G. Klabbers

Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age

BACKGROUND Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population. METHODS Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity. RESULTS Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk. CONCLUSIONS In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.

Measuring rebelliousness and predicting health behaviour and outcomes: an investigation of the construct validity of the Social Reactivity Scale.

The Social Reactivity Scale is a questionnaire measure of individual differences in rebelliousness. The associations between rebelliousness, health behaviours and health outcomes were examined in two Dutch samples by means of cross-sectional survey data. We found moderate support for the reliability and construct validity of the scale. Findings were suggestive of rebelliousness, first, being associated with low control beliefs, second, being related to hostility and, third, also heightening the risk of engaging in unhealthy behaviours and that of poor health (perhaps through deliberately rejecting health education messages). Findings thus contribute to the ongoing emergence of an empirically viable theoretical construct.

The relative contributions of hostility and depressive symptoms to the income gradient in hospital-based incidence of ischaemic heart disease: 12-Year follow-up findings from the GLOBE study☆

There is evidence to support the view that both hostility and depressive symptoms are psychological risk factors for ischaemic heart disease (IHD), additional to the effects of lifestyle and biomedical risk factors. Both are also more common in lower socioeconomic groups. Studies to find out how socioeconomic status (SES) gets under the skin have not yet determined the relative contributions of hostility and depression to the income gradient in IHD. This has been examined in a Dutch prospective population-based cohort study (GLOBE study), with participants aged 15-74 years (n=2374). Self-reported data at baseline (1991) and in 1997 provided detailed information on income and on psychological, lifestyle and biomedical factors, which were linked to hospital admissions due to incident IHD over a period of 12 years since baseline. Cox proportional hazard models were used to study the contributions of hostility and depressive symptoms to the association between income and time to incident IHD. The relative risk of incident IHD was highest in the lowest income group, with a hazard ratio of 2.71. Men on the lowest incomes reported more adverse lifestyles and biomedical factors, which contributed to their higher risk of incident IHD. An unhealthy psychological profile, particularly hostility, contributed to the income differences in incident IHD among women. The low number of IHD incidents in the women however, warrants additional research in larger samples.

The Voice of PhD Candidates and PhD Supervisors. A Qualitative Exploratory Study amongst PhD Candidates and Supervisors to Evaluate the Relational Aspects of PhD Supervision in the Netherlands

PhD trajectories are important to universities, as these contribute to the increase in knowledge and output. Therefore, they aim to decrease the completion time and dropout.This article reports on our survey amongst PhD candidates and supervisors of the Graduate School CAPHRI, Maastricht University, The Netherlands. We investigated interpersonal aspects of coaching and (implicit) assumptions on skills and competences.Both groups consider personality, knowledge, skills, communication and coaching the major factors contributing to a successful PhD trajectory. PhD candidates consider responsiveness and respectful, good-quality feedback by supervisors important and suggest regular assessment of their performance. Supervisors consider flexibility, openness for feedback, taking initiative and being a team-player as good qualities for PhDs. Supervisors indicate struggling with offering support versus independence during different stages of the PhD trajectory.The study shows that a good match between PhDs and supervisors is essential for a successful PhD trajectory, and we advise that both discuss and formally agree upon mutual expectations and responsibilities within the project. We advocate that Graduate Schools foster an open and safe learning environment, organise meetings where supervisors can share experiences to learn from one another, provide contacts for advice and support and involvement of HR during the selection process.

The educational patterning of health-related adversities in individuals with major depression

BACKGROUND Major depressive disorder and depression severity are socially patterned, disfavouring individuals from lower socioeconomic groups. Depressive disorders are associated with several adverse health-related outcomes. We examined the educational patterning of somatic health, lifestyles, psychological function and treatment modalities in individuals suffering from major depressive disorder. METHODS We used cross-sectional medical and psychiatric data from 992 participants of The Netherlands Study of Depression and Anxiety (NESDA) with a diagnosed current major depressive disorder. Associations of education with somatic, lifestyle-related, and psychological outcomes, and with treatment modalities, adjusted for depression severity, were examined by means of (multinomial and binary) logistic and linear regression analyses. RESULTS In addition to and independent of major depressions being more severe in the less educated patients, metabolic syndrome, current smoking, low alcohol consumption, hopelessness and low control were more prevalent in a group of less educated individuals suffering from major depression, compared with their more highly educated peers. The less educated persons were more likely to be treated with antidepressant medication and less likely to receive psychotherapy treatment. None of these observations were explained by a higher depression severity in the less educated group. LIMITATIONS The cross-sectional design does not allow us to make direct causal inferences regarding the mutual influences of the different health-related outcomes. CONCLUSIONS Further research should explore the necessity and feasibility of routine screening for additional health risk, particularly among less educated depressed individuals.

Perceived unfairness and socioeconomic inequalities in functional decline: the Dutch SMILE prospective cohort study

BackgroundPeople in lower socioeconomic positions report worse health-related functioning. Only few examined whether perceptions of unfairness are particularly common in these people and whether this perceived unfairness relates to their subsequent poor health outcomes. We thus set out to examine the contribution of perceived unfairness to the higher risks of physical and mental dysfunction in men and women with a lower socioeconomic position.MethodsSeven-year prospective cohort data from the Dutch SMILE study among 1,282 persons, 55 years old and older, were used. Physical and mental health-related functioning was measured with the SF-36, socioeconomic status with income and education, and the perception of unfairness with an extended new measure asking for such perceptions in both work and non-work domains.ResultsPerceived unfairness was more common in lower socioeconomic positions. Such perpection was related to both physical (odds ratio = 1.57 (95% confidence interval: 1.17-2.11)) and mental (1.47 (1.07-2.03)) decline, while low socioeconomic position was only related to mental decline (1.33 (1.06-1.67)). When socioeconomic position and perceived unfairness were simultaneously controlled, odds ratios for both determinants decreased only very little. Socioeconomic position and perceived unfairness were for the largest part independently related to longitudinal health-related decline.ConclusionsThe general perception of unfairness, at work and beyond work, might have implications for functional decline in middle and older age. We recommend that – rather than addressing and changing individual perceptions of unfairness – more research is needed to find out whether specific environments can be defined as unfair and whether such environments can be effectively tackled in an attempt to truly improve public health.