Allostatic load (AL) reflects the deteriorating influences of stress on the body and comprises a selection of biological markers. AL is associated with negative life events, stress, and negative ...affect (NA), as well as poor health outcomes. However, whether AL is also associated with positive affect (PA) is not clear. The present study therefore explores the association between PA and AL, accounting for age, sex, NA, and health behaviors.
Data of 45,225 individuals from the first wave of the multidisciplinary prospective population-based cohort study Lifelines were used. AL was operationalized as the sum of 12 inflammatory, cardiovascular, and metabolic markers. The association between PA and AL was tested in a cross-sectional study design using multiple linear regression analysis, adjusting for NA, confounders, and health behaviors. In addition, we explored whether the relation was moderated by age, sex, and NA.
The AL profile was inversely associated with PA (B = -0.083, p < .001) when adjusted for NA, age, and sex. The association between AL and PA remained significant after adjusting for health behaviors (B = -0.076, p < .001). A significant moderating effect was found for sex (PA by sex: B = 0.046, p = .001), indicating that the association between PA and AL was stronger in women than in men.
PA was associated with a more favorable AL profile, especially in women. These results add to the evidence that PA might be of relevance to the etiology of disease.
To compare the odds of depressive and anxiety disorders for participants with diagnosed diabetes, participants with diabetes but unaware of this, and participants without diabetes. Such knowledge ...might improve etiological insight into psychopathology in diabetes.
Data of 90,686 participants (mean age = 45 years; 59% female) from the LifeLines cohort was used. Depressive and anxiety disorders were assessed by the Mini-International Neuropsychiatric Interview. The odds of depression and anxiety were assessed for three groups: a) diagnosed diabetes, diabetes medication use and/or self-reported "diabetes"; b) undiagnosed diabetes, fasting blood glucose ≥7.0 mmol/l, but no diabetes medication use and self-reported "no diabetes"; and c) no diabetes, fasting blood glucose <7.0 mmol/l and self-reported "no diabetes." Logistic regression was performed to compare the odds of depression and anxiety in these groups, adjusting for age, sex, diabetes-related diseases, comorbid depressive or anxiety disorders, and glycosylated hemoglobin.
A total of 3002 (3.3%) participants were diagnosed as having depression and 9018 (9.9%) as having anxiety; 1781 (2.0%) had diagnosed and 786 (0.9%) had undiagnosed diabetes. Both diagnosed (odds ratio OR = 1.4:1.1-1.8, p = .006) and undiagnosed (OR = 1.8:1.3-2.6, p = .001) diabetes were independently associated with depression. The odds of depression did not differ between diagnosed and undiagnosed diabetes (OR = 0.7, p = .17). Diagnosed diabetes was independently associated with anxiety (OR = 1.4:1.2-1.7, p < .001), but undiagnosed diabetes was not (OR = 0.8:0.6-1.1, p = .20). The odds of anxiety were significantly higher in diagnosed compared with undiagnosed diabetes (1.68:1.23-2.31, p = .001).
Depression was more prevalent in participants with diagnosed and undiagnosed diabetes, whereas anxiety was more prevalent only in participants who were aware of their diabetes. Longitudinal research is needed to assess the causal pathways of these associations.
This paper aims to provide an overview of the current state of affairs on psychophysiological factors that may explain the link between depression and adverse outcome in coronary artery disease (CAD) ...patients. Factors discussed include heart rate variability, inflammation, platelet function, hypothalamus–pituitary–adrenal axis activity, serotonin metabolism and polyunsaturated fatty acids. Evidence suggests the involvement of each of these factors in both depression and CAD, together contributing to the prospective association between depression and cardiac outcome. Unfortunately, the involvement of above factors has been evaluated mostly in isolation, despite their functional interrelations and associations with behavioral factors. Moreover, there may be specific relations between individual symptoms of depression and certain psychophysiological mechanisms, rather than with general depression, further complicating the notion of depression as a cardiotoxic factor. The relatively understudied complexity of the relation between depression and CAD may serve as an explanation for the finding that depression treatment does not or barely affect cardiac outcome. Future studies should focus on the network of psychophysiological (and behavioral) factors to elucidate their precise role and timing in depressed cardiac patients.
It has been claimed that functional somatic syndromes share a common etiology. This prospective population-based study assessed whether the same variables predict new onsets of irritable bowel ...syndrome (IBS), chronic fatigue syndrome (CFS) and fibromyalgia (FM).
The study included 152 180 adults in the Dutch Lifelines study who reported the presence/absence of relevant syndromes at baseline and follow-up. They were screened at baseline for physical and psychological disorders, socio-demographic, psycho-social and behavioral variables. At follow-up (mean 2.4 years) new onsets of each syndrome were identified by self-report. We performed separate analyses for the three syndromes including participants free of the relevant syndrome or its key symptom at baseline. LASSO logistic regressions were applied to identify which of the 102 baseline variables predicted new onsets of each syndrome.
There were 1595 (1.2%), 296 (0.2%) and 692 (0.5%) new onsets of IBS, CFS, and FM, respectively. LASSO logistic regression selected 26, 7 and 19 predictors for IBS, CFS and FM, respectively. Four predictors were shared by all three syndromes, four predicted IBS and FM and two predicted IBS and CFS but 28 predictors were specific to a single syndrome. CFS was more distinct from IBS and FM, which predicted each other.
Syndrome-specific predictors were more common than shared ones and these predictors might form a better starting point to unravel the heterogeneous etiologies of these syndromes than the current approach based on symptom patterns. The close relationship between IBS and FM is striking and requires further research.
The risk for multifactorial diseases is determined by risk factors that frequently apply across disorders (universal risk factors). To investigate unresolved issues on etiology of and individual's ...susceptibility to multifactorial diseases, research focus should shift from single determinant-outcome relations to effect modification of universal risk factors. We present a model to investigate universal risk factors of multifactorial diseases, based on a single risk factor, a single outcome measure, and several effect modifiers. Outcome measures can be disease overriding, such as clustering of disease, frailty and quality of life. "Life course epidemiology" can be considered as a specific application of the proposed model, since risk factors and effect modifiers of multifactorial diseases typically have a chronic aspect. Risk factors are categorized into genetic, environmental, or complex factors, the latter resulting from interactions between (multiple) genetic and environmental factors (an example of a complex factor is overweight). The proposed research model of multifactorial diseases assumes that determinant- outcome relations differ between individuals because of modifiers, which can be divided into three categories. First, risk-factor modifiers that determine the effect of the determinant (such as factors that modify geneexpression in case of a genetic determinant). Second, outcome modifiers that determine the expression of the studied outcome (such as medication use). Third, generic modifiers that determine the susceptibility for multifactorial diseases (such as age). A study to assess disease risk during life requires phenotype and outcome measurements in multiple generations with a long- term follow up. Multiple generations will also enable to separate genetic and environmental factors. Traditionally, representative individuals (probands) and their first- degree relatives have been included in this type of research. We put forward that a three- generation design is the optimal approach to investigate multifactorial diseases. This design has statistical advantages (precision, multiple-informants, separation of non- genetic and genetic familial transmission, direct haplotype assessment, quantify genetic effects), enables unique possibilities to study social characteristics (socioeconomic mobility, partner preferences, between-generation similarities), and offers practical benefits (efficiency, lower non-response). LifeLines is a study based on these concepts. It will be carried out in a representative sample of 165,000 participants from the northern provinces of the Netherlands. LifeLines will contribute to the understanding of how universal risk factors are modified to influence the individual susceptibility to multifactorial diseases, not only at one stage of life but cumulatively over time: the lifeline.
Infections with different herpes viruses have been associated with cognitive functioning in psychiatric patients and healthy adults. The aim of this study was to find out whether antibodies to ...different herpes viruses are prospectively associated with cognitive functioning in a general adolescent population.
This study was performed in TRAILS, a large prospective general population cohort (N = 1084, 54% female, mean age 16.2 years (SD 0.6)). At age 16, immunoglobulin G antibodies against HSV1, HSV2, CMV and EBV were measured next to high sensitive C-Reactive Protein (hsCRP). Two years later, immediate memory and executive functioning were assessed using the 15 words task and the self ordered pointing task. Multiple linear regression analysis with bootstrapping was performed to study the association between viral infections and cognitive function, adjusting for gender, socioeconomic status, ethnicity, and cannabis use.
Presence of HSV1 antibodies was associated with memory function ((B = -0.272, 95% CI = -0.556 to -0.016, p = 0.047)), while the association with executive functioning did not reach statistical significance (B = 0.560, 95% CI is -0.053 to 1.184, p = 0.075). The level of HSV1 antibodies was associated with both memory function (B = -0.160, 95% CI = -0.280 to -0.039, p = 0.014) and executive functioning (B = 0.296, 95% CI = 0.011 to 0.578, p = 0.046). Other herpes viruses and hsCRP were not associated with cognitive functioning.
Both presence and level of HSV1 antibodies are prospectively associated with reduced cognitive performance in a large cohort of adolescents.
Objective To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of ...effects. Study design Cochrane, PubMed, PsycINFO, EMBASE, and CINAHL were searched for randomized controlled trials published in peer-reviewed journals. Randomized controlled trials studying the effect of a psychological treatment on symptom load and disability in children with functional somatic symptoms were selected. Data on symptom load, disability, and school absence directly post-treatment and at follow-up were extracted by 2 assessors. Studies were appraised with the Cochrane risk of bias tool. Standardized mean differences were pooled in a random-effects model. Heterogeneity in effect-sizes was explored by use of meta-regressions. PROSPERO Registration ID: CRD42015029667. Results Out of 4098 identified records, 27 studies were included in this review of which 21 were included in meta-analyses. Psychological treatments reduced symptom load (Hedges g = −0.61), disability (Hedges g = −0.42), and school absence (Hedges g = −0.51) post-treatment in children suffering from various functional somatic symptoms. Effects were maintained at follow-up. Type and duration of symptoms, age, and treatment dose did not explain heterogeneity in effect-sizes between studies. Effect-sizes should be interpreted with caution because of the variety in outcome measures, unexplained heterogeneity in found effects and potential publication bias. Conclusions Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.
Abstract The main aim of this study was to investigate the effect of childhood sexual abuse on medically not well explained or functional somatic symptoms (FSSs) in adolescents. We hypothesized that ...sexual abuse predicts higher levels of FSSs and that anxiety and depression contribute to this relationship. In addition, we hypothesized that more severe abuse is associated with higher levels of FSSs and that sexual abuse is related to gastrointestinal FSSs in particular. This study was part of the Tracking Adolescents’ Individual Lives Survey (TRAILS): a general population cohort which started in 2001 ( N = 2,230; 50.8% girls, mean age 11.1 years). The current study uses data of 1,680 participants over four assessment waves (75% of baseline, mean duration of follow-up: 8 years). FSSs were measured by the Somatic Complaints subscale of the Youth Self-Report at all waves. Sexual abuse before the age of sixteen was assessed retrospectively with a questionnaire at T4. To test the hypotheses linear mixed models were used adjusted for age, sex, socioeconomic status, anxiety and depression. Sexual abuse predicted higher levels of FSSs after adjustment for age sex and socioeconomic status ( B = .06) and after additional adjustment for anxiety and depression ( B = .03). While sexual abuse involving physical contact significantly predicted the level of FSSs (assault; B = .08, rape; B = .05), non-contact sexual abuse was not significantly associated with FSSs ( B = .04). Sexual abuse was not a stronger predictor of gastrointestinal FSSs ( B = .06) than of all FSSs. Further research is needed to clarify possible mechanisms underlying relationship between sexual abuse and FSSs.
To determine whether self-rated health of patients with motor functional neurologic disorder (FND) can be improved by unguided Internet-based self-help and education.
In this nonblinded randomized ...controlled trial, patients were allocated 1:1 unbiased to an unguided education and self-help website in addition to usual care or usual care only. Patients over 17 years of age with a functional motor symptom that caused distress or disability were included. The primary outcome was self-rated health on the Clinical Global Improvement scale at 3 and 6 months. Secondary outcomes were severity of motor symptoms, other physical and psychiatric symptoms, physical functioning, quality of life, work and social adjustment, illness beliefs, and satisfaction with care.
A total of 186 patients were randomized, with a follow-up rate of 87% at 6 months. There was no difference in improvement of self-rated health at 3 months (44% vs 40%,
= 0.899) or 6 months (42% vs 43%,
= 0.435). Secondary outcomes did not differ between groups, with a threshold of
< 0.01. Satisfaction was high, with 86% of patients recommending the website to other patients.
We found no significant effect of the intervention added to usual care on self-rated health or secondary outcome measures, despite high patient satisfaction with the intervention. These results suggest that online education and nonguided self-help could be valuable additions to stepped care for motor FND, but are not effective treatments as interventions in their own right.
NCT02589886.
This study provides Class III evidence that for patients with motor FND, online education and self-help intervention does not significantly improve self-rated health.
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