Wolfgang Linden

Social support interventions: Do they work?

Presence of support has repeatedly been linked to good long-term health outcomes based on demonstrations of better immune function, lower blood pressures, and reduced mortality (among others). Despite a massive literature on the benefits of support, there is surprisingly little hard evidence about how, and how well, social support interventions work. Using a computerized search strategy, 100 studies that evaluated the efficacy of such interventions were located. The presenting problems ranged from cancer, loneliness, weight loss, and substance abuse to lack in parenting skills, surgery, and birth preparation. For the purpose of review and evaluation, studies were subdivided into (1) group vs. individual interventions, (2) professionally led vs. peer-provided treatment, and (3) interventions where an increase of network size or perceived support was the primary target vs. those where building social skills (to facilitate support creation) was the focus. On the whole, this review provided some support for the overall usefulness of social support interventions. However, because of the large variety of existing different treatment protocols and areas of application, there is still not enough evidence to conclude which interventions work best for what problems. Specific methodological and conceptual difficulties that plague this area of research and directions for future research are discussed.

Depression as a Predictor of Disease Progression and Mortality in Cancer Patients

Cancer patients and oncologists believe that psychological variables influence the course of cancer, but the evidence remains inconclusive. This meta‐analysis assessed the extent to which depressive symptoms and major depressive disorder predict disease progression and mortality in cancer patients.

Physiological stress reactivity and recovery: Conceptual siblings separated at birth?

This article discusses theoretical assumptions underlying physiological stress reactivity research. It examines early conceptualizations of activation and recovery and contrasts these with current practices in designing, analyzing, and reporting stress reactivity studies. Study protocols from four major journals covering the last 2 years of publication were examined for current practices. Of the 105 studies which tested physiological reactivity, 63% collected recovery data but only 23% reported the recovery data. We concluded that stress recovery issues are neglected and a renewed case is made for their conceptual and ecological importance. The case for studying recovery is further supported by a selective review of studies using recovery protocols that revealed positive findings not apparent in reactivity comparisons only. Finally, options for sound design of recovery protocols, statistical processing of resulting data, and interpretation of findings are presented.

Toward a causal model of cardiovascular responses to stress and the development of cardiovascular disease

Objective Cardiovascular reactivity is hypothesized to mediate the relationship between stress and cardiovascular disease. We describe three considerations that are crucial for a causal model of cardiovascular responses to stress: the need for laboratory-life generalizability, the role of interactions between environmental exposures and individual response predispositions, and the importance of the duration of both stressor exposure and cardiovascular responding. Methods We illustrate current understanding of stress–cardiovascular disease relationships with examples from the human and animal psychophysiology, epidemiology, and genetics literature. Results In a causal model of reactivity, the usefulness of laboratory assessment rests on the assumption that laboratory-based cardiovascular reactivity predicts responses in the natural environment. We find only limited generalizability and suggest that cardiovascular responses to stress can be better understood when examined in the natural environment. The interaction of individual response predispositions and stressor exposures contributes to the development and progression of cardiovascular disease; stress-disease relationships could therefore be better understood if predispositions and exposures were assessed simultaneously in interactive models. Cardiovascular responses to stress are likely to be most deleterious when responses are prolonged. Responses may vary in their magnitude, frequency, and duration; however, reactivity captures only response magnitude. The assessment of anticipatory and recovery measures, with response magnitude, may therefore lead to a more useful model of the stress-disease relationship. Conclusions A causal model of cardiovascular responses to stress should generalize to the real world, assess interactions between individual predispositions and environmental exposures, and focus on sustained pathogenic exposures and responses.

Getting the most out of cardiac rehabilitation: a review of referral and adherence predictors

Comprehensive cardiac rehabilitation reduces mortality and morbidity but is utilised by only a fraction of eligible cardiac patients, with the participation rate of women being only about half that of men. This quantitative review assesses 32 studies meeting inclusion criteria, describing 16 804 patients, 5882 of whom were female. It was found that the main predictor of referral to a cardiac rehabilitation programme was the physician’s endorsement of the effectiveness of such a programme. Patients were more likely to participate in rehabilitation programmes when they were actively referred, educated, married, possessed high self efficacy, and when the programmes were easily accessible. Patients were less likely to participate when they had to travel long distances to participate in a cardiac rehabilitation programme, or experienced guilt over family obligations. Women were less often referred and participated less often even after referral. In conclusion, many of the observed predictors, including those particular to women, are potentially modifiable with the help of health professionals.

Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments

Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies–Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21–50 items), the Beck Depression Inventory and the General Health Questionaire–28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients–Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

Type D personality is related to cardiovascular and neuroendocrine reactivity to acute stress

OBJECTIVE The relationship between Type D personality (the joint tendency towards negative affectivity [NA] and social inhibition [SI]) and laboratory indices of cardiovascular health was examined. METHOD 173 undergraduates (86 male) completed a stress protocol involving a mental arithmetic task with harassment. Blood pressure, heart rate (HR), and salivary cortisol were measured both prior to and during the task. RESULTS The relationships between personality and both resting and reactivity levels were examined. Results indicated that socially inhibited men demonstrated heightened blood pressure reactivity. NA was related to dampened HR change during the stress task in men. Correlational analyses indicated that both Type D dimensions were associated with greater cortisol reactivity to stress; however, results no longer remained significant in more stringent regression analyses. CONCLUSION Findings are consistent with the noted relationship between Type D and cardiovascular disease (CVD), and suggest a possible pathway to disease via an association with physiological hyperreactivity.

Sex differences in social support, self-deception, hostility, and ambulatory cardiovascular activity.

The quality of the social network, ambulatory cardiovascular indices, and other health risks were assessed in 129 students. Ss carried an ambulatory monitor for a working day and completed a social support scale, an index of daily stress, and measures of anger expression, hostility, depression, and self-deception. Alcohol intake and skinfold thickness were assessed. Results indicated that quality of social support was related in an inverse manner to ambulatory systolic pressure in women only. Stepwise multiple regression confirmed that social support was an independent predictor of daily systolic pressure for women and was not confounded with subjective stress. For men, tendencies to self-deception and high hostility were independently related to elevated blood pressure and heart rate.

Psychological treatments in cardiac rehabilitation: review of rationales and outcomes.

OBJECTIVE In this review, the place of psychological interventions in cardiac rehabilitation and differences in underlying rationales are presented. Treatment approaches vary in that some practitioners favor biobehavioral approaches with strong relaxation/breathing components, whereas others offer unstructured support, psychoeducation to maximize compliance, or psychological interventions directed at reducing emotional distress. METHODS The effectiveness of psychosocial rehabilitation for endpoints like mortality, recurrence, emotional distress, and intermediate hard endpoints is reviewed by integrating conclusions from narrative and meta-analytic reviews as well as recent major clinical trials. RESULTS The aggregated findings support the use of psychosocial interventions and they also help to explain critical differences in outcome in that studies which fail to reduce distress also fail to lead to reduced mortality or reduced event recurrence. CONCLUSION Gender differences in outcome and recent trends in cardiology are discussed because both have distinct consequences for the effective delivery of psychological services to cardiac patients.

Differential effects of harassment on cardiovascular and salivary cortisol stress reactivity and recovery in women and men

To explore the differential effects of harassment on cardiovascular and neuroendocrine stress reactivity and recovery, 28 men and 32 women were randomized to a harassment or no-harassment control condition (four groups in total). The harassment consisted of three scripted statements delivered during performance of a mental arithmetic stress task. The harassing statements were delivered on a fixed schedule during the task by a same-gender experimenter. Cardiovascular, salivary cortisol, and state affect measures were taken at baseline, immediately posttask, and throughout an extended recovery period. In comparison to the control condition, harassment accentuated the stress reactivity responses on all measures, physiological and self-report of subjective affect. In addition, several gender differences in response to the stressor and during the recovery period were observed. Harassed men had the largest reactivity on cortisol and diastolic blood pressure, whereas the harassed women showed a more pronounced response on heart rate and self-reported hostility. The harassed groups were the only ones to show significant cortisol responses. Within the harassed condition, comparison of effect sizes revealed that cortisol reactivity in men was twice that of women. Control groups did not exhibit significant cortisol changes. During the recovery period, harassed men exhibited attenuated return to baseline on cardiovascular indices and cortisol, whereas women, overall, tended to exhibit an overcompensation response on cardiovascular measures. These results contribute to showing a pathway that may link negative affect (i.e., hostile or angry feelings) with the development of cardiovascular disease.