Perseverative Cognition, Psychopathology, and Somatic Health

Stressful life events and leucocyte telomere length: Do lifestyle factors, somatic and mental health, or low grade inflammation mediate this relationship? Results from a cohort of Danish men born in 1953

Introduction Impairment in affect regulation continues even after remission from depression. However, little is known about whether difficulties in affect regulation persist or improve as time in remission grows and how they manifest in everyday life. With the aim of addressing this gap, we hypothesized that greater time in remission would correspond with more positive affect and perceived regulatory success, and with less negative affect, perseverative cognition, and momentary impulsivity. An exploratory aim was to determine whether executive dysfunction would mediate relationships between time in remission and regulatory outcomes. Method A sample of 42 young adults with remitted major depressive disorder completed ecological momentary assessments, which included measures of positive and negative affect, perseverative cognition (rumination and worry), perceived regulatory success, and momentary impulsivity multiple times per day across the assessment period. Each person’s mean level and variability of these constructs was computed and time in remission was calculated using a semi-structured clinical interview. Results Regression analyses indicated that a shorter time in remission predicted higher levels of negative affect, perseverative cognition, and momentary impulsivity and less perceived success with regulating affect in everyday life (ps < .05). Shorter time in remission also predicted more variability in perseverative cognition and positive and negative affect. Discussion Although cognitive-affective processes often are conceptualized as traits, our data indicate that these measures are dynamic, fluctuating across the course of a week. Several of these processes also appear to attenuate and stabilize as depressive episodes become more distal. These findings have important clinical implications, suggesting that remitted individuals may continue to benefit from interventions to reduce impulsive and perseverative cognitive-behavioral patterns and improve regulation success and affective stability. Interventions may have particular utility earlier in remission when these skills may be more impaired, with the goal of restoring functioning and reducing the likelihood of relapse.

FREDERICK O. LORENZ, RONALD L. SIMONS, AND RAND D. CONGER Iowa State University GLEN H. ELDER, JR. University of North Carolins* CHRISTINE JOHNSON AND WEI CHAO Iowa State University** We examined the relationship between divorce and psychological distress in adult women by combining data from two studies, one of divorced mothers with adolescent children (n = 188) and another of married mothers (n = 306). The data were modeled using latent growth curves to chart change over time. Change in depressive symptoms paralleled changes in stressful events. For divorced mothers, stressful events and depressive symptoms increased significantly soon after the divorce and then diminished over the next 3 years, although not to the same levels reported by married women, The data were consistent with a proposed model that incorporated aspects of both the social causation and the selection perspectives. Key Words: depressive symptoms, divorce, latent growth curves, panel studies, stressful events. The dramatic increase in divorce rates in the United States is well documented. Current estimates project that at least half of recent first marriages will end in divorce (Bumpass, 1990). Despite its frequency and growing acceptance, divorce is still a traumatic life change; single parents have higher rates of both emotional and physical health problems than their married counterparts (Amato & Keith, 1991; Bachrach, 1975; Kitson, 1992; Tschann, Johnston, & Wallerstein, 1989). In this article, we examine the relationship between divorce and psychological distress by introducing stressful life events as a mediating link between family structure and depressive symptoms in women. This study is conducted by combining data from two three-wave panel studies, one of recently divorced mothers with adolescent children and another of a parallel sample of married mothers. Although several earlier studies have used panel data (see Kitson, 1992, pp. 24-25), this combined data set permits us to extend previous research in specific methodological and substantive ways. Methodologically, we extend previous panel studies on divorce and distress by using latent growth curves to explicitly model intra-individual change in psychological distress and stressful life events in recently divorced mothers, and we then compare their trajectories of change with those of the parallel sample of married mothers. Substantively, we draw on traditional research of family stress (McCubbin & Patterson, 1983) and the stress-distress process (Coyne & Downey, 1991; Kessler, Price, & Wortman, 1985; Mirowsky & Ross, 1989; Pearlin, 1989) to conceive of divorce as a primary stressor that makes women susceptible to an array of stressful life events. These events accumulate quickly following divorce and then subside over time. Changes in depressive symptoms parallel changes in stressful events. To accommodate the competing argument that some people experience more stressful events and higher levels of depressive symptoms because of past behavior problems and that these people are more likely to be among the divorced, we also incorporate measures of antisocial behavior into our model. Taken together, the mother's family structure and past antisocial behavior capture aspects of two competing perspectives: Social causation asserts that divorce creates conditions that make women susceptible to more stressful life events (e.g., Turner, Wheaton, & Lloyd, 1995) and, therefore, higher levels of distress; selection claims that women with a history of antisocial behavior are likely to experience more stressful events, become depressed, and are more likely to be among the divorced (e.g., Patterson & Dishion, 1988). THEORETICAL MODEL The connection between family structure and psychological distress is based on the empirical observation that both divorced men and women are more depressed than their married counterparts. …

There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer 2 major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by 2 independent reviewers. Five hundred fifty-seven unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n = 36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n = 15, 21.4%), extraction of events from free-text notes (n = 12, 17.1%), discussing privacy and other issues of storing life events (n = 5, 7.1%), and new EHR features related to life events (n = 4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n = 7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n = 7, 46.7%) were discussing interventions related to social determinants of health in general. Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.

Objective.Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer two major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care.Materials and Methods.Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by two independent reviewers.Results.557 unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n=36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n=15, 21.4%), extraction of events from free-text notes (n=12, 17.1%), discussing privacy and other issues of storing life events (n=5, 7.1%), and new EHR features related to life events (n=4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n=7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n=7, 46.7%) were discussing interventions related to social determinants of health in general.Discussion and Conclusions.Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.

To evaluate the added value of somatic screening for patients with severe mental illness over regular care. We compared the information on somatic health problems collected by screening with the general practitioner (GP) files (n = 118). The mean number of somatic health problems detected with somatic health screening was significantly higher than those noted in GP records (p < .01). Somatic health screening is an addition to the care provided by the GP. Advanced mental health nurses can play a key role in somatic health screening and initiating further cooperation and communication of GP and mental health care.

Older adults are receiving increased attention in gambling research, in part because gambling and related problems appear to be increasing in this population. To date, little or no research has examined the complexities of gambling and later-life circumstances, including life events, andindividual and social factors. This study utilized longitudinal data (5 waves) from older adults (60 + ; N = 670) in the Quinte Longitudinal Study (Williams et al., in: The Quinte longitudinal study of gambling and problem gambling 2006-2011, Bay of Quinte region, Ontario, 2014). Longitudinal multilevel models examined between- and within-person effects of stressful life events on gambling frequency and Problem Gambling Severity Index (PGSI) scores, and the possible moderating role of individual (age, gender, mental health, physical health) and social variables (marital status, social support) on this relationship. Results of the final model showed significant effects (p < .01) for linear time (PGSI scores declined across waves; β = - .06); gender (women's mean PGSI greater than men's; γ = .26); social support (less support associated with greater PGSI; γ = .05); and an interaction between age and stressful life events (effect of stressful events on PGSI is lesser with greater age; γ = - .02). Simple slopes (at mean age of 66 at wave 1, and ± 1SD) showed that at 61 (γ = .35) and 66years (γ = .23), mean PGSI scores were greater with each additional stressful life event; there was no significant effect for stressful events at age 71. These findings suggest women, those with less social support, and greater stressful life events may be at greater risk of problem gambling, while greater age weakens the effect of stressful events and problem gambling.

Psychological stress is a major risk factor for cardiovascular diseases. While the relevance of early life stress, such as that which is due to child maltreatment (CM), is well known to impact individual stress responses in the long-term, and data on the interplay between CM and stressful events in adulthood on cardiovascular health are sparse. Here, we aimed to assess how stressful life events in adulthood are associated with cardiovascular health infarction in later life and whether this association is independent of CM. In a cross-sectional design, a probability sample of the German population above the age of 14 was drawn using different sampling steps. The final sample included 2510 persons (53.3% women, mean age: 48.4 years). Participants were asked about sociodemographic factors, adult life events, CM, and health conditions in adulthood. Results indicate that the number of experienced adverse life events in adulthood is associated with significantly increased odds for obesity (Odds Ration (OR)women = 1.6 [1.3; 2.0], ORmen = 1.4 [1.1; 1.9]), diabetes (ORwomen = 1.5 [1.1; 2.1], ORmen = 1.5 [1.1; 2.3]) and myocardial infarction (ORwomen = 2.1 [1.0; 4.3], ORmen = 1.8 [1.1; 2.8]). This association is not moderated by the experience of CM, which is associated with cardiovascular problems independently. Taken together, adult stressful life events and CM are significantly and independently associated with cardiovascular health in men and women in the German population in a dose-dependent manner. General practitioners, cardiologists and health policy-makers should be aware of this association between psychosocial stressors during childhood and adulthood and cardiovascular health.

Individuals with borderline personality disorder (BPD) often experience stressful life events at a higher frequency than those without BPD. It is less clear what specific types of events are involved in this effect, and it has not been determined whether some features of BPD are more important than others in accounting for this effect. The latter issue is important in light of the heterogeneous nature of this diagnostic construct. These issues were examined in a large, representative community sample of men and women, ages 55-64. Ten Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR, Washington, DC, American Psychiatric Association, 2000) personality disorders were assessed at baseline using the Structured Interview for DSM-IV Personality: SIDP-IV (B. Pfohl, N. Blum, & M. Zimmerman, 1997, Washington, DC, American Psychiatric Press). Life events were measured at three sequential assessments following baseline at 6-month (N = 1,294), 12-month (N = 1,070), and 18-month (N = 837) follow-ups. Stressful life events were identified using a self-report questionnaire (LTE-Q; List of Threatening Experiences Questionnaire: A subset of prescribed life events with considerable long-term contextual threat by T. Brugha, C. Bebbington, P. Tennant, and J. Hurry, 1985, Psychological Medicine, Vol. 15, pp. 189-194.) followed by a telephone interview. Only borderline personality pathology was related to an increase in the frequency of interpersonal stressful life events. Three specific symptoms of BPD were largely responsible for this connection: unstable interpersonal relationships, impulsivity, and chronic feelings of emptiness (negative association). Symptoms of avoidant and schizoid personality disorders were associated with a reduced number of stressful life events that are considered to be outside a person's control (e.g., serious illness, injury, or death of a loved one). None of the personality disorders predicted an increase in the number of stressful financial events (e.g., major financial crisis). These findings suggest that, as individuals approach later life, certain features of BPD continue to serve as important risk factors for stressful life events of an interpersonal nature.

Normothymic states in bipolar disorders are generally considered to be devoid of severe symptoms. However, bipolar patients present subsyndromal symptoms for half of their lives, and often have comorbid psychiatric disorders. If we go beyond the concept of temperamental features, can we identify certain emotional characteristics distinguishing normothymic bipolar patients from normal controls? We previously showed, using self-completed questionnaires, that normothymic bipolar patients display higher levels of emotional lability and intensity than controls. The aim of this study was to assess the emotional reactivity of normothymic bipolar patients, comparing such patients with a normal control group during an experimental mood induction procedure. We evaluated the subjective emotional reactivity of 145 subjects (90 control subjects and 55 normothymic bipolar patients), using an emotional induction method based on the viewing of a set of 18 pictures (6 positive, 6 negative, 6 neutral) extracted from the International Affective Picture System. Subjective valence and arousal were recorded with the Self-Assessment Manikin. We also recorded startle reflexes, triggered by a tone occurring during the viewing of two-thirds of the pictures. We controlled for confounding factors, such as concurrent treatments, in all analyses. Normothymic bipolar patients and normal controls assessed valence and arousal similarly for positive and negative images. However, neutral images were considered more pleasant [F(1,143) = 8.4; p = 0.004] and induced a higher level of arousal [F(1,143) = 12.3; p = 0.001] in normothymic bipolar patients than in control subjects. Neutral pictures also triggered a stronger startle reflex in normothymic bipolar patients compared to controls [F(3,123) = 3.1; p = 0.03]. Normothymic bipolar patients displayed emotional hyper-reactivity, mostly evidenced in neutral situations. This feature may be linked to emotional dysregulation and is a potential endophenotype and/or a risk factor for bipolar disorders. This trait may be responsible for vulnerability to minor stressful events in everyday life. These findings have potential implications for the daily management of bipolar disorder between crises.

BackgroundA subset of persons with mild traumatic brain injury (mTBI) experience long-term difficulties. Preinjury stress has been hypothesised to play a role in long-term maintenance of symptoms.ObjectiveTo investigate the predictive...

BackgroundResearch highlighted that Stressful Life Events have high incidence among infertile patients and significant impact on physical and medical parameters related to reproductive functions, but their potential role among factors influencing the infertile patients’ perception of fertility-related Quality of Life (QoL) has not been explored. The present study aims to investigate the associations of Stressful Life Events (Stressful events in the family of origin, In family pre-existing pregnancy difficulties, Health problems in childhood) with perceived fertility-related QoL in women attending infertility treatments, examining the potential moderating role of adopted coping strategies and perceived couple’s dyadic adjustment.MethodsA questionnaire consisting of Socio-demographics and Infertility-related characteristics, Stress-inducing events in the couples’ lives Questionnaire (FLS), Coping Orientations to Problem Experienced (COPE), Dyadic Adjustment Scale (DAS), and Core and Treatment subscales of Fertility Quality of Life (FertiQoL) was administered to 266 women attending infertility treatments. A descriptive correlational design with cross-sectional comparison was used. Results Logistic Regression Analyses after adjusting for socio-demographic and infertility-related characteristics revealed that women who reported Stressful events in the family of origin and In family pre-existing pregnancy difficulties were more likely to report lower levels of perceived Core QoL, while women who reported Health problems in childhood were more likely to report lower levels of perceived Treatment QoL. Couple’s dyadic adjustment and specific coping strategies were significantly associated with perceived Core and Treatment QoL and they also significantly moderated the associations between stressful life events and perceived QoL.ConclusionsData provided original evidence on the strong association between stressful life events and perceived fertility-related QoL also highlighting individual and couples’ resources to define counselling interventions with women attending infertility treatments.

Prenatal maternal stress has been linked to multiple adverse outcomes. Researchers have used a variety of methods to assess maternal stress. The purpose of this study was to explore and compare factors associated with stress in pregnancy as measured by perceived stress and stressful life events. We analyzed data from the Canadian Maternity Experiences Survey. A randomly selected sample of 8,542 women who had recently given birth was drawn from the 2006 Canadian Census. Women were eligible if they were at least 15 years of age, had delivered a live, singleton infant, and were living with their infant at the time of the interview (5-14 months postpartum). Prevalence estimates and odds ratios were calculated using sample weights of the survey and their variances were calculated using bootstrapping methods. Bivariate analyses identified statistically significant factors associated with each stress measure. Backward stepwise multivariate logistic regression models were constructed. A total of 6,421 women (78%) participated in the computer assisted telephone interview. Twelve percent of women experienced high levels of perceived stress and 17.1% reported having three or more stressful life events in the year prior to the birth of their baby. In the final model, psychosocial variables were associated with both outcomes, whereas demographic factors were associated only with life event stress. Different factors contributed to perceived stress and life event stress, suggesting that these concepts measure different aspects of stress. These findings can inform routine psychosocial risk assessment in pregnancy.

Perceived life events and presentation of depression symptoms: An examination of the pathoplasticity model.