Pharmacological treatment of depression is an important topic in people with type 2 diabetes because depressive symptoms interfere with quality of life and increase the risk of diabetes-related complications and premature mortality. Tharmaraja et al. conducted a systematic review and meta-analysis to test whether selective serotonin reuptake inhibitors (SSRIs) are associated with change in glycemia after treatment. Fluoxetine and escitalopram/citalopram, but not paroxetine, were associated with significant improvement in glycemia. This suggests that short-term use of SSRIs is safe and may improve glycemic control. Adequately powered clinical trials are needed to confirm the findings.
In an accompanying editorial comment, Dr. Lawson Wulsin notes that previous cross-sectional studies have reported adverse effects of SSRIs on glycemic control, and that the new meta-analysis published in this issue of Psychosomatic Medicine provides new insights on this topic, indicating beneficial effects of SSRIs. Meta-analysis in biobehavioral medicine offers certain advantages in analyzing such data. He discusses the importance of the study designs on which meta-analyses are based. The article concludes with an outline for future research directions in the area of SSRIs and glycemic control.
The Clinical Applications series in this issue of the journal presents a review by Doering et al. of the epidemiology and treatment of borderline personality disorder (BPD) with a focus on somatic illness. Patients with BPD are frequent users of health care services. Because of comorbidities and a range of behavioral and interpersonal challenges, patients with BPD are often regarded as difficult to treat optimally. Health care could be substantially improved if health care providers would become more familiar with BPD, its pathology, medical and psychiatric comorbidities, complications, and the available validated treatments.
Positive psychology interventions involve systematic completion of activities designed to promote well-being. In a meta-analysis, Brown et al. examined positive psychology interventions in reducing anxiety in medical patients. Results showed that these interventions were helpful, with a small-to-medium effect size. Given that illness is a common source of anxiety for many patients, positive psychology interventions may exert anxiolytic effects in medical populations.
Cognitive perseveration (for example, worry, rumination) maintains perceived stress and may increase blood pressure (BP). Using data from a large ambulatory monitoring study, Birk et al. examined momentary associations among the duration of perseverative episodes, perceived stress, and BP. Although perseveration duration did not show strong associations with BP, higher perceived stress mediated its associations with both higher systolic and diastolic BP, suggesting that more time spent in perseverative mental activity may have adverse cardiovascular effects.
Mindfulness-based interventions (MBIs) target novel pain relief mechanisms, but there is a need for improved pain assessment tools. Hanley et al. built a digital sensation manikin by overlaying a human figure silhouette with a grid of 469 marked sensation areas. Use of the sensation manikin showed expected relationships with multiple measures of pain and well-being, pain interference, and a significant association with pain attentional bias. MBI involvement increased the ratio of reported pleasant to unpleasant sensations. This study supports the validity of the digital sensation manikin and indicates that assessing both pleasant and unpleasant sensations broadens the scope of pain measurement.
Duncan et al. examined the association between experiencing sexual abuse during childhood and then having medically unexplained symptoms as an adult. Severe childhood sexual abuse involving attempted or completed sexual penetration was strongly associated with medically unexplained symptoms. This association appeared specific and was not confounded by general childhood adversity, intervening mental health, family, or individual characteristics. The strength and specificity of this association has clinical implications for the prevention and treatment of medically unexplained symptoms.
In examining the psychological vulnerabilities of people with disorders or differences of sexual development (DSD), de Vries et al. found clinical cut-off symptoms of anxiety in 19.5% of participants, depression in 7.1%, attention deficit hyperactivity disorder in 4.1%, and autism in 9.1%. Symptoms were associated with self-esteem, satisfaction with care, body dissatisfaction, and experiences of shame, which deserve specific attention in DSD care.
Fine particle air pollution (particulate matter smaller than 2.5 μm in diameter; PM2.5) is linked to adolescent pathophysiology. The implications of PM2.5 for physiological reactivity to social stress, however, are not known. In a sample of adolescents, Miller et al. found that higher neighborhood-level concentrations of PM2.5 were associated with greater autonomic reactivity to a social stress test. Adolescents who experienced more severe symptoms of anxiety and depression appeared to be particularly vulnerable to the effects of PM2.5 on stress reactivity.
Dialysis patients have a high prevalence of depressive symptoms, which are associated with adverse clinical outcomes. Schouten et al. identified two factors (general and somatic symptom) characterizing dimensions of depression. All symptom dimensions showed an association with a higher hospitalization rate and a reduced quality of life. Only the somatic symptom dimension showed an association with all-cause mortality. Unraveling specific dimensions of depressive symptoms may help to improve screening and treatment of patients undergoing dialysis.
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Chronic experience of stress can lead to allostatic load, which is the dysregulation of interrelated physiological systems. Experience of unfair treatment is a stressor that disproportionately affects Puerto Ricans living in the United States. Cuevas et al. found that exposure to major lifetime events of unfair treatment was associated with greater allostatic load. Prevention and intervention efforts aimed at reducing health disparities among Puerto Ricans should consider unfair treatment as an important risk factor for adverse health outcomes.
Older adults are among the most frequent users of emergency departments. Among the most common presentations are complaints of non-specific symptoms. Interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) are inflammation markers that are associated with chronic stress and non-specific physical symptoms. Mausbach et al. studied risks for emergency department admission among dementia caregivers. Caregivers with IL-6 levels above the 80th percentile who were experiencing high caregiving demands were at highest risk of an emergency department visit. Interventions that modify inflammation markers may be useful in preventing costly and detrimental outcomes for adults under stress.