Myocardial infarction is associated with an excess risk of mortality and major long-term adverse health outcomes. However, many individuals have “unrecognized myocardial infarction.” In a sample of over 125,000 participants, Iozzia et al. investigated associations of recognized myocardial infarction (RMI) and unrecognized MI (UMI) with depressive and anxiety disorders. Participants with RMI (N=1,068) had greater odds of having depressive and/or anxiety disorders as compared to participants without MI. Participants with UMI (N=346) did not differ from participants without MI. After adjustment for somatic comorbidities and low physical health-related quality of life, the association between RMI with depressive disorder was no longer significant, but the association with anxiety disorder remained. Recognition of MI appears to play a major role in the occurrence psychological problems, particularly anxiety disorders.
Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in clinical practice. Anxiety is often present among patients diagnosed with AF and has been linked to worse symptoms and quality of life. A study by García-Izquierdo et al. indicated that higher levels of trait anxiety, along with left atrial enlargement, can predict early AF recurrence after cardioversion. This study shows that more research is needed to assess the beneficial effects of anxiety-reducing strategies on clinical outcomes in patients with AF.
Methodological issues are key in cutting-edge biobehavioral research. In studies of physiologic measures, such as cortisol profiles, small sample sizes and “noisy” measurement may result in problems related to reliability and validity. With small effect sizes and high variability in the data points, study results sometimes may show statistically significant, yet spurious relationships – a misestimation of the true effect size. In a simulation study, Segerstrom and Boggero used real designs from cortisol awakening response studies to investigate the probability that the design would result in misestimation in a simple regression (beta weights too low or too high). The average probability of an effect being in the wrong direction was around 20%, with some designs reaching 40%; misestimation probabilities were around 40%, with some designs reaching 80%. The article provides suggestions for improving estimation accuracy.
A history of experiencing adversity during childhood has been associated with elevated blood pressure during adulthood. This association, however, has received little scientific attention in pregnant women. In a study of 127 pregnant women, Bublitz et al. found that women with histories of childhood adversity exhibited higher nighttime blood pressure and loss of blood pressure dipping. Associations were independent of effects of prenatal stress. More research is needed to determine if pregnant women who experienced greater adversity in childhood are at risk for cardiovascular complications.
Positive mental health may have positive effects on cardiometabolic health in young individuals. Thumann et al. studied psychophysiological) and behavioral pathways from psychosocial well-being to cardiometabolic markers. Higher psychosocial well-being was found to be associated with lower waist circumference, lower insulin resistance, and higher high-density lipoprotein cholesterol. Further, results were in line with the hypothesis that a healthy lifestyle may serve as an underlying mechanism linking higher psychosocial well-being with better cardio-metabolic health profiles.
Psychosocial factors that promote and preserve a favorable cardiovascular health profile are understudied. A variety of factors are associated with lower risk for developing cardiovascular disease, including healthy blood pressure, lipid levels, body mass index, and being a nonsmoker and free of diabetes. Boehm et al. investigated whether optimism was associated with better cardiovascular health across 10 years. Baseline optimism was associated with favorable cardiovascular health, but other factors may relate to how slowly or quickly cardiovascular health deteriorates over time.
Amenorrhea is a disabling medical consequence of anorexia nervosa (AN). Resumption of menses (ROM) represents an important goal in the treatment of these patients. Castellini et al. evaluated possible clinical, psychopathological, and biological predictors of ROM, including age, body mass index (BMI), AN subtype, childhood abuse, duration of illness, and general and eating disorder–specific psychopathology. Time to ROM, BMI at last evaluation, and data regarding diagnostic cross-over into bulimia nervosa were collected. Time-to-event analysis showed that a shorter duration of illness, binge-eating/purging subtype, and history of childhood abuse, were associated with an earlier ROM.
People with chronic vestibular diseases experience variable degrees of disability. Longitudinal data examining the predictive validity of relevant clinical variables alongside psychological variables are limited. In a study by Herdman et al., patients completed standardized questionnaires on mood, cognitive, behavioral, and dizziness-related limitations before and 3 months after their initial consultation and diagnosis. There were significant improvements in limitations, depression, and anxiety at 3 months. Most baseline psychological variables significantly correlated with dizziness-related limitations at 3 months.
Ye et al. showed that individual variation in pain sensitivity relates to implicit negative bias toward pain. This linkage is partially accounted for by the neurophysiological response that has been related to the cognitive process of stimulus evaluation and categorization. Beyond highlighting the role of implicit pain-related cognition on individual variance in the experience of pain, the findings also suggest the potential benefits for multi-modal pain treatment by including techniques that intervene on implicit bias.
Patients with comorbid medical and psychiatric illness consistently experience worse health outcomes and higher costs, but there is limited integration of medical and psychiatric care in most general medical hospitals. “Complexity intervention units” provide care for patients with high-acuity medical and psychiatric illness. In a survey of US hospitals, Jansen et al. found that only 2.7% had CIUs. In the US, some patients who are not treated in CIUs may receive psychiatric consultation services in general medical units, but some may not receive such care at all.