Multilevel Modeling in Psychosomatic Medicine Research

Myers, Nicholas D.; Brincks, Ahnalee M.; Ames, Allison J.; Prado, Guillermo; Penedo, Frank J.; Benedict, Catherine

doi:10.1097/psy.0b013e3182736971

Cited by 22 publications

(11 citation statements)

References 80 publications

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“…This allowed us to account for the nested data structure of patient ratings within physician burnout ratings and to examine variance and model fit at two levels. 23,24 Patient variables were measured at level 1, and physician variables at level 2.…”

Section: Discussionmentioning

confidence: 99%

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Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…We hypothesized that these physician characteristics were related to patient perceptions of empathy and enablement. To compare fit of successive nested models, we used absolute fit indices (Akaike information criterion; Bayesian information criterion), with lower values indicating better fit, 23,27 and chi-square deviance statistics. 28 …”

Section: Discussionmentioning

confidence: 99%

Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic

et al. 2015

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“…Data analysis was primarily conducted in multi-level models with visits at Level 1 and people at Level 2 using SAS PROC MIXED with maximum likelihood estimation (for detailed description of multilevel models, see (26)). Indices of model quality included variance estimates at Level 1 and Level 2, Aikake’s information criterion (AIC), and Bayes’s information criterion (BIC).…”

Section: Methodsmentioning

confidence: 99%

Endogenous Cortisol Exposure and Declarative Verbal Memory

Segerstrom

Geiger

Boggero

et al. 2016

Psychosomatic Medicine

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Objective Exposure to endogenous cortisol is associated with hippocampal degeneration and may contribute to problems with declarative memory, but effects of persistent vs. phasic cortisol elevations have not been established. The present longitudinal investigation examined persistent individual differences and phasic changes in cortisol as they related to verbal memory, executive functions, and subjective cognitive function. Methods Older adults (N = 132, aged 60 to 93 years) were followed for up to 5 years. They were assessed annually for verbal memory and every 6 months for executive functions, subjective cognitive function, and cortisol area under the curve (averaged over 3 days). Results In multilevel models, persistently but not phasically higher cortisol was associated with worse verbal memory in both learning (t(181)=2.99, p=.003) and recall (t(280)=3.10, p=.002). This effect withstood adjustment for stress, depression, metabolic health, and age. There was evidence for attenuated primacy in learning with higher persistent cortisol. Phasic increases in cortisol were not associated with changes in memory, and cortisol was not related to executive functions or subjective cognitive function. Conclusions Higher secretion of cortisol may, over time, contribute to memory dysfunction in older adults.

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“…LMMs account for dependence between observations and allow for different numbers of participant observations. [22] A random (subject-specific) intercept was employed. Parameter estimates are reported as B (SE) or as OR (95% CI); t values with associated p values test the null hypotheses that the B value is equal to zero, or that the OR is equal to one, in the population.…”

Section: Methodsmentioning

confidence: 99%

Psychological stress and short-term hospitalisations or death in patients with heart failure

Endrighi

Waters

Gottlieb

et al. 2016

Heart

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Objective Standard predictors do not fully explain variations in the frequency and timing of heart failure (HF) adverse events (AEs). Psychological stress can trigger acute cardiovascular (CV) events, but it is not known whether stress can precipitate AEs in HF patients. We investigated prospective associations of psychological stress with AEs in patients with HF. Methods 144 HF patients (77% male; 57.5±11.5, range 23–87 years, LVEF≤40%) were longitudinally evaluated for psychological stress (Perceived Stress Scale; PSS) and AEs (CV hospitalizations/death) at 2-week intervals for 3 months, and at 9-month follow- up. Results 42 patients (29.2%) had at least one CV hospitalization and 9 (6.3%) died. Patients reporting high average perceived stress across study measurements had a higher likelihood of AEs during the study period compared to those with lower stress (OR=1.10, 95% CI=1.04, 1.17). In contrast to average levels, increases in stress did not predict AEs (p=.96). Perceived stress was elevated after a CV hospitalization (B=2.70, SE=0.93, p=.004) suggesting that CV hospitalizations increase stress. Subsequent analysis indicated that (24 of 38; 63%) of patients showed a stress increase following hospitalization. However, a prospective association between stress and AEs was present when accounting for prior hospitalizations (B=2.43, SE=1.23, p=.05). Conclusions Sustained levels of perceived stress are associated with increased risk of AEs, and increased distress following hospitalization occurs in many, but not all, HF patients. Patients with chronically high stress may be an important target group for HF interventions aimed at reducing hospitalizations.

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Multilevel Modeling in Psychosomatic Medicine Research

Cited by 22 publications

References 80 publications

Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic

Burned Out at the Bedside: Patient Perceptions of Physician Burnout in an Internal Medicine Resident Continuity Clinic

Endogenous Cortisol Exposure and Declarative Verbal Memory

Psychological stress and short-term hospitalisations or death in patients with heart failure

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