Depressed Affect, Hopelessness, and the Risk of Ischemic Heart Disease in a Cohort of U.S. Adults

Anda, Robert F.; Williamson, David; Jones, Diane; Macera, Carol A.; Eaker, Elaine D.; Glassman, Alexander H.; Marks, James S.

doi:10.1097/00001648-199307000-00003

Cited by 694 publications

(418 citation statements)

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“…10,127 Premature ischemic heart disease is likely to play an important role, and the relative risk for clinically significant coronary artery disease in patients with major depression is 2.0 or more in studies that independently controlled for risk factors such as smoking and hypertension. 10,127 Figure 7 details the potential mechanisms for premature ischemic heart disease that includes a vicious spiral between insulin resistance and increased visceral fat, potentially leading to hypertension, dyslipidemia, hypercoagulation, and enhanced endothelial inflammation. 128,129 Increased sympathetic outflows seen in both our severely depressed inpatients and less severely depressed outpatients also further add to cardiac risk in several other ways.…”

Section: Long-term Medical Consequences Of Melancholic Depressionmentioning

confidence: 99%

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

2002

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Stress precipitates depression and alters its natural history. Major depression and the stress response share similar phenomena, mediators and circuitries. Thus, many of the features of major depression potentially reflect dysregulations of the stress response. The stress response itself consists of alterations in levels of anxiety, a loss of cognitive and affective flexibility, activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system, and inhibition of vegetative processes that are likely to impede survival during a life-threatening situation (eg sleep, sexual activity, and endocrine programs for growth and reproduction). Because depression is a heterogeneous illness, we studied two diagnostic subtypes, melancholic and atypical depression. In melancholia, the stress response seems hyperactive, and patients are anxious, dread the future, lose responsiveness to the environment, have insomnia, lose their appetite, and a diurnal variation with depression at its worst in the morning. They also have an activated CRH system and may have diminished activities of the growth hormone and reproductive axes. Patients with atypical depression present with a syndrome that seems the antithesis of melancholia. They are lethargic, fatigued, hyperphagic, hypersomnic, reactive to the environment, and show diurnal variation of depression that is at its best in the morning. In contrast to melancholia, we have advanced several lines of evidence of a down-regulated hypothalamic-pituitary adrenal axis and CRH deficiency in atypical depression, and our data show us that these are of central origin. Given the diversity of effects exerted by CRH and cortisol, the differences in melancholic and atypical depression suggest that studies of depression should examine each subtype separately. In the present paper, we shall first review the mediators and circuitries of the stress system to lay the groundwork for placing in context physiologic and structural alterations in depression that may occur as part of stress system dysfunction. Molecular Psychiatry (2002) 7, 254-275. DOI: 10.1038/sj/mp/4001032 Keywords: atypical depression; corticotropin releasing hormone (CRH); melancholic depression; norepinephrine (NE); stress Stress precipitates major depression and influences its incidence, severity and course. 1,2 The stress response and major depression share many features because of similar brain circuitries and mediators (reviewed in 3-5 ). Each is associated with a diminution of cognitive and affective flexibility, alterations in arousal, and perturbations in neuroendocrine and autonomic function (reviewed in 5 ). Because major depression is a heterogeneous disorder, we focus here on two subtypes, melancholic and atypical depression. Our data and those of others indicate that the principal arousal producing mediators of the stress response, such as the corticotropin releasing hormone (CRH) system, are hyperactive in melancholic depression. 6 Not surprisingly, melan- cholia is associated with anxiety, dread of the ...

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Section: Long-term Medical Consequences Of Melancholic Depressionmentioning

confidence: 99%

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

2002

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“…Studies of initially healthy populations have shown that symptoms of depression and anxiety and reports of hopelessness predict future coronary events (i.e., MI, coronary death), even with statistical controls for health behavior (e.g., smoking) and other potential confounding factors (Anda et al, 1993;Ariyo et al, 2000;Aromaa et al, 1994;Barefoot & Schroll, 1996;Eaker, Pinsky, & Castelli, 1992;Everson et al, 1996;Everson, Roberts, Goldberg, & Kaplan, 1998;Ford et al, 1998;Jonas & Mussolino, 2000;Kawachi, Colditz, Ascherio, Rimm, & Giovannucci, 1994;Kubzansky et al, 1997;Penninx et al, 2001;Pratt et al, 1996).…”

Section: Depression Anxiety and Negative Affectivitymentioning

confidence: 99%

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Smith¹,

Ruiz²

2002

Journal of Consulting and Clinical Psychology

292

208

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Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.Coronary heart disease (CHD) is the leading cause of death in the United States; each year about 450,000 people die from CHD, and 1,000,000 experience an initial or recurrent coronary event (American Heart Association, 2001). Among healthy 40-year olds, between 40% and 50% of men and between 25% and 35% of women will later develop CHD (Lloyd-Jones, Larson, Beiser, & Levy, 1999). Over $100 billion is spent on CHD each year in the United States in direct medical costs, disability payments, and lost productivity (American Heart Association, 2001). This disease involves the three major topics composing behavioral medicine and health psychology, making it a central focus throughout their 30-year history. In the first (i.e., health behavior and prevention), modifiable behavioral risk factors (e.g., smoking, activity level, diet) are important risk factors for the development of CHD (Stamler et al., 1999;Wannamethee, Shaper, Walker, & Ebrahim, 1998), and behavior change is an essential component of prevention. In the second topic (i.e., stress and disease or psychosomatics), other psychological and social factors have more direct effects on the development and course of CHD through the intervening psychobiological effects of stress and negative emotions. In the third (i.e., psychosocial aspects of medical illness and care), established CHD has extensive emotional and social impacts on patients and their families, behavior is a key element of standard care (e.g., medication adherence, dietary change, exercise), and psychosocial interventions are useful additions to traditional medical and surgical treatment.Like the article on CHD in the previous special issue on behavioral medicine in this journal (Thoresen & Powell, 1992), we focused primarily on the second major topic-psychosocial influences on the development and course of CHD. We also reviewed one aspect of the third topic-interventions targeting psychosocial risk factors and their underlying psychophysiological mechanisms. Perhaps the most important implication of research on psychosocial risk factors for coronary disease is that interventions targeting these factors could reduce cardiac morb...

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“…The experience of these stressors among AI/ ANs is associated with increased substance abuse and a higher incidence of depressive and anxiety-related disorders (including post-traumatic stress disorder), suicidality, and substance abuse ( -6). Such mental and behavioral states have, in turn, been shown to have direct detrimental effects on physiology relevant to obesity, diabetes, and cardiovascular disease (27)(28)(29)(30)(31)(32)(33)(34)(35)(36). These relationships help explain the increased prevalence of chronic, lifestyle-related diseases in AI/AN communities witnessed over the last several decades.…”

Section: Introductionmentioning

confidence: 99%

Stress, coping, and well-being among the Yup`ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation

Wolsko

Lardon

Mohatt

et al. 2007

International Journal of Circumpolar Health

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Objectives. To report on the relationships between cultural identity and stress, coping, and psychological well-being in Yup'ik communities. Study Design. A quantitative self-administered questionnaire. Methods. A health and wellness survey was completed by a total of 88 Yup'ik participants ( 8 women and 0 men) from 6 rural villages in the Yukon-Kuskokwim Delta region. Respondents were fairly equally distributed across an age range of 14 to 94 (mean ± SD = 38.50 ± 17.18). Results. Participants who reported living more of a Kass'aq way of life (greater acculturation) reported experiencing greater psychosocial stress, less happiness, and greater use of drugs and alcohol to cope with stress. Participants who reported identifying more with a traditional Yup'ik way of life reported greater happiness, more frequent use of religion and spirituality to cope with stress, and less frequent use of drugs and alcohol to cope with stress. Conclusions. In conjunction with previous research, the data strongly indicates that in general, Yup'ik people in the Y-K Delta tend to associate stress and negative health outcomes with the process of acculturation, and health and healing with the process of enculturation. Research that focuses on documenting the intrinsic strengths of indigenous worldviews may contribute to positive transformations in community health. (Int J Circumpolar Health 2007; 66(1):51-61)

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Depressed Affect, Hopelessness, and the Risk of Ischemic Heart Disease in a Cohort of U.S. Adults

Cited by 694 publications

References 0 publications

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

Psychosocial influences on the development and course of coronary heart disease: Current status and implications for research and practice.

Stress, coping, and well-being among the Yup`ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation

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