P. R. J. Falger

Depressive symptomatology and vital exhaustion are differentially related to behavioral risk factors for coronary artery disease.

Objective This study proposes to assess the differences of two psychosocial risk indicators for coronary artery disease (CAD), ie, depressive symptoms and vital exhaustion. Method In a representative, stratified, nation-wide sample of the population of Hungary over the age of 16 years (N = 12,640), analyses were made of whether those risk indicators were differentially related to several illness behaviors (including history of cardiovascular treatment and cardiovascular sick days), cognitions, mood states, and socioeconomic characteristics that may generally be associated with increased CAD risk. The sample was stratified by age, sex, and composition of the population of all counties in Hungary. Results Although depressive symptoms and vital exhaustion correlated strongly, there were clear and significant differences in strength of association between depressive symptoms, vital exhaustion and several variables under study. Dysfunctional cognitions, hostility, lack of purpose in life, low perceived self-efficacy, illegal drug use, alcohol and drug abuse, several forms of subjective disability complaints and history of treatment because of congenital disorders, and chronic skin and hematological disorders were more often associated with depressive symptoms, whereas loss of energy, use of stimulants, chest-pain-related disabilities, history of treatment because of cardiovascular disorders, and self-reported cardiovascular sick days were significantly more often associated with vital exhaustion. Conclusions Vital exhaustion and depressive symptomatology are differentially associated with relevant external criteria. Vital exhaustion is associated with perceived cardiovascular complaints and history of cardiovascular treatment, whereas depressive symptomatology seems to be more closely connected to disabilities and complaints related to alcohol, drug, and congenital-disorder, and to dysfunctional cognitions and hostility.

Current Posttraumatic Stress Disorder and Cardiovascular Disease Risk Factors in Dutch Resistance Veterans from World War II

The extraordinary trauma experienced by Resistance veterans from World War II (WW II) and other veterans may be associated with an increased incidence of posttraumatic stress disorder (PTSD) and somatic morbidity, including cardiovascular disease (CVD). This study explored some relationships between current PTSD and CVD risk factors in 147 male Dutch WW II Resistance veterans. They were compared to 65 same-aged male patients with a recent myocardial infarction and 79 surgical patients. Of these subjects, WW II Resistance veterans scored highest on CVD risk factors (i.e., angina pectoris, type A behavior, life stressors, and vital exhaustion), except smoking. Fifty-six percent of these veterans were currently suffering from PTSD. They reported CVD risk factors, in particular type A behavior and vital exhaustion, more often than veterans without PTSD; they also reported more premorbid adverse living conditions. These data suggest that early sensitization to environmental stressors may be associated with a high prevalence of current PTSD and excess CVD risk factors in subjects exposed to extraordinary war-time trauma and that this may lead to vital exhaustion.

Exhaustion, psychological stressors in the work environment, and acute myocardial infarction in adult men

In a case-control study in adult men from The Netherlands, the associations of work stressors with both exhaustion prior to first acute myocardial infarction (AMI) and with first AMI itself were explored. The 133 AMI-cases reported more exhaustion, work stressors, and smoking than the controls (i.e. 133 neighborhood controls and 192 hospital controls). After controlling for smoking, exhaustion constituted a firm risk indicator for first AMI; it was also positively associated with work stressors, in particular conflicts at work. Work stressors that may disrupt ones occupational career, and increased responsibility (in younger AMI-cases), were directly associated with elevated risk for first AMI. Conflicts at work were conducive to first AMI through their associations with exhaustion.

Risk factor modification through nonpharmacological interventions in patients with coronary heart disease.

Coronary heart disease (CHD) is still the main cause of death in developed countries. Because of improved treatment, many patients survive the acute phase of a myocardial infarction, which makes secondary prevention of CHD of major importance. Most risk factors responsible for the development and progression of CHD are associated with behavior. Therefore, interventions aimed at behavior change may contribute to risk factor modification and secondary prevention of CHD. The effects of separate risk factor modification efforts by means of randomized, controlled clinical trials of nonpharmacological interventions in patients suffering from CHD are reviewed. Interventions aimed at healthy lifestyles may stimulate smoking cessation rates, reduce elevated serum total and low-density lipoprotein (LDL)-cholesterol concentrations, and favorably modify type A behavior in CHD patients. Moreover, reduction of coronary atherosclerosis has been reported after intensive lifestyle and exercise interventions, whereas exercise and type A interventions may also lead to reduced CHD morbidity and mortality. As for hypertension and obesity, studies aimed at secondary prevention are lacking.

Posttraumatic Stress Disorder in Dutch Resistance Veterans from World War II

At present it is generally accepted that extensive war traumata can cause permanent damage to a person’s mental and physical health. However, the precise nature of the associations between traumatic war experiences and subsequent disorders remains uncertain.

PREVALENCE AND COURSE OF POSTTRAUMATIC STRESS DISORDER IN DUTCH VETERANS OF THE CIVILIAN RESISTANCE DURING WORLD WAR II: AN OVERVIEW

This study concerns the prevalence of current and lifetime Posttraumatic Stress Disorder (PTSD) in various groups of officially recognized Veterans of the Dutch civilian Resistance against the Nazi occupation during World War II. In total, 1046 Resistance veterans living in The Netherlands and 52 who emmigrated to the United States after the war were examined. Between four and five decades after the end of WW 11, between 25 and 50% were suffering from current PTSD. The life-time prevalence is estimated to be substantially higher. The course of PTSD proved highly variable. There had often been a delay of several decades between the end of the war and reoccurrence or first onset of posttraumatic symptoms. The prevalence of PTSD in Resistance veterans who emigrated to the United States was hardly different from that of the veterans still living in The Netherlands.

sleep complaints, behavioral characteristics and vital exhaustion in myocardial infarction cases

Abstract Prodromal symptoms of vital exhaustion and sleep complaints are increasingly being recognized as important risk indicators for myocardial infarction (MI). In this study, the relationships between vital exhaustion, behavioral characteristics, and MI, and between several sleep complaints and MI were investigated. The subjects were 133 male cases with first MI, 192 male hospital controls, and 133 male neighborhood controls. The instruments used were the Maastricht Questionnaire (vital exhaustion), the Life Styles Questionnaire (sleep complaints, coffee consumption, and current smoking), and the Structured Interview (Type A behavior). All sleep complaints, vital exhaustion, Type A behavior, excessive coffee consumption, and current smoking occurred significantly more often in MI-cases. After controlling for these potential confounders, and age, most sleep complaints retained significant associations with MI, in particular often taking naps during the day and waking up in the morning feeling tired and...

A self-rating scale for the assessment of posttraumatic stress disorder in Dutch Resistance veterans of World War II.

The present study reports on the development of a Dutch PTSD scale based on the DSM-III criteria for PTSD. Test-retest reliability was .91. The scale showed an internal consistency with a coefficient alpha of .88. Factor analysis on a large sample of Resistance veterans (N = 967) yielded six factors, which represent intrusive thoughts, physiological reactions, detachment, rage, active confrontation, and guilt.

Posttraumatic Stress Disorder in Male and Female Dutch Resistance Veterans of World War II in Relation to Trait Anxiety and Depression

In this study, 680 male and 144 female Dutch Resistance veterans of World War II were evaluated on Posttraumatic Stress Disorder, trait anxiety, and depression. Approximately 27% of these men and 20% of these women showed current Posttraumatic Stress Disorder. Resistance veterans, as a group, appeared comparable to the controls from Dutch validation studies on trait anxiety and depression. Gender differences were not observed. Veterans with current PTSD symptoms scored higher on trait anxiety and depression than the remaining veterans and were comparable on trait anxiety and depression to psychiatric patients. Correlational analyses showed that there was a strong association between trait anxiety and depression. Posttraumatic Stress Disorder correlated highly with trait anxiety and depression.

Vital exhaustion measures and their associations with coronary heart disease risk factors in a sample of spanish-speakers

Abstract The main purpose of this research was to study the reliability and conceptual validity of two Spanish language measures of Vital Exhaustion (VE), a short-term risk factor for coronary artery disease (CAD). The English version of the Maastricht Questionnaire for Vital Exhaustion was used to make a Spanish language questionnaire (VEQ) and a Spanish language interview (VEI) whose scoring systems were equal to the original version. These instruments were administered to a sample of healthy working men (n = 100) and women (n = 130) in Caracas, Venezuela. Participants also completed questionnaires designed to measure anger-expression and social support and were assessed by means of the Structured Interview to measure Type A Behaviour Pattern (TABP). Information about other CAD-risk factors, such as age, smoking behavior, and health habits, were collected. High reliability coefficients, .85 and .91, were found for the VEI and VEQ, respectively. Principal component analysis provided one-factor solutions for each instrument. The pattern of correlations between VE, assessed by the VEI, and other personality characteristics was rather similar to the pattern observed in other cultures. In general significant, but modest, correlations were observed between VE and TABP, anger expression, a negative self-concept, and low social support. We conclude that VE appears to be a meaningful construct in this particular cultural context.