Mind and Body
Written and researched by Bob Murray, PhD
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Hostility, Depression May Boost Heart Disease
August 13, 2003
Mild to moderate levels of depression symptoms combined with feelings of hostility in healthy men may raise their levels of a protein that is associated with clogged arteries and a greater risk of heart attack, according to new research published in Psychosomatic Medicine.
The new findings suggest "the possibility that men who are hostile and exhibit depressive symptoms, even in the mild to moderate range, are at heightened risk for cardiac events," according to Edward C Suarez, PhD, of Duke University Medical Center. "Although studies have shown that hostility and depressive symptoms are associated with greater risk of heart disease, the reasons for these associations are not well understood. It is increasingly apparent, however, that inflammation in the bloodstream is linked with heart disease."
Previous studies indicate that the protein, called IL-6, is at least a marker of inflammation, and may even be involved in the inflammatory processes that cause artery thickening and buildup. However, researchers know little about IL-6's relation to psychological risk factors, Suarez says.
Suarez examined the link between depression and hostility and IL-6 levels in 90 healthy, nonsmoking men ages 18 to 45. After giving a blood sample, the participants answered two questionnaires to determine their level of depressive symptoms and hostility.
Men who scored highest on both questionnaires, indicating increased symptoms of depression and higher levels of hostility, had IL-6 levels that were two to five times higher than men who scored low on both questionnaires or scored high on only one questionnaire.
The association between the psychological factors and IL-6 held steady even after accounting for other factors associated with IL-6, such as age, body weight, cholesterol levels, and blood pressure. Suarez is currently studying the relationship between IL-6, hostility and depression in women.
Read more in Psychosomatic Medicine
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Children with Bowel Disease Prone to Emotional Problems
August 13, 2003
According to a new study, more than one-third of children with mild inflammatory bowel disease (IBD) also suffered from psychological problems, such as symptoms of anxiety and depression. What's more, parents of children with the disease reported that their children had more problems socially than did parents of healthy children, said Laura Mackner, a study co-author and an assistant professor of pediatrics at Ohio State University.
The researchers compared the psychological health of 41 children with mild IBD to 27 healthy children in the areas of body image, self-esteem and behavioral, emotional, social, school and family functioning. The children with IBD had been diagnosed at least a year before the study began.
"The strength of family relationships, along with a higher self-esteem may play more important roles than having active IBD. Children with poor family relationship and lower self-esteem may be at greater risk of developing behavioral and emotional problems, even with mild IBD."
"We thought these patients would be doing pretty well in managing all aspects of their disease, given that they had had the condition for at least a year and that they only had mild symptoms at the time of the study," Crandall said. "We were surprised to find so many with psychological issues."
Mackner reported the team's findings at the annual meeting of the American Psychological Association.
Inflammatory bowel disease is really a group of chronic intestinal disorders, and the course of the disease is often unpredictable. Symptoms result from inflammation of the bowel, and may include abdominal pain, bleeding and diarrhea. Children diagnosed with IBD are often given a combination of medications, including drugs that affect the immune system, with side effects that range from mild to severe, such as vomiting, diarrhea, rash, hair loss, pancreatitis, bone loss and decreased white blood cell counts.
According to parental reports, more than three times as many children with mild IBD had significant behavioral and emotional problems as compared to healthy children. Such problems included being withdrawn, anxious or depressed. Similarly, teachers of children with IBD reported that these students had more attention problems and were absent from school one-and-a-half times as often as healthy children.
The researchers did find that children with IBD who had stronger family relationships and higher self-esteem also had better behavioral and emotional functioning. "In this case, the strength of family relationships, along with a higher self-esteem may play more important roles than having active IBD," Mackner said. "Children with poor family relationship and lower self-esteem may be at greater risk of developing behavioral and emotional problems, even with mild IBD."
"Research on adults with IBD has shown that patients with better coping skills and less psychological distress have fewer hospitalizations and visits to the doctor's office. While medication is necessary in controlling IBD, psychosocial interventions may help improve the course of the disease," the researchers concluded.
This story is based on an Ohio State University press release. The study has not yet been published.
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People You're Ambivalent about Can Hurt Your Health
August 13, 2003
"Sometimes you make me sick!" How often have you said that about someone? Well, maybe you were right. New US research has found that our feelings for people affect out health.
A Bingham Yung University study required 102 people to wear portable blood pressure monitors for three days and press a button about five minutes into every social interaction to record their blood pressure. They kept detailed diaries and answered questions about their relationships.
Lead researcher Julianne Holt-Lunstad, an assistant professor of psychology, said mixed feelings seem to be more unsettling, at least in relation to raising blood pressure, than outright hostility. She says that some relationships can cause interpersonal stress, such as with a mother you love but who is overbearing and critical. The study is published in Health Psychology.
Read more in Health Psychology
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At Cost to Carers
July 8, 2003
Taking care of chronically ill loved ones over long periods stresses caregivers, as everyone knows, but a new study provides strong new evidence that such continuing stress boosts the risk of age-related diseases by prematurely aging caregivers' immune systems.
Levels of a damaging compound known as a proinflammatory cytokine not only increased considerably faster among those taking care of ailing spouses but also continued to increase faster for years after the spouses died.
A report on the research is in the Proceedings of the National Academy of Sciences.
"Our study examined effects of a long-term chronic stress situation on overproduction of the cytokine IL-6 in older adults," said Dr Robert MacCallum, director of the LL Thurstone Psychometric Laboratory at the University of North Carolina. "IL-6 is a substance secreted by a variety of cells in the body, including blood cells and bone marrow. Among other things, it is associated with the functioning of the immune system in its response to challenges, as well as the inflammatory response to injury and infection."
As people age, production of IL-6 tends to increase, he said. Overproduction of IL-6 has been linked to a variety of age-related conditions, including cardiovascular disease, arthritis, periodontal disease, frailty and diabetes. The study involved examining IL-6 levels in two groups of older adults over six years. One group of 119 people consisted of men and women who were caring for a spouse with dementia, usually Alzheimer's disease. The other group consisted of 106 people who were not caregivers. When they entered the investigation, subjects' average age was 70.5 years.
"Statistical analyses showed a more rapid increase in IL-6 level for the care giver group than for the non-care giver group, such that the average rate of increase was about four times greater in the care giver group," MacCallum said.
The team carried out additional analyses to learn whether the difference might be associated with other variables such as age, gender, ethnicity, depression, loneliness or health-related behaviors including smoking, exercise and sleep patterns. "We found no other variables that accounted for the group difference in rate of change in IL-6," MacCallum said.
"Overall, the study provides evidence that a severe chronic stress situation can accelerate production of IL-6, a phenomenon which has been shown to be associated with the onset and course of a variety of age-related diseases and conditions," MacCallum said. "In effect, this phenomenon represents a sort of premature aging of the immune response."
The same results would hold true, I imagine, if the caretaker was looking after a loved one with any serious disability. The solution, we believe, lies in the caretaker remembering that they must be the most important person in their lives and act as if that were so. BM
more in the Proceedings of the National Academy of Sciences
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Is Chronic Fatigue Caused by a Neurological Breakdown?
December 2, 2002
The research shows that subtle changes in a hormonal stress response system called the hypothalamus-pituitary-adrenal (HPA) axis could be a factor in chronic fatigue syndrome. The HPA axis uses three hormones to help the body remain stable during physiological and psychological stress. The hypothalamus secretes a hormone that stimulates the pituitary gland to secrete a second hormone, which then prompts the adrenal gland to produce cortisol. A problem anywhere along that chain can result in a variety of diseases, and that may include chronic fatigue syndrome, the researchers say.
People with chronic fatigue syndrome experience debilitating fatigue and may also have muscle aches, low-grade fever and sleep disturbances.
This study included about 40 people between the ages of 30 and 50. Half of them suffered from chronic fatigue and the other half were healthy. All the study participants filled out questionnaires that measured fatigue, depression and coping skills. The participants were given stress tests and then had blood, cardiovascular and saliva tests to check on their HPA axis.
The study found that people with chronic fatigue syndrome had significantly lower response levels of one of the HPA hormones called ACTH before and during the stress tests.
Read more in Psychosomatic Medicine
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Outlook Affects Bowel Disorder Patients
November 12, 2002
If sufferers believe their Irritable Bowel Syndrome (IBS) is due to an external factor, such as a virus, and that it can be controlled, they cope well. But if they believe it is caused by psychological factors, they are less likely to cope with IBS.
Researchers from the University of Kent interviewed over 200 patients with IBS. They were asked about their symptoms and what they believed about the causes and the severity of the disorder. Patients were also asked to what extent people believed their IBS could be controlled or cured, how they coped with it and how anxious or depressed they were.
It was found that those who believed it could be controlled or cured were likely to accept their IBS and have a better quality of life. But those who thought IBS was a very serious illness with potentially serious consequences suffered more anxiety and depression (this may not be a surprise -- BM). They also had a lower quality of life.
But Drs Claire and Derek Rutter, who carried out the research, said these people were more likely to try to avoid thinking about, or dealing with, their IBS, which meant they were likely to fare less well. They said therapy may help IBS patients to feel better.
Writing in the British Journal of Health Psychology, they said: "The effectiveness of psychological therapy for IBS patients may improve if therapists challenge patients' perceptions of serious consequences and may offer alternatives to behavioral disengagement. "Therapists might also try to increase control beliefs and acceptance of the illness."
IBS varies between patients, but it usually includes cramping discomfort, a feeling of fullness or bloating, constipation and diarrhoea. Women are affected more than men. Sufferers often desperately need to go to the toilet with little warning, which severely limits their lifestyle. No-one knows what causes the condition, although it is suggested that stress can make it worse.
I find it interesting that people believe that an illness with a viral cause is more susceptible to cure than that with an emotional cause. What does this say about the reputation and, in some instances, the success, of psychotherapy? AF
Read more in the British Journal of Health Psychology
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Chronic Stress Can Interfere with Immune System
November 12, 2002
Chronic stress not only makes people more vulnerable to catching illnesses but can also impair their immune system's ability to respond to its own anti-inflammatory signals that are triggered by certain hormones, say researchers, possibly altering the course of an inflammatory disease. This finding is reported on in the November/December '02 issue of Health Psychology.
Chronic stress seems to impair the immune system's capacity to respond to glucocorticoid hormones that normally are responsible for terminating an inflammatory response following infection and/or injury, according to researchers Gregory E Miller, PhD, of Washington University, and colleagues.
To examine what happens to people's immune systems during on-going stressful situations, the researchers compared 25 healthy parents with children undergoing treatment for pediatric cancer with 25 healthy parents with healthy children on measures of mental health, effects of social support and certain immune system responses. All the parents had blood drawn at the initial session and salivary cortisol samples taken at intermittent times over two days.
Parents of cancer patients reported more psychological distress than parents with healthy children, according to the study. The parents of cancer patients also were found to have diminished glucocorticoid sensitivity compared to parents of medically healthy children. This hormone is responsible for turning off the in vitro production of the pro-inflammatory cytokines interleukin-1B, interleukin-6 and tumor necrosis factor, said Dr Miller.
The good news found by the researchers was that social support lessened the immunologic consequences of caring for a child with cancer, perhaps by helping the parents deal with the economic, work and family disruptions caused by the disease and its treatment. "These findings suggest a novel mechanism through which psychological stress could influence the onset and/or progression of conditions that involve excessive inflammation, like allergic, autoimmune, cardiovascular, infectious and rheumatologic illnesses," says Dr Miller.
But even though the cancer patient parents reported more depressive symptoms, depression does not seem to operate as a mediator. It may be that anxiety, intrusive thoughts, feelings of helplessness or lack of sleep may be influencing the stress-related reductions in glucocorticoid sensitivity.
Reported in the Nov/Dec '02 issue of Health Psychology
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Boosting Activity Helps Substance Abusers Stick with Treatment
September 4, 2002
Previous research has repeatedly shown that participants who stick with their treatment programs for the longest times are most likely to recover and not relapse, explains lead author Carolynn Kohn, PhD, of the Kaiser Permanente Division of Research. Prior research also has shown that people whose basic approach to coping with problems is tackling them, not avoiding them, are most likely to succeed in treatment.
The researchers note that the study also provides evidence for a link between emotional outbursts and a higher risk of dropping out of treatment, as well as lower risk for patients who engage in rewarding activities that do not involve chemical use.
To determine which specific coping strategies might predict longer -- and therefore more successful -- participation in treatment, Kohn and her colleagues followed 747 adults admitted to an outpatient chemical dependence treatment program. The program consisted of eight weeks of treatment, followed by 10 months of aftercare.
Each participant completed a questionnaire upon admission to treatment that measured reliance on different "approach" and "avoidance" coping strategies. The "approach" strategies included such tactics as attempting to better understand the problem and dealing with it directly. The "avoidance" strategies included avoiding thinking about the problem, becoming involved in substitute activities that provide satisfaction and reducing tension by inappropriately venting negative feelings.
The researchers' findings, reported in Alcoholism: Clinical and Experimental Research, confirm that at least one avoidance behavior may be a risk factor for dropping out of treatment. Participants who relied most heavily on emotional discharge, they found, also tended to leave the treatment program earliest.
Extreme emotional expressions were more common among women than men. However, the investigators note, this appeared to be the result not of gender, but of the greater severity of depression and drug use problems among the women. Also, women sought support from others -- an "approach" strategy -- more often than men did. A more surprising finding, the investigators report, is their observation that seeking alternative rewards was linked to a longer and potentially more productive stay in treatment. This result, according to Kohn, suggests that this avoidance tactic may actually be productive among chemical users.
This interpretation, she adds, is supported by previous findings that chemical users are less likely than the general population to engage in leisure and social activities that are not related to alcohol or drug use. "This study provides evidence for identifying and decreasing the use of
emotional discharge early on in treatment, possibly through the use of intervention strategies such as anger management," the investigators conclude.
At the same time, they note, the results underscore "the importance of clinicians assisting clients in identifying and engaging in new, sober activities," starting early in treatment.
Read more in Alcoholism: Clinical and Experimental Research
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Negative Stereotypes About Aging May Shorten Your Life
Even if we are not aware of them, negative thoughts about aging that we pick up from society may be cutting years off our lives, according to Becca Levy, PhD, the lead researcher of a study conducted at Yale University's Department of Epidemiology and Public Health.
The study found that older people with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. The findings appear in the August issue of the Journal of Personality and Social Psychology.
The 7.5 year higher longevity for those with the more positive attitudes toward aging remained even after other factors were taken into account, including age, gender, socioeconomic status, loneliness and overall health. "The effect of more positive self-perceptions of aging on survival is greater than the physiological measures of low systolic blood pressure and cholesterol, each of which is associated with a longer life span of four years or less," said the study authors. "It is also greater than the independent contributions of lower body mass index, no history of smoking, and a tendency to exercise, each of these factors has been found to contribute between one and three years of added life."
Using information from 660 participants aged 50 and older from a small town in Ohio who were part of the Ohio Longitudinal Study of Aging and Retirement, Dr Levy and her co-authors compared mortality rates to responses made 23 years earlier by the participants (338 men and 322 women). The responses included agreeing or disagreeing with such statements as "As you get older, you are less useful."
In the same study, the researchers also find that the will to live partially accounts for the relationship between positive self-perceptions of aging and survival, but does not completely account for difference in longevity. Another factor likely involved, according to the researchers, is cardiovascular response to stress, which Dr Levy's earlier research has shown can be adversely affected when elderly persons are exposed to negative stereotypes of aging.
These negative views of aging can operate without older people's awareness, say the researchers, because they are thought to be internalized in childhood and unlikely to be consciously evaluated as we get older.
"Our study carries two messages. The discouraging one is that negative self-perceptions can diminish life expectancy; the encouraging one is that positive self-perceptions can prolong life expectancy," say the authors.
Read more in Journal of Personality and Social Psychology
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Pets Boost Children's Immune System
June 24, 2002
Researchers at Warwick University in Coventry found that having a cat or dog exposed children to more infections early in life. However, this exposure boosted their immune systems in the medium term and meant these children attended school more often, on average, than pupils who did not have pets.
The authors said the benefits were most pronounced in children aged between five and eight. Dr June McNicholas and colleagues tested the saliva of 138 children for the antibody immunoglobulin A (IgA), which is used as an indicator of immune system strength. High levels of IgA suggest that the immune system is under strain while low levels show that it is vulnerable to infection.
The study showed that antibody levels among pet-owning children were significantly more stable, indicating that they had robust immune systems. Pet-owning children were found to have an extra nine days at school over the course of the year compared to those without animals. According to the researchers, the findings appear to support the so-called "dirty hypothesis," which suggests that too much cleanliness early in life can leave the immune system weakened later on. It has been linked to soaring rates of childhood asthma in recent years.
Dr McNicholas, a health psychologist who led the study, said: "Pet ownership was significantly associated with better school attendance rates. This was apparent across all classes, but was most pronounced in the lower school (classes one to three, aged groups five to eight). Here, the pet owners benefited from up to 18 extra half days schooling per annum than their non-pet owning counterparts."
Workplace & Healthcare Pets in Demand
Separately, an office pet such as a hamster or a parrot would make people more productive, a poll of workers suggests. Employees said a little bird or animal would also create a happier atmosphere at work. They also said that they would be more productive. The same poll said that people didn't like open plan offices and that a cappuccino machine should replace the traditional coffee facilities.
Other recent studies have shown that pet ownership helps the elderly to live longer, more healthy lives, can help people recover from strokes and are better for emotional health than most forms of psychotherapy. It is for this reason that one Australian State, New South Wales, enacted a law saying that pet ownership in apartment complexes cannot reasonably be denied (though most still try to enforce the no-pet rule).
Specifically researchers at Cambridge University Veterinary School in England are awaiting funding to test the viability of what they call "dognosis" -- detecting the traces of prostate cancer by training dogs to smell signatures of the disease in urine samples. Other studies have shown that dogs can detect cancers 100% of the time and are much more accurate than the most advanced screening devices.
Past cases led the Cambridge researchers to think dogs would be up to the task. As detailed in the British medical journal The Lancet in 1989, a Border Collie-Doberman mix belonging to a British woman repeatedly sniffed a mole on its owner's thigh and once even tried to bite it off. The constant attention prompted the woman to have the lesion examined and she learned it was a malignant melanoma.
"The dog may have saved her life by forcing her to seek medical advice while the mole was still at a thin stage," wrote Hywell Williams and Andrew Pembroke, surgeons at the dermatology department at King's College Hospital in London, in a letter to The Lancet.
In another case, a pet Labrador named Parker repeatedly pushed his nose against his 66-year-old owner's leg, sniffing a lesion through the owner's pants. When the man had the lesion examined, he learned it was a basal cell carcinoma, a form of skin cancer, and had it removed. Neither dogs showed any interest in their owners' lesions after they were treated.
And yet we regularly abandon, mistreat and put down these wonderful health practitioners! Hominids such as ourselves have lived and worked with animals for over 2.5 million years, no wonder our systems are geared to their presence. Their absence adds to our stress levels, our depression rates and to our overused and declining health services. BM
Read more in BBC News
Read more in ABC News
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About the Author
Dr Bob Murray is a widely published psychologist and expert on emotional health and optimal relationships. Together with his wife and long-term collaborator Alicia Fortinberry, he is founder of the highly successful Uplift Program, and author of Raising an Optimistic Child (McGraw-Hill, 2006) and Creating Optimism (McGraw-Hill, 2004).
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