Methods: Female primary care patients aged ≥40 years (n = 75) completed questionnaires, a clinical interview, and a blood draw. Interleukin (IL)-6 and insulin-like growth factor (IGF)-1 were assayed, using standard enzyme-linked immunosorbent assay protocols and anticytokine antibody pairs.

Results: History of sudden loss was positively associated with IL-6 (mean = 4.07 pg/mL; log₁₀ values, B = 0.314, p = .009) and negatively associated with IGF-1 (mean = 97.05 ng/mL; B = –0.277, p = .023). A linear relationship parsimoniously captured the association between ordered categories of lifetime loss (0, 1, 2–5, 5+) and increases in log₁₀ IL-6 (B = 0.107, p = .005) and decreases in IGF-1 (B = –0.116, p = .005). Adjusting for illness burden, depressive symptom severity, and obesity did not change the observed associations. The hypothesized effect of type of loss was not supported.

Conclusions: These preliminary findings encourage further investigations to elucidate pathways from sudden unexpected loss to biomarker changes that increase risk for morbidity and mortality.

Methods: We measured prospectively incident stressful and traumatic events, medication adherence, and viral load over 27 months in an eight-site, five-state study. Using multivariable logistic and generalized estimating equation modeling, we assessed the impact of incident stressful events on 27-month changes in self-reported medication adherence and virologic failure (viral load = ≥400 c/mL).

Results: Of 474 participants on antiretroviral therapy at baseline, 289 persons were interviewed and still received treatment at 27 months. Participants experiencing the median number of incident stressful events (n = 9) had over twice the predicted odds (odds ratio = 2.32) of antiretroviral medication nonadherence at follow-up compared with those with no events. Stressful events also predicted increased odds of virologic failure during follow-up (odds ratio = 1.09 per event).

Conclusions: Incident stressful events are exceedingly common in the lives of HIV-infected individuals and negatively affect antiretroviral medication adherence and treatment outcomes. Interventions to address stress and trauma are needed to improve HIV outcomes.

Methods: Participants were 158 healthy adolescents who completed self-report measures of chronic negative life stress as well as assessments of heart rate and blood pressure reactivity to acute laboratory stressors at two time points, approximately 3.3 years apart. At Time 2, intima-media thickness (IMT), a measure of subclinical atherosclerosis, was also measured.

Results: In hierarchical regression models adjusting for demographic variables and body mass index, chronic negative life stress at Time 2 was concurrently associated with greater diastolic blood pressure (DBP) reactivity to stress (β = 0.18, p = .016), but neither chronic stress nor cardiovascular reactivity was associated concurrently with IMT. Increasing life stress from Time 1 to Time 2 was accompanied by increasing cardiovascular reactivity (β = 0.14–0.20, p < .05), and increasing DBP reactivity over time was also associated with IMT (β = 0.24, p = .03), although increasing chronic life stress was not directly related to IMT.

Conclusions: Adolescents exposed to chronic, negative stressors that worsen over time may show heightened cardiovascular reactivity that puts them at risk for subclinical atherosclerosis.

Case Presentation: A 13-year-old girl with fever (>38°C) of unknown causes was referred to our department because psychogenic fever was suspected. To determine if the fever was actually induced by psychological stress, we conducted a 60-minute stress interview. Her baseline oral temperature was 36.60°C and it began to increase immediately after commencement of the interview, reaching a maximum of 37.42°C 20 minutes after the end of the interview. The plasma level of prostaglandin E₂ and the serum interleukin-6 level were increased 90 minutes after the interview. Serum levels of interleukin-1, interleukin-1β, and macrophage inflammatory protein-1 were all less than their minimum detectable level throughout the observation period. We also measured the patient's thermal preference by immersing her hands in warm (40°C) and cold (20°C) water. Her preference changed from cold to warm only during the increasing phase of oral temperature.

Conclusions: This case report shows that a stress interview actually increased Tc in a patient with psychogenic fever. This study suggests that, although pyrogenic cytokines are not involved, the stress interview-induced increase in Tc was an active hyperthermia under the control of the brain, as is infection-induced fever.

Methods: Cohorts aged 40 to 44 years (n = 2530) and 60 to 64 years (n = 2551) at baseline (Wave 1) were followed up after 4 years (Wave 2) as part of the PATH Through Life Study based in Canberra and Queanbeyan, Australia. Cross-sectional analyses evaluated rates of CVRF and LE in depressed compared with nondepressed participants. Hierarchical generalized linear models were used to evaluate demographic variables, CVRF (diabetes, smoking, alcohol, body mass index, cholesterol medication, hypertension), LE, and Wave 1 depressive symptoms as predictors of depressive symptoms at Wave 2.

Results: At baseline, those with high levels of depressive symptoms were more likely to report smoking, using cholesterol-lowering medications, hypertension, diabetes, past stroke, and higher body mass index. Predictors of depressive symptoms at Wave 2 in the cohort of 40- to 44-year-old persons included Wave 1 depressive symptoms, diabetes, and LE at Wave 2. In the cohort of 60- to 64-year-old individuals, Wave 1 depression, stroke, smoking, low education, and Wave 2 LE predicted depressive symptoms. There was no evidence of interactions between CVRF and LE.

Conclusions: LE and CVRF are independent sets of risk factors for depressive symptoms with different effects in the 40- to 44-year-old and 60- to 64-year-old cohorts. These findings have implications for preventative strategies for depression.

Methods: Self-reported somatic and cognitive-affective depressive symptoms were examined in relationship to heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and the cortisol awakening response (CAR) in 2049 preadolescents (mean age = 11.1 years; 50.7% = girls) from the Tracking Adolescents' Individual Lives Survey (TRAILS).

Results: Physiological measurements were not associated with the overall measure of depressive symptoms. Somatic depressive symptoms were negatively related to HRV and BRS, and positively to the CAR; cognitive-affective depressive symptoms were positively related to HRV and BRS, and negatively to the CAR. Associations with the CAR pertained to boys only.

Conclusions: Somatic and cognitive-affective depressive symptoms differ in their association with both cardiac autonomic and HPA axis function in preadolescents. Particularly, somatic depression symptoms may mark cardiac risk.

Methods: Community-residing women (n = 108) participated in a combined concurrent-retrospective design. Physical symptoms were assessed concurrently over 21 consecutive days followed by a retrospective assessment of the collective symptom experience for the same time period.

Results: Based on evidence of differences in cognitive processing of emotion-relevant material, we predicted and found that depressive symptomatology (at baseline) was a stronger predictor of inflated physical symptom recall than N/NA. Depressive symptomatology was also a stronger, independent predictor of concurrent physical symptoms. Notably, these results were obtained even when physical depressive symptoms in both the physical symptom checklist and the baseline depression assessment were eliminated.

Conclusions: The results suggest that the classic symptom perception hypothesis should be refined and operationalized in terms of depressive symptomatology rather than N/NA. This study demonstrates how cognitive-affective processing differences associated with depressive symptomatology can shed additional light on the psychology of symptom perception. Implications for treatment seeking, medical diagnoses, and treatment decisions are discussed.

Method: A total of 489 women completed a baseline protocol including coronary angiogram, CVD risk factor assessment, and questionnaire-based measures of depression and anxiety symptoms, using the Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI), respectively. Participants were followed for a median 5.9 years to track the prevalence of CVD events (stroke, myocardial infarction, heart failure, and CVD-related mortality). We tested the BDI x STAI interaction effect in addition to the BDI and STAI main effects.

Results: Seventy-five women (15.3% of sample) experienced a CVD event, of which 18 were deaths attributed to cardiovascular causes. Results using Cox regression indicated a significant BDI x STAI interaction effect in the prediction of CVD events (p = .02) after covariate adjustment. Simple effect analyses indicated that depression scores were significant predictors of CVD events among women with low anxiety scores (hazard ratio [HR] = 2.3 [in standard deviation units]; 95% Confidence Interval [CI] = 1.3–3.9; p = .005) but not among women with higher levels of anxiety (HR = 0.99; 95% CI = 0.70–1.4; p = .95).

Conclusion: Among women with suspected myocardial ischemia, the value of depression symptoms for predicting CVD events varied by the severity of comorbid anxiety. These results suggest that the clinical utility of depression measures may be improved by using them in combination with measures of anxiety.

Methods: In a cohort of 4117 patients with diabetes, depression was measured at baseline with the Patient Health Questionnaire-9 (PHQ-9). Patient adherence and physician intensification of treatment were measured in those who had evidence of poor disease control (HbA_1c ≥8.0%, LDL ≥130 mg/dL, systolic blood pressure ≥140 mm Hg) over this 5-year period. Poor adherence was defined as having medication refill gaps for ≥20% of days covered for medications prescribed for each of these conditions. Treatment intensification was defined as an increased medication dosage in a class, an increase in the number of medication classes, or a switch to a different class within 3-month periods before and after notation of above target levels.

Results: Among patients with diabetes and poor disease control, depression was associated with an increased likelihood of poor adherence to diabetes control medications (odds ratio [OR] = 1.98; 95% Confidence Interval [CI] = 1.31, 2.98), antihypertensives (OR = 2.06; 95% CI = 1.47, 2.88), and LDL control medications (OR = 2.43; 95% CI = 1.19, 4.97). In patients with poor disease control who were adherent to medication or not yet started on a medication, depression was not associated with differences in likelihood of physician intensification of treatment.

Conclusions: In patients with diabetes and poor disease control, depression is an important risk factor for poor patient adherence to medications, but not lack of treatment intensification by physicians.

Methods: Serum levels of xanthine oxidase (XO), inducible heat shock protein (Hsp)70, and deoxyribonucleic acid damage marker 8-OHdG were measured in 122 patients, and effects of Type D, depression, and etiology were assessed.

Results: CHF patients with Type D personality had lower levels of Hsp70 than non-Type D patients (6.48 ng/mL versus 7.85 ng/mL, p = .04, d = 0.26), and in case of an ischemic etiology, higher levels of XO (13.57 ng/mL versus 9.84 ng/mL, p = .01, d = 0.98). There were no significant univariate differences for depression. When adding depression as an additional independent variable in the Type D analysis, the effect of Type D personality remained significant (F = 5.460, p = .02) and was independent of depression (F = 0.942, p = .33). The ratio of XO to Hsp70 was significantly higher in Type D patients with CHF as compared with non-Type D patients (6.14 versus 2.83, p = .03, d = 0.39), independent of etiology class.

Conclusion: CHF patients with Type D personality are characterized by an increased oxidative stress burden, apparent in the decreased antioxidant levels and an increased oxidative stress ratio.

Methods: In total, 1012 healthy young adults from across the United Kingdom and Ireland completed the DS14, the standard index of Type D, and scores were submitted to two taxometric procedures MAMBAC and MAXCOV.

Results: Graphical representations (comparing actual with simulated data) and fit indices indicated that Type D is more accurately represented as a dimensional rather than categorical construct.

Conclusion: Type D is better represented as a dimensional construct. Implications for theory development and clinical practice with respect to Type D are examined as well as the wider use of taxometrics within psychosomatic medicine (e.g., to investigate if there are medically unexplained syndrome taxons, such as a Gulf War Syndrome taxon).

Methods: A total of 213 8th grade Hispanic adolescents with behavior problems and their primary caregivers were assigned randomly to one of two conditions: Familias Unidas or Community Control. Participants were assessed at baseline and at 6, 18, and 30 months post baseline.

Results: Results showed that, relative to a Community Control condition, Familias Unidas was efficacious in preventing or reducing externalizing disorders, preventing and reducing substance use, and in reducing unsafe sexual behavior. The effects of Familias Unidas on these outcomes were partially mediated by improvements in family functioning.

Conclusions: These findings suggest that parent-centered intervention is an efficacious strategy for preventing/reducing specific health risk behaviors in Hispanic adolescents with behavior problems.

Methods: Functional disabilities of 164 older adults were assessed over 4 years by measuring participants' problems with performing activities of daily living. The main predictors included baseline levels of diurnal cortisol secretion and control strategies used to manage physical health threats.

Results: A large increase in functional disabilities was observed among participants who secreted elevated baseline levels of cortisol and did not use health-related control strategies. By contrast, high cortisol level was not associated with increases in functional disabilities among participants who reported using these control strategies. Among participants with low cortisol level, there was a relatively smaller increase in functional disabilities over time, and the use of control strategies was not significantly associated with changes in functional disabilities.

Conclusions: The findings suggest that high cortisol level is associated with an increase in older adults' functional disabilities, but only if older adults do not engage in adaptive control strategies.

Methods: Cross sectionally, we studied various psychobehavioral characteristics of 197 inpatients with suspected allergies. At the beginning of the medical work-up, patients were interviewed and completed a set of self-rating questionnaires (Illness Perception Questionnaire-Revised, Whiteley Index-7, Cognitions About Body And Health Questionnaire, Scale for the Assessment of Illness Questionnaire, Health Attitude Survey, Reassurance Questionnaire, and Patient Health Questionnaire). Organic explicability of the presenting symptoms was assessed by allergists at the end of the work-up. Forty-eight patients with SFD were compared with 149 patients without SFD, and predictive models were set up. To control for effects of the work-up situation, we also investigated 47 patients with an established diagnosis of hymenoptera venom allergy.

Results: In the work-up group, various self-reported psychobehavioral features discriminated patients with SFD from patients without SFD. In logistic regression analysis, self-reported dissatisfaction with medical care, disease conviction, reduced symptom controllability, and reduced body scanning independently predicted SFD. A predictive model based on these psychobehavioral characteristics had high sensitivity and specificity (area under the curve = 0.86, 95% Confidence Interval = 0.79–0.93; p < .001), which was comparable to the Patient Health Questionnaire-15, an established SFD screening tool assessing somatization.

Conclusions: Psychobehavioral characteristics in patients with SFD cannot solely be attributed to the uncertainty of a work-up situation. Their predictive value is comparable to that of the traditional measuring of symptom number and severity; hence, they should be considered as SFD positive criteria in Diagnostic and Statistic Manual of Mental Disorders, 5th Edition.

Methods: Medical histories including cardiovascular, endocrine, pulmonary, and other chronic diseases were obtained from 3171 adults living in the community. They were administered the PTSD module of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and were assigned to three groups: no trauma (n = 1440); trauma, but no PTSD (n = 1669); and trauma with subsequent PTSD (n = 62).

Results: After adjustments for sociodemographic factors, smoking, body mass index, blood pressure, depression, and alcohol use disorders, subjects with trauma history had higher odds ratios (ORs) for angina pectoris and heart failure (OR = 1.2; 95% Confidence Interval [CI] = 1.1–1.3), stroke (OR = 1.2; 95 CI = 1.0–1.5), bronchitis, asthma, renal disease, and polyarthritis (ORs between 1.1and 1.3) compared with nontraumatized participants. The PTSD positive subsample had increased ORs for angina (OR = 2.4; 95% CI = 1.3–4.5), heart failure (OR = 3.4; 95% CI = 1.9–6.0), bronchitis, asthma, liver, and peripheral arterial disease (ORs, range = 2.5–3.1).

Conclusions: Our findings suggest a strong association between PTSD and cardiovascular and pulmonary diseases. Particular diagnostic and treatment attention should be paid to physical illness in PTSD positive patients in primary care, medical, and mental health settings.

Methods: Before the CPT, participants were asked to complete the Godin Leisure-Time Exercise Questionnaire, the Beck Depression Inventory, and the Anxiety Sensitivity Index. After the CPT, participants completed a modified version of the Pain Catastrophizing Scale and the Short Form-McGill Pain Questionnaire.

Results: At a high level of anxiety sensitivity, controlling for depressive symptoms, CPT immersion time, and sex differences, a bias-corrected (BC), bootstrapped confidence interval revealed that pain catastrophizing significantly mediated the relationship between self-reported weekly strenuous exercise bouts and pain response (95% BC Confidence Interval = –9.558, –0.800 with 1000 resamples). At intermediate and low levels of anxiety sensitivity, no significant mediation effects were found.

Conclusions: These findings support that, for pain catastrophizing to mediate the strenuous exercise-pain response relation, individuals must possess a high level of anxiety sensitivity.

Methods: Participants were 4240 male U.S. veterans who underwent detailed medical and psychological examinations in middle age. Psychological health was assessed by structured diagnostic interview and the clinical scales of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI includes an item on the presence of globus.

Results: The prevalence of globus was 6.4%. Men with globus had an increased risk of being diagnosed with somatization disorder, odds ratio (OR) = 5.92, 95% Confidence Interval (CI) = 3.22, 10.9l; major depression, OR = 4.98, 95% CI = 3.63, 6.67; generalized anxiety disorder, OR = 3.70, 95% CI = 2.75, 4.90; posttraumatic stress disorder, OR = 3.50, 95% CI = 2.54, 4.76; and drug abuse or dependence, OR = 1.89, 95% CI = 1.15, 3.13; and they scored significantly higher on nine of the ten MMPI clinical scales. Globus was also associated with lower cognitive ability, socioeconomic and educational disadvantage, a higher pulse rate, and increased likelihood of being on antihypertensive medication.

Conclusions: Globus is linked with a wide range of psychopathology in men, notably depression and somatization disorder. Men presenting with globus might have developed that particular symptom to "represent" other, related and treatable psychopathology, which should also be investigated.