia elicited by mental arithmetic and exercise. The cold pressor test did not affect sIgA under either the placebo or the propranolol. Mental arithmetic increased sIgA concentration, and this increase was not blocked by propranolol. Exercise elicited increases in both sIgA concentration and sIgA secretion rate, which were not diminished by beta blockade. These data suggest that sIgA is not regulated by beta-adrenergic mechanisms.

Secretory immunoglobulin A and cardiovascular reactions to mental arithmetic and cold pressor

Secretory immunoglobulin A (sIgA) in saliva and cardiovascular reactions to mental arithmetic and cold pressor tasks were recorded in 16 healthy young men on two sessions, 4 weeks apart. Both tasks elicited significant increases in sIgA secretion rate, reflecting increases in both salivary volume and sIgA concentration. Whereas mental arithmetic elicited a mixed pattern of alpha- and beta-adrenergic cardiovascular reactions, the pattern of reactions to cold pressor was predominantly alpha-adrenergic. Task levels of sIgA secretion rate, sIgA concentration, and saliva volume showed moderate to high test-retest reliability (r = .52-.83), although test-retest correlations were less impressive for change scores (r = -.19-.53). The pattern of correlations between change in sIgA secretion rate and cardiovascular reactivity variables was inconsistent.

Catastrophizing is related to pain ratings, but not nociceptive flexion reflex threshold

&NA; Catastrophizing is reliably associated with increased reports of clinical and experimental pain. To test the hypothesis that catastrophizing may heighten pain experience by increasing nociceptive transmission through spinal gating mechanisms, the present study examined catastrophizing as a predictor of pain ratings and nociceptive flexion reflex (NFR) thresholds in 88 young adult men (n=47) and women (n=41). The NFR threshold was defined as the intensity of electrocutaneous sural nerve stimulation required to elicit a withdrawal response from the biceps femoris muscle of the ipsilateral leg. Participants completed an assessment of their NFR threshold and then provided pain ratings using both a numerical rating scale (NRS) and the short‐form McGill pain questionnaire (SF‐MPQ). Pain catastrophizing was assessed using the catastrophizing subscale of the coping strategies questionnaire (CSQ). Although catastrophizing was positively related to both NRS and SF‐MPQ pain ratings, catastrophizing was not significantly related to NFR threshold. These findings suggest that differential modulation of spinal nociceptive input may not account for the relationship between catastrophizing and increased pain.

Acute stress exposure prior to influenza vaccination enhances antibody response in women

Animal studies have shown that an acute stressor in close temporal proximity to immune challenge can enhance the response to delayed-type hypersensitivity and antibody response to vaccination. The current study examined the effects of acute exercise or mental stress prior to influenza vaccination on the subsequent antibody response to each of the three viral strains. Sixty young healthy adults (31 men, 29 women) were randomly allocated to one of three task conditions: dynamic exercise, mental stress, or control. After an initial baseline, participants completed their allocated 45 min task and then received the influenza vaccine. Plasma cortisol and interleukin-6 were determined at the end of baseline, after the task, and after 60 min recovery. Antibody titres were measured pre-vaccination and at 4 weeks and 20 weeks post-vaccination follow-ups. For the A/Panama strain, women in both the exercise and mental stress conditions showed higher antibody titres at both 4 and 20 weeks than those in the control condition, while men responded similarly in all conditions. Interleukin-6 at +60 min recovery was found to be a significant predictor of subsequent A/Panama antibody response in women. In line with animal research, the current study provides preliminary evidence that acute stress can enhance the antibody response to vaccination in humans.