Karl J. Maier

Relation of cognitive appraisal to cardiovascular reactivity, affect, and task engagement

The relation of primary cognitive appraisals to cardiovascular reactivity, affect, task engagement, and perceived stress was examined in 56 men (ages 18–29). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate, preejection period, stroke index, cardiac index, and total peripheral resistance were assessed at rest and during performance of a computerized mental arithmetic task. Extending on prior investigations, threat and challenge appraisals were assessed independently from one another and from secondary appraisals. Positive and negative affect, task engagement, and levels of perceived stress were also assessed. Results indicated that threat (R2 = .08, p = .01), challenge (R2 = .14, p = .003), and their interaction (R2 = .11, p = .006) independently predicted DBP reactivity; DBP responses were greatest among participants with a high threat/low challenge pattern of appraisal. Threat appraisals predicted greater negative affect (R2 = .32) and perceived stress (R2 = .48), whereas challenge appraisals were related to greater positive affect (R2 = .44) and task engagement (R2 = .40, ps < .0001). Greater positive affect was correlated with increased SBP and DBP reactivity, and greater levels of task engagement with increased DBP response (ps ≤ .002). Results suggest that primary cognitive appraisals are more potent predictors of affect and task engagement than cardiovascular reactivity.

Stress-Induced Blood Pressure Reactivity and Silent Cerebrovascular Disease

Background and Purpose— Exaggerated blood pressure (BP) responses to mental stress, an index of autonomic dysregulation, have been related to enhanced risk for stroke. This study examined cross-sectional relations of stress-induced BP reactivity to silent cerebrovascular disease assessed by magnetic resonance imaging (MRI) in healthy older adults. Methods— Sixty-seven nondemented, community-dwelling older adults (ages 55 to 81; 75% male) free of major medical, neurological, or psychiatric disease, engaged in: (1) clinical assessment of resting systolic and diastolic BP; (2) assessment of systolic and diastolic BP responses to 3 laboratory-based mental stressors; and (3) MRI. MRIs were rated for small silent infarcts (≥3 mm), infarct-like lesions (<3 mm), and periventricular and deep white matter hyperintensities (WMH). Results— After adjustment for age, gender, resting clinic BP, and fasting glucose levels, higher systolic BP reactivity was associated with an increased number of small silent infarcts (r2=0.14; P=0.004) and greater severity ratings of periventricular (r2=0.08; P<0.04) and deep WMH (r2=0.06; P<0.05). Higher diastolic BP reactivity was similarly associated with an increased number of small silent infarcts (r2=0.08; P<0.04), and greater severity ratings of periventricular (r2=0.08; P<0.04) and deep WMH (r2=0.11; P=0.009). Conclusions— These results indicate that greater stress-induced BP reactivity is associated with enhanced silent cerebrovascular disease on MRI in healthy asymptomatic older adults independent of resting BP levels. Exaggerated stress-induced BP reactivity warrants further examination as a potential biobehavioral risk factor for cerebrovascular disease.

Role-played interpersonal interaction: Ecological validity and cardiovascular reactivity

Conflictual role-play scenarios have been used to model brief interpersonal interaction and to elicit cardiovascular reactivity in the laboratory. Here we discuss data suggesting that role-played interactions constitute an ecologically valid laboratory task that may improve laboratory-to-field generalization of cardiovascular response. Specifically, our research indicates that young adults perceive the stress associated with role-play scenarios as similar to that encountered in everyday life. Furthermore, these stress appraisals moderate cardiovascular response to role-play in men. We also find that a social stressor (i.e. speech task) is perceived as significantly more similar to a real-life stressor as compared to other standard laboratory tasks. We propose that particular constellations of cognitive, affective, and behavioral responses to laboratory-based social stressors, such as role-played interaction, may elicit different patterns of hemodynamic response. Further understanding of interrelations among cognitive, affective, behavioral, and physiological response patterns may assist in the study of cardiovascular reactivity as a potential mechanism linking personality factors and the development of cardiovascular disease.

Nonlinear associations between chronic stress and cardiovascular reactivity and recovery.

A mixed literature on the influence of chronic and acute stress on cardiovascular reactivity (CVR) and recovery suggests a need for improved modeling of these associations. We examined these associations using both linear and nonlinear (quadratic) models. Data were collected on 129 healthy adults [59% female, ages 18-29 years]. Participants completed the Perceived Stress Scale (PSS) after engaging in a mental arithmetic and a stress recall task. Heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were measured during rest, task, and recovery periods. Hierarchical ordinary least squares regression was used to examine the association of chronic stress to CVR and recovery with initial cardiovascular values and body mass index entered first as covariates. Hierarchical linear modeling (HLM) was also used for recovery. For reactivity, a quadratic relationship between PSS scores and DBP was observed in females such that those scoring at moderate levels of stress displayed lesser reactivity than those scoring either low or high. For recovery, a quadratic model was supported for SBP among females, with moderate levels of stress associated with greater recovery relative to either low or high levels. For females the quadratic model was also supported for SBP and DBP when examined using HLM. Quadratic modeling may better represent current theories of how chronic stress influences CVR and recovery. Our findings further suggest that these associations may be differentially evident by gender, perhaps due to gender differences in reported stress levels or gender-related task relevance.

Silent Myocardial Ischemia and Cardiovascular Responses to Anger Provocation in Older Adults

To determine if older, asymptomatic individuals with no prior history of coronary heart disease with exercise-induced silent myocardial ischemia (SI) during graded exercise treadmill testing exhibit exaggerated cardiovascular reactivity to anger provocation, we compared 42 SI participants and 95 controls. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) changes from baseline to three tasks & #x2014;anger recall, speech role-play, and mental arithmetic with harassment & #x2014;were assessed. Compared to controls, SI displayed greater HR responses for the speech role-play task only. The SI group was significantly older, had higher levels of fasting glucose and triglycerides, and had lower HDL-cholesterol. In multiple regression analyses, after controlling for these differences, SI was significantly associated with greater HR responses to the speech role-play. In sum, the SI group had significantly exaggerated HR responses to the speech role-play task, whereas SBP and DBP reactivity were comparable between groups. This suggests minimally enhanced cardiovascular reactivity among older SI patients that may nonetheless increase risk for cardiac events.

Cardiopatia coronarica e depressione: prevalenza, prognosi, fisiopatologia e trattamento

La comorbilita di depressione e cardiopatia coronarica (coronary heart disease, CHD) e stata dimostrata da un vasto numero di pubblicazioni edite nel corso degli ultimi due decenni. In questa sede riassumiamo lo stato della letteratura, ponendo particolare attenzione alla diffusione della CHD e della depressione, alla relazione tra la depressione e lo sviluppo e la prognosi della CHD ed ai meccanismi fisiopatologici attraverso i quali questi due fenomeni clinici potrebbero essere legati.Vengono anche discusse le questioni chiave rilevanti per la valutazione e il trattamento sia nella pratica clinica sia nella ricerca.

Toward a biopsychosocial ecology of the human microbiome, brain-gut axis, and health

Objective Rapidly expanding insights into the human microbiome and health suggest that Western medicine is poised for significant evolution, or perhaps revolution—this while medicine continues on a trajectory from reductionism to a biopsychosocial (BPS) paradigm recognizing biological, psychological, and social influences on health. The apparent sensitivity of the microbiota to perturbations across BPS domains suggests that a broad and inclusive framework is needed to develop applicable knowledge in this emerging area. We outline an ecological framework of the human microbiome by extending the BPS concept to better incorporate environmental and human factors as members of a global, dynamic set of systems that interact over time. Methods We conducted a selective literature review across disciplines to integrate microbiome research into a BPS framework. Results The microbiome can be understood in terms of ecological systems encompassing BPS domains at four levels: (a) immediate (molecular, genetic, and neural processes), (b) proximal (physiology, emotion, social integration), (c) intermediate (built environments, behaviors, societal practices), and (d) distal (physical environments, attitudes, and broad cultural, economic, and political factors). The microbiota and host are thus understood in terms of their immediate interactions and the more distal physical and social arenas in which they participate. Conclusions A BPS ecological paradigm encourages replicable, generalizable, and interdisciplinary/transdisciplinary research and practices that take into account the vast influences on the human microbiome that may otherwise be overlooked or understood out of context. It also underscores the importance of sustainable bioenvironmental, psychological, and social systems that broadly support microbial, neural, and general health.

Pain catastrophizing differs between and within West Haven-Yale Multidimensonal Pain Inventory (MPI) pain adjustment classifications: theoretical and clinical implications from preliminary data.

Objectives:Pain catastrophizing is associated with multiple pain outcomes, and is differentially associated with the adaptive coping (AC), dysfunctional (DYS), and interpersonally distressed (ID) coping classifications of the West Haven-Yale Multidimensional Pain Inventory (MPI). We examined how catastrophizing, and the underlying components of magnification, rumination, and helplessness, may relate to MPI classifications and differentially relate to pain outcomes across classification groups to inform clinical treatment planning. Materials and Methods:Sixty-nine adults (70% women) diagnosed with musculoskeletal pain were recruited from 2 pain clinics and completed self-report measures of pain severity, the MPI, Pain Catastrophizing Scale, and the Mood and Anxiety Symptom Questionnaire. Results:Patients in the DYS and ID groups reported the greatest levels of rumination, helplessness, and overall catastrophizing, as well as the greatest depression, anxiety, and pain interference compared with the AC group. Catastrophizing related to average pain only in the DYS group (P<0.05), however, catastrophizing was associated with depression, anxiety, and interference (Ps<0.05) among those in the AC group, with a similar pattern observed among the ID group. Discussion:Our findings suggest a continued need for targeting catastrophizing and negative affect among pain patients. However, our data suggest that even among relatively well-adjusted patients, there may be clinical utility in assessing catastrophic thinking given the associations of it with pain-related outcomes. The present findings additionally support the value of enlisting multiple theoretical perspectives such as the stress appraisal and attentional models in future research and clinical applications.

Hostility and Social Support Explain Physical Activity beyond Negative Affect among Young Men, but not Women, in College

We examined social support as a moderator of cynical hostility in relation to physical activity and body mass index among college students (n = 859; M = 18.71 years (SD = 1.22); 60% women, 84% White). After controlling for negative affect in hierarchical linear regression models, greater hostility was associated with lesser physical activity among those with low social support, as expected. Greater hostility was also associated with greater physical activity among those high in social support, ps < .05. Effects were observed for men only. Hostility and social support were unrelated to body mass index, ps > .05. Young men with a hostile disposition and low social support may be at risk for a sedentary lifestyle for reasons other than negative affect.

Novel virus, atypical risk group: understanding young adults in college as an under-protected population during H1N1 2009

Objective: To examine illness/vaccination perceptions of and intentions to vaccinate for seasonal influenza (SI) and 2009 H1N1 in the college setting. Participants: 1190 adults [M=23.5 years (SD=9.5)] from a university in the North-Eastern U.S. Methods: We deployed a web-based survey via campus email just prior to the 2009 H1N1 vaccine release. Results: Younger adults (18-24 years) had lesser understanding of the difference between influenza types, and they reported less regular and current SI vaccination compared to older adults (25-64 years). Younger respondents perceived lesser likelihood of illness from, but attributed greater severity to H1N1 versus SI. Regularity of SI vaccination and perceived vaccine efficacy were the strongest predictors of intent to vaccinate against H1N1, followed by perceived likelihood of illness and confidence in what experts know about vaccine safety. Conclusions: Young adults in college may require additional information during novel influenza pandemics. Measuring perceptions and past vaccination behaviors may facilitate targeting of preventive efforts in the college setting.