Terje A. Murberg

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.

Social relationships and mortality in patients with congestive heart failure.

The present study was undertaken to evaluate the possible effects of social relationships (perceived social support, and perceived social isolation) upon mortality risk among patients with congestive heart failure (CHF). Proportional hazard models were used to evaluate the effects of different social factors on mortality among 119 clinically stable patients (71.4% men; mean age 65.7+/-9.6 years) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the 24-month period of data collection, all from cardiac causes. Results indicated that social isolation was a significant predictor of mortality (relative risk, 1.50, confidence interval (CI), 1.00 to 2.19; P<.038), controlling for depressive symptoms, heart failure severity, and functional status and age. Perceived intimate network support was marginally significantly associated with increased risk of mortality in this population of CHF patients (relative risk, 0.60, CI, 0.35-1.02; P<.06). However, the sample is small and caution in drawing conclusions should be exercised. Further research is required in order to either deny or confirm these findings, and to illuminate the mechanisms behind the relationships between social isolation and mortality.

School-Related Stress and Psychosomatic Symptoms among Norwegian Adolescents

This study examines the relationships between school-related stress, gender and psychosomatic symptoms in a sample of 531 adolescents pupils in years (grades) 8, 9 and 10 (aged 13-16 years) from two compulsory schools in Norway. Results showed that 18.1 percent reported being ‘very much’ affected by at least one of the assessed psychosomatic symptoms. Girls reported significantly more psychosomatic symptoms than did boys. Tests of the dimensionality of the school-related stress that was assessed in the present study showed four main categories: (1) difficulties with peers at school; (2) worries about school achievement; (3) schoolwork pressure and (4) conflicts with parents and/or teachers. Results from multiple regression analyses showed that scores for the different stressors were significantly associated with psychosomatic symptoms. Findings suggest that frequency of psychosomatic symptoms might be related to how well or otherwise pupils adapt to the demands of school and to the interpersonal climate of the school. Gender seems to play a differentiating role here. Girls reported significantly more stress that was related to worries about school achievement, whereas boys reported significantly more stress arising from conflicts with parents and/or teachers. Finally, stress due to difficulties with peers at school was more closely correlated with psychosomatic symptoms among boys than among girls.

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.

Long-Term Effect of Social Relationships on Mortality in Patients with Congestive Heart Failure

Congestive heart failure is a major cause of morbidity and mortality within the Western world, and yet psychosocial impact of this disease is under-researched. The aim of this study was to evaluate the possible effects of social relationships (perceived social support and perceived social isolation) on mortality risk in 119 patients with stable, symptomatic congestive heart failure. Fifty-one deaths were registered during the six-year follow-up period, all from cardiac causes. Analysis using proportional hazard models indicated that social isolation was a significant predictor of mortality (relative risk, 1.36; confidence interval, 1.04 to 1.78; p < 0.03), controlling for neuroticism, heart failure severity, functional status, gender, and age. The small sample size was a limitation of the study; therefore, further research is required in order to confirm these findings and to illuminate the mechanisms behind the relationships between social isolation and mortality.

Social Support, Negative Life Events and Emotional Problems Among Norwegian Adolescents.

Relationships between negative life events, perceived social support and emotional problems were assessed in a national representative sample of 1053 adolescents in eighth grade. Thirty-one percent of the adolescents reported that they had experienced at least one negative life event during the last year. Serious illness or injury among close relatives or friends was reported as the most prevalent negative life event. Negative life events were significantly associated with emotional problems among both female and male adolescents. Moreover, support from parents, friends and teachers was directly, negatively associated with emotional problems in both sexes. Finally, results indicate that support from parents moderate the relationship between negative life events and emotional problems among adolescent girls.

Perceptions of support, diabetes-related coping and psychological well-being in adults with type 1 and type 2 diabetes

The purpose of this cross-sectional study is to examine the relationship between support from health care professionals and the family, diabetes-related coping, and psychological well-being by testing a model hypothesizing the structure of these relations in adults with type 1 and type 2 diabetes. A sample comprising 534 Norwegian adults with both types of diabetes aged 25 to 70 completed questionnaires assessing perceptions of support, diabetes-related coping styles and psychological well-being. Results indicate that perceptions of support from the family are more closely linked to diabetes-related coping than support from the health care professionals. Moreover, results suggest that association between perceptions of support and psychological well-being is mainly mediated by coping. Only associations of emotion-focused coping and self-blame with psychological well-being, however, were detected. Differences in patterns of associations among the sub samples of people with type 1 and type 2 diabetes were identified. The findings are discussed in the light of previous research and assumptions. Suggestions are given regarding implications for the health care of people with diabetes.

Avoidance coping styles predict mortality among patients with congestive heart failure: a 6-year follow-up study

The present study was undertaken to evaluate the effects of avoidance coping styles upon mortality risk among patients with symptomatic congestive heart failure. Proportional hazard models were used to evaluate the effect of avoidance coping styles on mortality among 119 clinically stable patients (71.4% men; mean age 66.0±9.1 years), recruited from an outpatient cardiology practice. Fifty-one deaths were registered during the 6-year follow-up period, all from cardiac causes. The results showed that behavioural disengagement was significantly associated with increased risk of mortality. This finding is of concern to health care professionals and should have implications for treatment of patients with CHF. Given the link between avoidance-oriented coping styles and mortality demonstrated in the present study, it is important to explore possible ways in which counselling in active coping skills might help patients to manage their disease and thereby increase their longevity.

Coping and mortality among patients with congestive heart failure

This study was undertaken to evaluate the effects of different coping styles on mortality risk among patients with symptomatic congestive heart failure (CHF). Proportional hazard models were used to evaluate the effects of different coping styles on mortality among 119 clinically stable patients (71.4% men, mean age 65.7 ± 9.6 years), recruited from an outpatient cardiology practice. Twenty deaths were registered during the 24-month period of data collection, all from cardiac causes. The findings showed that behavioral disengagement was a significant predictor of mortality with a hazard ratio of 1.64 (p ≤ .049), whereas acceptance of the CHF condition showed a marginally significant association with mortality (hazard ratio .64; p ≤ .09). The results suggest that behavioral disengagement in relation to coping with disease-related strain is a significant predictor of mortality among heart failure patients. This finding is of concern to clinicians and should have implications for treatment of patients with CHF. Given the link between behavioral disengagement and mortality demonstrated in this study, it is important to explore ways in which counseling in active coping skills might help patients who behaviorally disengage to manage their disease and thereby increase their longevity.

Personality as predictor of mortality among patients with congestive heart failure: a two-year follow-up study

The present study was undertaken to evaluate the effects of neuroticism upon mortality risk among patients with congestive heart failure. Proportional hazard models were used to evaluate the effect of the enduring personality factor, neuroticism, on mortality among 119 clinically stable patients (71.4% men; mean age 65.7±9.6 years) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the 24-month period of data collection, all from cardiac causes. Results indicated that neuroticism was an independent predictor of mortality with a hazard ratio of 1.14, P<0.01. Health care professionals should identify CHF patients with a tendency to express high levels of neuroticism and should try to provide appropriate treatment if possible.