George E. Vaillant

A systematic review of the mortality of depression.

OBJECTIVE The literature on the mortality of depression was assessed with respect to five issues: 1) strength of evidence for increased mortality, 2) controlling for mediating factors, 3) the contribution of suicide, 4) variation across sample types, and 5) possible mechanisms. METHOD All relevant English language databases from 1966 to 1996 were searched for reviews and studies that included 1) a formal assessment of depressive symptoms or disorders, 2) death rates or risks, and 3) an appropriate comparison group. RESULTS There were 57 studies found; 29 (51%) were positive, 13 (23%) negative, and 15 (26%) mixed. Twenty-one studies (37%) ranked among the better studies on the strength of evidence scale used in this study, but there are too few comparable, well-controlled studies to provide a sound estimate of the mortality risk associated with depression. Only six studies controlled for more than one of the four major mediating factors. Suicide accounted for less than 20% of the deaths in psychiatric samples, and less than 1% in medical and community samples. Depression seems to increase the risk of death by cardiovascular disease, especially in men, but depression does not seem to increase the risk of death by cancer. Variability in methods prevents a more rigorous meta-analysis of risk. CONCLUSION The studies linking depression to early death are poorly controlled, but they suggest that depression substantially increases the risk of death, especially death by unnatural causes and cardiovascular disease. Future well-controlled studies of high risk groups may guide efforts to develop treatments that reduce the mortality risk of depression.

Pessimistic Explanatory Style Is a Risk Factor for Physical Illness: A Thirty-Five-Year Longitudinal Study

Explanatory style, the habitual ways in which individuals explain bad events, was extracted from open-ended questionnaires filled out by 99 graduates of the Harvard University classes of 1942-1944 at age 25. Physical health from ages 30 to 60 as measured by physician examination was related to earlier explanatory style. Pessimistic explanatory style (the belief that bad events are caused by stable, global, and internal factors) predicted poor health at ages 45 through 60, even when physical and mental health at age 25 were controlled. Pessimism in early adulthood appears to be a risk factor for poor health in middle and late adulthood.

Life event stress, social support, coping style, and risk of psychological impairment.

The effects of life event stress, coping style, and social support on psychological impairment were examined in a survey of a representative Australian suburban sample (N = 863). Psychological impairment was defined as a score of 4 or more on the 20-item General Health Questionnaire. Life event stress, coping style, and one of the social support variates, crisis support, were related to impairment, significantly decreasing or increasing the risk of being identified as impaired from the total sample frequency of 24 per cent. There was no evidence that coping style or social support became associated by moderating the relationship between life event stress and impairment, but rather because of their independent relationship with psychological impairment.

Some Psychologic Vulnerabilities of Physicians

Abstract The childhoods of 47 physicians were compared with those of 79 socioeconomically matched controls in occupations other than medicine. During 30 years of adult life, drug use, marital instability and resort to psychotherapy of the physicians was also compared with that of the controls. Physicians, especially those involved in direct patient care, were more likely than controls to have relatively poor marriages, to use drugs and alcohol heavily, and to obtain psychotherapy. Although these difficulties are often assumed to be occupational hazards of medicine, their presence or absence appeared to be strongly associated with life adjustment before medical school. Only the physicians with the least stable childhoods and adolescent adjustments appeared vulnerable to these occupational hazards. The findings may contribute to the medical and psychologic management of physician patients.

Ego mechanisms of defense and personality psychopathology

It is often not just life stress but also a persons idiosyncratic response to life stress that leads to psychopathology. Thus, despite problems in reliability, the validity of defenses makes them a valuable diagnostic axis for understanding psychopathology. By including a patients defensive style as part of the diagnostic formulation, the clinician is better able to comprehend what seems initially most unreasonable about the patient and to appreciate what is adaptive as well as maladaptive about the patients defensive distortions of inner and outer reality. Clinical appreciation of the immature defenses (e.g., hypochondriasis, fantasy, dissociation, acting out, projection, and passive aggression) is particularly useful in classifying and caring for individuals with personality disorders.

Is the U-Curve of Marital Satisfaction an Illusion? A 40-Year Study of Marriage.

The AA. report on a 40-year study of 169 college men and their wives. They examined marital satisfaction prospectively and retrospectively. When examined retrospectively, marital satisfaction followed a weak curvilinear pattern with the lowest point of marriage at approximately 20 years. When studied prospectively, the U-curve disappeared and marital satisfaction remained relatively stable, particularly in the middle and later years. The difference between the spouses came only in their assesment of the difficulty of solving disagreements, which seemed for the wives to become more difficult over time. These patterns of marital satisfaction held true whether studied according to number of years married, age of each partner, or stage of the family life cycle.

Physicians' use of mood-altering drugs. A 20-year follow-up report

Abstract A prospective study carried out over a 20-year period showed that a group of 45 physicians took more tranquilizers, sedatives and stimulants than 90 matched controls. As college sophomores both groups had been selected for the study because of better than average physical and psychologic health. The physicians drank alcoholic beverages and smoked cigarettes to the same extent as the controls.

Natural history of male psychologic health: effects of mental health on physical health

Four decades ago 204 men were selected as adolescents for an interdisciplinary study of health; since then they have been followed biennially. Of the 185 men who remained in the study and in good health until 1964 (age, 42 +/- 1 years), 100 men remained in excellent physical health over the next 11 years, 54 acquired minor problems, and 31 acquired serious chronic illness or died. Of 59 men with the best mental health, assessed from the age of 21 to 46 years, only two became chronically ill or died by the age of 53. Of the 48 men with the worst mental health from the age of 21 to 46, 18 became chronically ill or died. The relation between previous mental health and subsequent physical health remained statistically significant when the effects on health of alcohol, tobacco use, obesity, and longevity of ancestors were excluded by multiple regression analysis. The data suggest that good mental health retards midlife deterioration in physical health.

Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

PURPOSE Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent definitions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. DESIGN AND METHODS A survey questionnaire comprised 53 Likert scale statements related to the concepts of wisdom, intelligence, and spirituality was developed to determine if and how wisdom was viewed as being distinct from the latter 2 concepts. Of the 57 international wisdom experts contacted by e-mail, 30 completed the Phase 1 survey and 27 also completed the Phase 2 survey. RESULTS In Phase 1, there were significant group differences among the concepts of wisdom, intelligence, and spirituality on 49 of the 53 items rated by the experts. Wisdom differed from intelligence on 46 of these 49 items, whereas wisdom differed from spirituality on 31 items. In Phase 2, we sought to define wisdom further by selecting 12 items based on Phase 1 results. Most experts agreed on many of the suggested characteristics of wisdom-that is, it is uniquely human; a form of advanced cognitive and emotional development that is experience driven; and a personal quality, albeit a rare one, which can be learned, increases with age, can be measured, and is not likely to be enhanced by taking medication. IMPLICATIONS There was considerable agreement among the expert participants on wisdom being a distinct entity and a number of its characteristic qualities. These data should help in designing additional empirical research on wisdom.

Are social supports in late midlife a cause or a result of successful physical ageing

BACKGROUND Many studies have noted a strong association between poor social support and premature mortality. A limitation of such studies has been their failure to control adequately for confounders that damage both social supports and physical health. METHODS A 50-year prospective multivariate study of 223 men was used to examine the possible causal relationships between social supports and health. Alcohol abuse, prior physical health and mental illness prior to age 50 were controlled. Relative social supports were quantified over the period from age 50 to 70. RESULTS Adequacy of social supports from age 50 to 70 was powerfully correlated with physical health at age 70 (P < 0.001). However, such social supports were also powerfully predicted by alcohol abuse (P < 0.001), smoking (P < 0.001) and indicators of major depressive disorder (P < 0.01) assessed at age 50. When prior smoking, depression and alcohol abuse were controlled, then the association of physical health with social supports was very much attenuated. Some facets of social support like religion and confidantes were unassociated with health even at a univariate level. Surprisingly, in this sample friends seemed more important for sustained physical health than closeness to spouse and to children. CONCLUSIONS While social supports undoubtedly play a significant role in maintaining physical well-being in late life, much of the association between poor social supports and mortality may be mediated by alcoholism, smoking and pre-morbid psychopathology.