Depression and inflammation fuel one another. Inflammation plays a key role in depression's pathogenesis for a subset of depressed individuals; depression also primes larger cytokine responses to ...stressors and pathogens that do not appear to habituate. Accordingly, treatment decisions may be informed by attention to questions of how (pathways) and for whom (predispositions) these links exist, which are the focus of this article. When combined with predisposing factors (moderators such as childhood adversity and obesity), stressors and pathogens can lead to exaggerated or prolonged inflammatory responses. The resulting sickness behaviors (e.g., pain, disturbed sleep), depressive symptoms, and negative health behaviors (e.g., poor diet, a sedentary lifestyle) may act as mediating pathways that lead to further, unrestrained inflammation and depression. Depression, childhood adversity, stressors, and diet can all influence the gut microbiome and promote intestinal permeability, another pathway to enhanced inflammatory responses. Larger, more frequent, or more prolonged inflammatory responses could have negative mental and physical health consequences. In clinical practice, inflammation provides a guide to potential targets for symptom management by signaling responsiveness to certain therapeutic strategies. For example, a theme across research with cytokine antagonists, omega-3 fatty acids, celecoxib, and exercise is that anti-inflammatory interventions have a substantially greater impact on mood in individuals with heightened inflammation. Thus, when inflammation and depression co-occur, treating them in tandem may enhance recovery and reduce the risk of recurrence. The bidirectional links between depression, inflammation, and disease suggest that effective depression treatments could have a far-reaching impact on mood, inflammation, and health.
Objectives
To (1) evaluate existing eHealth/mHealth interventions developed to help manage cancer‐related fatigue (CRF); and (2) summarize the best available evidence on their effectiveness.
Methods
...A comprehensive literature search of PubMed, MEDLINE, EMBASE, and the Cochrane Library up to November 2016 was conducted. Study outcomes were extracted, tabulated, and summarized. Random effects meta‐analyses were conducted for the primary outcome (fatigue), and the secondary outcomes quality of life and depression, yielding pooled effect sizes (r), and 95% confidence intervals (CI).
Results
For eHealth interventions, our search of published papers identified 9 completed studies and 6 protocols for funded projects underway. No studies were identified for mHealth interventions that met our inclusion criteria. A meta‐analysis of the 9 completed eHealth studies revealed a statistically significant beneficial effect of eHealth interventions on CRF (r = .27, 95% CI .1109 – .4218, P < 0.01). Therapist‐guided eHealth interventions were more efficacious then self‐guided interventions (r = .58, 95% CI: .3136 – .5985, P < 0.001). Small to moderate therapeutic effects were also observed for HRQoL (r = .17, 95% CI .0384 – .3085, P < 0.05) and depression (r = .24, 95% CI .1431 – .3334, P < 0.001).
Conclusions
eHealth interventions appear to be effective for managing fatigue in cancer survivors with CRF. Continuous development of eHealth interventions for the treatment of CRF in cancer survivors and their testing in long‐term, large‐scale efficacy outcome studies is encouraged. The degree to which mHealth interventions can change CRF in cancer survivors need to be assessed systematically and empirically.
Early-Life Stress and Adult Inflammation Fagundes, Christopher P.; Way, Baldwin
Current directions in psychological science : a journal of the American Psychological Society,
08/2014, Letnik:
23, Številka:
4
Journal Article
Recenzirano
The origins of modern psychology are deeply rooted in the notion that stressful early-life experiences negatively impact people's mental health. Emerging work in the field of health psychology ...suggests that early-life stress also impacts physical well-being. Indeed, those who experienced severe early-life stress as children are more at risk for cardiovascular disease, type 2 diabetes, and cancer compared with those who did not have those early-life experiences. Recent work in the field of psychoneuroimmunology suggests that inflammation may be one mechanism underlying these associations. In this article, we provide a brief overview of the literature on early-life stress and inflammation and how psychological, autonomic, neuroendocrine, and epigenetic responses to the early environment lead to potentiated inflammation in adulthood. We conclude by highlighting the need for health-promotion and disease-prevention programs that are designed to reduce the frequency and severity of early-life stress.
•At two visits, couples discussed marital disagreements and gave blood samples.•Hostile behaviors and depression predicted greater bacterial LPS translocation.•In turn, greater bacterial ...translocation was related to higher inflammation.•Bacterial translocation explained hostility and depression’s links to CRP.
Marital distress and depression work in tandem to escalate risks for inflammation-related disorders. Translocation of bacterial endotoxin (lipopolysaccharide, LPS) from the gut microbiota to blood circulation stimulates systemic inflammatory responses.
To investigate increased gut permeability (a “leaky gut”) as one potential mechanistic pathway from marital distress and depression to heightened inflammation, this secondary analysis of a double-blind, randomized crossover study examined serial assessments of two endotoxin biomarkers, LPS-binding protein (LBP) and soluble CD14 (sCD14), as well as C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) during two separate 9.5 h visits. The 43 (N = 86) healthy married couples, ages 24–61 (mean = 38.22), discussed a marital disagreement during both visits; behavioral coding of these interactions provided data on hostile marital behaviors, a hallmark of marital distress. The Structured Diagnostic Interview for DSM-IV assessed participants’ mood disorder history.
Participants with more hostile marital interactions had higher LBP than those who were less hostile. Additionally, the combination of more hostile marital interactions with a mood disorder history was associated with higher LBP/sCD14 ratios. Higher LBP and LBP/sCD14 were associated with greater CRP production; for example, only 21% of low LBP participants (lowest quartile) had average CRP across the day > 3, compared to 79% of those in the highest quartile. Higher sCD14 was associated with higher IL-6.
These bacterial LPS translocation data illustrate how a distressed marriage and a mood disorder history can promote a proinflammatory milieu through increased gut permeability, thus fueling inflammation-related disorders.
•Inflammatory markers can distinguish bereaved spouses higher on grief severity compared with bereaved spouses with lower grief severity.•Even in a population high on depressive symptoms, there is a ...positive relationship between depression and inflammation.•Similar to the general population, inflammation is an important marker of elevated levels of depression among bereaved spouses.
Grief is conceptualized by strong negative emotions, which include longing, sadness, and preoccupations with thoughts, recollections, and images of the spouse. In the initial months after the loss of a spouse, those who are widowed are at risk for cardiovascular problems and premature mortality. In the general population, depression is characterized by chronic low-grade inflammation, a key predictor of cardiovascular problems, morbidity, and mortality. Although depression and grief share similarities, they are distinct constructs. We aimed to identify if grief was related to inflammation among those who had a spouse recently die. We also sought to determine if those who are widowed and already experience elevated levels of depressive symptoms compared with the general population had higher levels of inflammation compared with those who are widowed who report fewer depressive symptoms. Ninety-nine recently bereaved individuals (M = 84.74 days since passing, SD = 18.17) completed a blood draw and psychological assessments. Proinflammatory T cell-derived cytokines were assessed, which included interferon gamma (IFN-γ), interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), IL17-A, and IL-2. Bereaved individuals with a higher grief severity (using an established cut-score) had higher levels of the proinflammatory cytokines IFN-γ, IL-6, and TNF-α than those with less grief severity. Those who experienced higher levels of depression exhibited elevated levels of proinflammatory cytokines compared with those who had lower levels of depression (using a continuous measure of depressive symptoms, as well as an established cut score). This is the first study to demonstrate that inflammatory markers can distinguish those who are widowed based on grief severity such that those who are higher on grief severity have higher levels of inflammation compared with those who are lower on grief severity. These findings also add to the broader literature on depression and inflammation by showing that even in a population with high levels of depressive symptoms, there is a positive relationship between depression and inflammation.
Following a stressful life event, there is considerable variation in how individuals respond and adapt. Multiple models of risk and resilience show that adverse childhood experiences may be ...associated with an individual's response to stress later in life. While there is considerable support that early adversity can sensitize the stress response system and lead to adverse outcomes later in life, there is mounting evidence that in adolescence and young adulthood, certain biological predispositions to stress may be associated with resilience in the context of subsequent stressors. In this study, we evaluated how individual differences in vagally mediated heart rate variability moderated the relationship between childhood maltreatment and grief among a sample of individuals experiencing a stressful life event (i.e., spousal bereavement) over time. Data were collected at approximately 3, 4.5, and 6.5 months after the death of a spouse (n = 130). Heart rate variability moderated the relationship between childhood maltreatment and grief symptoms over time (b = −0.03, p < .001), such that among individuals with more severe experiences of childhood maltreatment, those with higher heart rate variability had a faster recovery from grief than those with low heart rate variability. This research highlights an overall pattern of resilience among older adult's following spousal bereavement, as well as the relationships between childhood maltreatment, heart rate variability, and differential responses to grief following the loss of a spouse.
Public Significance Statement
Childhood maltreatment and heart rate variability may be related to differential responses to grief among bereaved spouses over time. Among bereaved spouses with a history of childhood maltreatment, those with higher heart rate variability experienced faster recovery from grief symptoms than bereaved spouses with lower heart rate variability. These findings suggest a pathway to intervention may include increased heart rate variability to mitigate the relationship between adverse childhood experiences and adjustment to stressors later in life, particularly among older adults.
Abstract Objectives Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated ...with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer. Methods Newly diagnosed patients (N = 60) with stage I or II non–small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan–Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery. Results The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Conclusions Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions.
Finances are a prevalent source of stress. In a sample of 799 nursing home workers measured multiple times over 18 months, we found that higher perceived income inadequacy, the perception that one's ...expenses exceeds one's incomes, was associated with poorer self-reported mental health indicators and Epstein-Barr Virus antibody titers (a marker of cell-mediated immune function). Perceived income inadequacy predicted outcomes over and above the role of other socioeconomic status variables (objective household income and education). Mental health variables were not related to Epstein-Barr Virus antibody titers. Additionally, we found an interaction between perceived income inadequacy and informal caregiver status on our mental health outcomes; informal caregivers with higher perceived income inadequacy had poorer mental health than non-caregivers with the same perceived income inadequacy. Our findings may add nuance to the reserve capacity model, which states that those at lower socioeconomic levels are at higher risk of adverse health outcomes partly because they have fewer resources to address demands and strain. Perceived income inadequacy may significantly predict mental and physical well-being beyond other socioeconomic status variables, especially among lower-income employees. Caregiving stress and perceived income inadequacy may have synergistic effects on mental health.
•Perceived income inadequacy predicted stress and distress beyond household income.•Perceived income inadequacy predicted Epstein-Barr virus antibody titers.•Informal caregivers had poorer mental health at high perceived income inadequacy.
Objective: Pain, depression, and fatigue function as a symptom cluster and thus may share common risk factors. Interpersonal relationships clearly influence health, suggesting that loneliness may ...promote the development of the pain, depression, and fatigue symptom cluster. We hypothesized that loneliness would be related to concurrent symptom cluster levels and increases in symptom cluster levels over time. Method: We utilized two observational studies with distinct longitudinal samples. Study 1 was a sample of cancer survivors and benign controls (N = 115) assessed annually for 2 years. Study 2 was a sample of older adults caring for a spouse with dementia (caregivers) and noncaregiver controls (N = 229) assessed annually for 4 years. Participants completed annual measures assessing loneliness, pain, depression, and fatigue. Results: Across both samples, lonelier participants experienced more concurrent pain, depression, and fatigue and larger increases in symptom cluster levels from one year to the next than less lonely participants. Sleep quality did not mediate the results in either study. All analyses were adjusted for relevant demographic and health variables. Conclusions: Two longitudinal studies with different populations demonstrated that loneliness was a risk factor for the development of the pain, depression, and fatigue symptom cluster over time. The current research helps identify people most at risk for pain, depression, and fatigue, and lays the groundwork for research about their diagnosis and treatment. These data also highlight the health risks of loneliness; pain, depression, and fatigue often accompany serious illness and place people at risk for poor health and mortality.
PDF
