Sven Svebak

Depressed Mood and Subjective Health Symptoms as Predictors of Mortality in Patients with Congestive Heart Failure: A Two-Years Follow-up Study:

Objective: The present study was undertaken in order to evaluate the relationship between depressed mood (depression, emotional distress) and disease-specific subjective health symptoms upon mortality risk among patients with congestive heart failure (CHF). Methods and Results: Proportional hazard models were used to evaluate the effects of selected biomedical, subjective health and psychological variables on mortality among 119 clinically stable patients (71.4% men; mean age 65.7 years +/− 9.6) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the twenty-four-month period of data collection, all from cardiac causes. Results indicated that depressed mood was a significant predictor of mortality with a hazard ratio of 1.9, p .002. In contrast, subjective health was not a significant predictor of mortality in a Cox regression model that included depressed mood. The hazard ratio for a 1-point increase in Zung Depression Scale score was equal to 1.08 based on the multivariate model. Conclusions: Results indicate that depressed mood is significantly related to increased mortality risk among heart failure patients. This finding is of concern to clinicians and should have implications for treatment of patients with congestive heart failure.

Analgesic use: A predictor of chronic pain and medication overuse headache The Head–HUNT Study

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Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls.

One hundred patients with functional dyspepsia, 100 patients with duodenal ulcer and 100 healthy controls were assessed on anamnestic factors, somatic symptoms and psychological measures. Patients with functional dyspepsia had significantly higher levels of state-trait anxiety, general psychopathology, depression, a lower general level of functioning and more somatic complaints from different organ systems, especially the musculo-skeletal system, compared to patients with duodenal ulcer and healthy controls. Patients with functional dyspepsia had more frequent dyspepsia symptoms and a longer disease history than duodenal ulcer patients. Discriminant analyses using a model of fifteen psychological and anamnestic variables, classified correctly 71.5% of the subjects due to diagnoses. The test for multiple somatic complaints (Giessener Beschwerdebogen) was the most important discriminating factor (Eigenvalue 0.78). Seventy-five per cent of the patients were correctly classified, 71% by diagnosis with respect to diagnoses of duodenal ulcer and functional dyspepsia using frequency of dyspeptic symptoms as discriminating factor (Eigenvalue 0.40). Functional dyspepsia seems to be a disease entity of its own, distinct from duodenal ulcer and strongly associated with psychological factors.

The co‐occurrence of headache and musculoskeletal symptoms amongst 51 050 adults in Norway

We have evaluated the association between headache and musculoskeletal symptoms in a large cross‐sectional population‐based study. Between 1995 and 1997, all 92 566 adults in Nord‐Trøndelag County in Norway were invited to participate in a health survey. A total of 51 050 (55%) responded to questions concerning headache and musculoskeletal symptoms. Both migraine and non‐migrainous headache were strongly associated with musculoskeletal symptoms. However, frequency of headache had a higher impact than headache diagnosis on this association. Thus, the prevalence of chronic headache (headache >14 days/month) was more than four times higher (OR = 4.6; 95% CI 4.0–5.3) in the group of individuals with musculoskeletal symptoms than in those without. Individuals with neck pain were more likely to suffer from headache as compared with those with musculoskeletal symptoms in other restricted areas. In conclusion, there was a strong association between chronic headache and musculoskeletal symptoms, which may have implications for the choice of treatment.

Low vagal tone and antral dysmotility in patients with functional dyspepsia.

&NA; Effects of acute mental stress on gastric antral motility were investigated in 23 healthy persons and 25 patients with functional dyspepsia (FD). Real‐time ultrasonography of gastric antrum was recorded, after ingestion of 500 ml meat soup, during a 4‐min resting period, 2.5 min of mental stress, and a 4‐min recovery period. Amplitude of antral contractions was scored as a fraction of relaxed area. Motility‐index was calculated as the amplitude multiplied by frequency. Measurement of skin conductance reflected sympathetic tone, and respiratory sinus arrhythmia (RSA) was calculated to index vagal tone. Antral motility was reduced by mental stress in the healthy persons, but not in FD patients. Group differences were significant for amplitude (p < 0.002) and motility‐index scores (p < 0.02). Sympathetic tone increased during stress in both groups. Vagal tone was lower in the FD patients than in the healthy controls (p < 0.001). The lack of stress‐related reduction of motility among patients with FD may, therefore, be a consequence of poor vagal tone.

Analgesic overuse among subjects with headache, neck, and low-back pain

Objectives: To examine the prevalence of chronic headache (≥15 days/month) associated with analgesic overuse in relation to age and gender and the association between analgesic overuse and chronic pain (i.e., migraine, nonmigrainous headache, neck and low-back pain). Methods: In the Nord–Trøndelag Health Study 1995 to 1997 (HUNT-2), a total of 51,383 subjects responded to headache questions (Head-HUNT), of which 51,050 completed questions related to musculoskeletal symptoms and 49,064 questions regarding the use of analgesics. Results: The prevalence of chronic headache associated with analgesic use daily or almost daily for ≥1 month was 1% (1.3% for women and 0.7% for men) and for analgesic overuse duration of ≥3 months 0.9% (1.2% for women and 0.6% for men). Chronic headache was more than seven times more likely among those with analgesic overuse (≥1 month) than those without (odds ratio [OR] = 7.5, 95% CI: 6.6 to 8.5). Upon analysis of the different chronic pain subgroups separately, the association with analgesic overuse was strongest for chronic migraine (OR = 10.3, 95% CI: 8.1 to 13.0), intermediate for chronic nonmigrainous headache (OR = 6.2, 95% CI: 5.3 to 7.2), and weakest for chronic neck (OR = 2.6, 95% CI: 2.3 to 2.9) and chronic low-back (OR = 3.0, 95% CI: 2.7 to 3.3) pain. The association became stronger with increasing duration of analgesic use for all groups and was most evident among those with headache, especially those with migraine. Conclusions: Chronic headache associated with analgesic overuse is prevalent and especially chronic migraine is more strongly associated with frequent intake of analgesics than other common pain conditions like chronic neck and chronic low-back pain.

Low vagal activity as mediating mechanism for the relationship between personality factors and gastric symptoms in functional dyspepsia

&NA; Low vagal tone may represent a mediating mechanism for relationships between personality and symptoms of functional dyspepsia (FD) through a mechanism of antral hypomotility. Twenty‐one patients with FD and seventeen healthy controls completed a series of personality tests before vagal and sympathetic activity, antral motility, and abdominal symptoms were assessed in response to a laboratory task. Functional dyspepsia patients had lower scores on vagal tone (p = .054) and motility index (p = .011) in addition to the expected higher scores on epigastric discomfort (p = .002). Psychological factors explained a substantial amount of the variance in vagal activity, antral motility, and reported symptoms. Symptoms were predicted by trait anxiety (STAI‐TR), depression (BDI), and neuroticism (EPQ‐N). Poor vagal tone was related to neuroticism (EPQ‐N). Poor motility was best explained by task‐related state dysphoria (SACL‐STR).

Color preference, arousal, and the theory of psychological reversals

The theory of psychological reversals asserts that there are two levels of preferred felt arousal, one high and one low. Only one of them is preferred at a given time, although discrete switches (“reversals”) occur from time to time, so that each level is preferred at different times. In order to document such changes in preferred levels of arousal, 75 subjects were asked to make color preference choices at regular intervals during their working day, some for as many as 8 days. The assumption was that different colors are arousing or relaxing, and that color choice indicates arousal preference. The typical patterns of color choices that occurred clearly displayed the expected reversal effect over time and were considerably more consistent with reversal theory than with optimal arousal theory. In a second study, 41 new subjects were asked to respond to a simple mood adjective checklist each time they made their color preference choices. The results strongly supported the association between arousal preference and color preference and also supported the reversal theory thesis that low arousal preference is associated with seriousness and planning orientation (all these characterizing the “telic state”), and that high arousal preference is associated with playfulness and spontaneity (all these characterizing the “paratelic state”). Finally, both studies showed that there is a systematic tendency for long-wavelength colors to induce feelings of high arousal and for short-wavelength colors to induce feelings of low arousal.

Functional Status and Depression among Men and Women with Congestive Heart Failure

Objective: The study was designed 1) to examine the prevalence of depression in patients with congestive heart failure (CHF); 2) to explore associations between the physicians rating of functional status (NYHA class) and patients assessment of functional status (physical limitation, dyspnea) with symptoms of depression; and 3) to explore gender related differences in relation to physicians rating and patients rating of function status, and symptoms of depression. Method: A sample of 119 clinically stable heart failure patients (85 males and 34 females) was recruited from an outpatient cardiology hospital practice. The patients underwent a physical examination and completed a set of questionnaires. Prevalence of depressive symptoms and the association of these symptoms with NYHA class and patients perceived functional status was studied. Results: Findings indicate that depressive symptoms were not predominant among this sample of CHF patients. Path analyses showed non-significant direct associations between NYHA class as well as patients perception of dyspnea with depression. In contract, the subjective indicator of physical limitations was strongly associated with symptoms of depression among the males, but this relation was not significant among the females. Conclusions: Results suggest that men and women respond differently to the burden of heart failure. However, interpretation of the results from the present study should be considered as tentative and additional research is required to examine mechanisms that explain gender differences in response to heart failure.

The development of the Sense of Humor Questionnaire: From SHQ to SHQ-6

The development ofthe Sense of Humor Questionnaire (SHQ) is reviewed in six sections. First, early approaches to sense ofhumor assessments are reviewed to the extent that these approaches provided a referencefor the need of a new scale. A second section presents the ideas and evaluations that guided the overall approach to the preliminary SHQ Content formation. A third section describes the content ofthepre-published SHQ andproblems that emergedfrom the use of this scale in empirical research. The 1974 revision of the SHQ is presented in a separate section along with the available Information on its psychometric characteristics and an evaluation of its usefulness in empirical research. A fifth section offers a review of some of the findings from other groups using the SHQf and a final section describes the content and psychometric properties of a recent six-item revision of the SHQ (SHQ-6) that appears to overcome some of the shortcomings of the previous versions of the scale. The SHQ-6 items and scoring format are included.