Depressive Symptoms Linked to CAD
Depressive symptoms appear to correlate with the development of coronary artery disease, but hostility and anxiety may not, reported Jesse C. Stewart, Ph.D., and his associates.
Several studies have linked various negative emotions with the development of coronary artery disease in initially healthy subjects. But teasing out the relative contributions of depression, anxiety, and hostility has been difficult because they tend to overlap. The researchers, of the University of Pittsburgh, assessed a range of such symptoms in a prospective cohort study of subclinical atherosclerosis in healthy subjects aged 50–70 years.
The 324 subjects underwent ultrasonographic assessment of carotid intima-media thickness (IMT), a noninvasive measure of subclinical atherosclerosis, as well as a battery of tests evaluating emotional factors, including the Beck Depression Inventory, the Beck Anxiety Inventory, the Cooke-Medley Hostility Scale, and the State-Trait Anger Expression Inventory.
During 3-year follow-up, only mild to moderate depressive symptoms correlated with the decreasing carotid IMT that signals progression of subclinical atherosclerosis. Symptoms of anxiety, hostility, the experience of anger, and the expression of anger showed no correlation with carotid IMT change. This suggests depression, but not anxiety or hostility, is involved in the initiation and/or the progression of atherosclerosis. This study is the first ever to report an association between depressive symptoms and carotid IMT change, the investigators said (Arch. Gen. Psychiatry 2007;64:225–33). The exact mechanism underlying this association is unclear, but depression is known to affect physiologic pathways also involved in atherosclerosis, they said.
Grief Begins to Ease at 6 Months
The normal grief response to the natural death of a loved one seems to start declining within 6 months of the loss, said Paul K. Maciejewski, Ph.D., of Yale University, New Haven, Conn., and his associates.
“The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted,” but no study has tested progression through disbelief, anger, yearning, depression, and acceptance (JAMA 2007;297:716–23).
They assessed data from the Yale Bereavement Study, a longitudinal study of grief in a sample of 317 subjects interviewed between 2000 and 2003 within 1–6 months of the death of a spouse (84%) or adult children, parents, or siblings. The 233 subjects whose loved ones died of natural rather than traumatic causes were included.
Disbelief declined from the first month onward. Yearning rose until 4 months after the loss, then declined. Anger peaked at 5 months, and its decline was accompanied by a rise in depressive mood, which peaked at 6 months and then diminished over the next 18 months. Acceptance was noted immediately after the loss and increased steadily over the next 2 years.
All the grief indicators peaked and began to decline within 6 months, so those experiencing significant levels of these emotions beyond 6 months seem to deviate from the normal response, lending some support for the stage theory of grief.
But “counter to the stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most often endorsed item,” the authors wrote. Yearning was the most common negative psychological response reported at all time points during the 2-year follow-up, and was significantly more common than was depressed mood. Since depressed mood is the focus of the bereavement section in the DSM-IV, “these results imply a need for revision.”
Delinquent Teens at Risk for Suicide
Teenage delinquency was significantly associated with an increased risk for suicidal behavior in girls, according to data from a sample of American teens.
Previous studies have shown an association between delinquency and suicide, but none has studied the association in delinquent vs. nondelinquent youth.
Martie P. Thompson, Ph.D., and her colleagues at Clemson (S.C.) University reviewed data on 15,034 teens aged 12–17 years from the National Longitudinal Study of Adolescent Health, a survey of factors that affect teens' health and behavior (J. Adolesc. Health 2007;40:232–7).
They assessed delinquency using a 15-item survey of behaviors in the previous 12 months. After controlling for age, race, gender, and urban dwelling status, delinquent teens were significantly more likely than their nondelinquent peers to report suicidal ideation, suicide attempts, and treatment for suicide attempts at both 1 year and 7 years' follow-up. After controlling for behavioral risk factors such as depression, impulsivity, religiosity, and problem drinking, delinquency remained significantly associated with suicidal ideation 1 year later and with suicide attempts 1 and 7 years later in girls. The association for boys remained, but the differences weren't significant.