People who experience a lot of negative emotions and do not express these experience more health problems, says Dutch researcher Aline Pelle. She discovered that heart failure patients with a negative outlook reported their complaints to a physician or nurse far less often. The personality of the partner can also exert a considerable influence on these patients.
Aline Pelle investigated patients with a so-called type D personality. These people experience a lot of negative emotions and do not express these for fear of being rejected by others. It was already known that such a type of personality in heart failure patients is associated with anxiety and depression and a reduced state of health. However, Aline Pelle also described which processes might contribute to this.
Many of the patients with a negative outlook were found not to contact the physician or specialist nurse in the event of heart failure symptoms. As a result of this they were six times more likely to experience a worse state of health than non-type D heart failure patients.
Better not a cheerful partner
Pelle established that not just the patient's personality but also that of the partner had a significant effect on the patient's mood. In particular, the combination within the couple proved to be particularly important. Type D patients with a non-type D partner reported the lowest marriage quality, even lower than that of type D patients with a partner with just as negative an outlook.
No cause for death
Although a type D personality is associated with a range of negative health outcomes, Pelle's results did not demonstrate a correlation with an increased risk of dying from heart failure. This observation refutes the results from a previous study.
Aline Pelle's research was part of Johan Denollet's Vici project. He received a Vici grant from NWO's Innovational Research Incentives Scheme in 2004.
суббота, 14 мая 2011 г.
Symptoms Of Depression Associated With Development Of Diabetes In Older Adults
Older adults who have had symptoms of depression whether those symptoms occurred once, increased or remained steady over a 10-year period may be more likely to develop diabetes than those without depressive symptoms, according to a report in the April 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous research suggests that high levels of symptoms of depression, including irritability and trouble sleeping, are associated with increased risk of development of type 2 diabetes, according to background information in the article. However, with few exceptions, most of the studies have defined symptoms of depression based on a single survey filled out by participants. "Given the episodic nature of depression and depressive symptoms, a single self-report of symptoms may not fully characterize the association between depressive symptoms and diabetes," the authors write.
Mercedes R. Carnethon, Ph.D., of Feinberg School of Medicine, Northwestern University, Chicago, and colleagues followed a group of 4,681 participants age 65 and older (average age 72.7) who did not have diabetes at the beginning of the study in 1989. Each year for 10 years, the participants were evaluated for the presence of 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep. Symptoms were scored on a scale of zero to 30, with scores of eight or higher indicating high levels of symptoms. Sociodemographic characteristics, clinical measures including height and weight, and information about medication use that would indicate the development of diabetes were also updated annually.
At the beginning of the study, the average depressive symptom score was 4.5, and one-fifth of participants had a score of eight or higher. During the follow-up period, scores increased by at least five points in nearly half the participants, and 234 individuals developed diabetes. Rates of diabetes were higher among those with a score of eight or higher, compared with those who had scores below eight.
"In this sample of older adults, a single report of high depressive symptoms, an increase in symptoms with time and persistently high symptoms over time are each associated with an excess incidence of diabetes," the authors write. "Furthermore, increasing symptoms with time are associated with incident diabetes beyond initial high depressive symptoms and the association between increasing scores and incident diabetes was strongest among those with initially low baseline scores."
These associations were not explained by considering other risk factors for diabetes, including physical activity, smoking and body mass index. "The pathophysiologic mechanism for this association remains unclear," the authors write.
"Our findings in this population of older adults are of particular public health importance because there are 35 million U.S. adults older than 65 years," they conclude. Because an estimated 2 million older adults experience depression or a related illness and 15.3 percent of those over 65 have diabetes, "findings from this study of a novel and highly prevalent risk factor for diabetes have important implications for a substantial subset of our population."
American Medical Association (AMA)
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Previous research suggests that high levels of symptoms of depression, including irritability and trouble sleeping, are associated with increased risk of development of type 2 diabetes, according to background information in the article. However, with few exceptions, most of the studies have defined symptoms of depression based on a single survey filled out by participants. "Given the episodic nature of depression and depressive symptoms, a single self-report of symptoms may not fully characterize the association between depressive symptoms and diabetes," the authors write.
Mercedes R. Carnethon, Ph.D., of Feinberg School of Medicine, Northwestern University, Chicago, and colleagues followed a group of 4,681 participants age 65 and older (average age 72.7) who did not have diabetes at the beginning of the study in 1989. Each year for 10 years, the participants were evaluated for the presence of 10 symptoms of depression, including those related to mood, irritability, calorie intake, concentration and sleep. Symptoms were scored on a scale of zero to 30, with scores of eight or higher indicating high levels of symptoms. Sociodemographic characteristics, clinical measures including height and weight, and information about medication use that would indicate the development of diabetes were also updated annually.
At the beginning of the study, the average depressive symptom score was 4.5, and one-fifth of participants had a score of eight or higher. During the follow-up period, scores increased by at least five points in nearly half the participants, and 234 individuals developed diabetes. Rates of diabetes were higher among those with a score of eight or higher, compared with those who had scores below eight.
"In this sample of older adults, a single report of high depressive symptoms, an increase in symptoms with time and persistently high symptoms over time are each associated with an excess incidence of diabetes," the authors write. "Furthermore, increasing symptoms with time are associated with incident diabetes beyond initial high depressive symptoms and the association between increasing scores and incident diabetes was strongest among those with initially low baseline scores."
These associations were not explained by considering other risk factors for diabetes, including physical activity, smoking and body mass index. "The pathophysiologic mechanism for this association remains unclear," the authors write.
"Our findings in this population of older adults are of particular public health importance because there are 35 million U.S. adults older than 65 years," they conclude. Because an estimated 2 million older adults experience depression or a related illness and 15.3 percent of those over 65 have diabetes, "findings from this study of a novel and highly prevalent risk factor for diabetes have important implications for a substantial subset of our population."
American Medical Association (AMA)
515 N. State St.
Chicago, IL 60610
United States
ama-assn
Improving Sleep Quality Could Ease Disability In Rheumatoid Arthritis Patients
A study in the Feb. 15 issue of the Journal of Clinical Sleep Medicine found that poor sleep quality correlated with higher levels of depressive symptoms, greater pain severity, increased fatigue, and greater functional disability in patients with Rheumatoid Arthritis (RA). The study suggests that addressing sleep problems via pharmacological or behavioral interventions may have a critical impact on the health and lives of patients with RA.
The study represents a cross-sectional examination of the relationship between sleep quality and functional disability in 162 patients with RA. The sample had an average age of 58.5 years, and 76 percent were female. All patients had been diagnosed with RA for at least two years; on average, patients had RA for 14 years.
Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II, Medical Outcomes Study Short Form - 36, and the Health Assessment Questionnaire. The results provided input on their sleep quality, depression, fatigue, and functional disability and pain severity, respectively. Patients also provided sociodemographic information and their medical history.
Results show that sleep quality has an indirect effect on functional disability after controlling for age, gender and number of comorbities. According to the PSQI results, 61 percent of patients were poor sleepers and 33 percent reported having pain that disturbed their sleep three or more times per week.
"The primary finding of our study is that poor sleep quality is associated with greater functional disability among patients with RA and this relationship may be explained by pain severity and fatigue," said lead author Dr. Faith S. Luyster, research assistant professor at the University of Pittsburgh School of Nursing in Pittsburgh, Pa. "These results highlight the importance of addressing sleep complaints among patients with RA. By treating sleep problems either pharmacologically or behaviorally, symptoms and activity limitations associated with RA may be reduced."
The study's finding that poorer sleep quality is associated with greater pain severity is consistent with recent evidence suggesting that sleep disruption may lower pain threshold and enhance pain in RA and otherwise healthy adults.
According to the National Institute of Health, RA is an inflammatory disease affecting about 1.3 million U.S. adults, and causes pain, swelling, stiffness, and loss of function in the joints. Disturbed sleep has been found to be a major concern among persons with RA.
Physical disability resulting from polyarticular joint disease in patients with RA may limit their ability to carry out daily activities such as dressing, walking, grooming, and writing - tasks that can be further restricted by fatigue, pain severity, and depression.
It is possible that functional disability may affect depression, pain severity and fatigue, which in turn may affect sleep quality. It is likely that the relationships are bidirectional to some extent.
"Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day which in turn can limit a patient's ability to engage in activities of daily living and discretionary activities," Luyster said.
Luyster noted that treating sleep disturbances in RA patients might have beneficial effects beyond improving sleep.
The study, "Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis," was supported by grants from the National Institute of Health.
The study represents a cross-sectional examination of the relationship between sleep quality and functional disability in 162 patients with RA. The sample had an average age of 58.5 years, and 76 percent were female. All patients had been diagnosed with RA for at least two years; on average, patients had RA for 14 years.
Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II, Medical Outcomes Study Short Form - 36, and the Health Assessment Questionnaire. The results provided input on their sleep quality, depression, fatigue, and functional disability and pain severity, respectively. Patients also provided sociodemographic information and their medical history.
Results show that sleep quality has an indirect effect on functional disability after controlling for age, gender and number of comorbities. According to the PSQI results, 61 percent of patients were poor sleepers and 33 percent reported having pain that disturbed their sleep three or more times per week.
"The primary finding of our study is that poor sleep quality is associated with greater functional disability among patients with RA and this relationship may be explained by pain severity and fatigue," said lead author Dr. Faith S. Luyster, research assistant professor at the University of Pittsburgh School of Nursing in Pittsburgh, Pa. "These results highlight the importance of addressing sleep complaints among patients with RA. By treating sleep problems either pharmacologically or behaviorally, symptoms and activity limitations associated with RA may be reduced."
The study's finding that poorer sleep quality is associated with greater pain severity is consistent with recent evidence suggesting that sleep disruption may lower pain threshold and enhance pain in RA and otherwise healthy adults.
According to the National Institute of Health, RA is an inflammatory disease affecting about 1.3 million U.S. adults, and causes pain, swelling, stiffness, and loss of function in the joints. Disturbed sleep has been found to be a major concern among persons with RA.
Physical disability resulting from polyarticular joint disease in patients with RA may limit their ability to carry out daily activities such as dressing, walking, grooming, and writing - tasks that can be further restricted by fatigue, pain severity, and depression.
It is possible that functional disability may affect depression, pain severity and fatigue, which in turn may affect sleep quality. It is likely that the relationships are bidirectional to some extent.
"Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day which in turn can limit a patient's ability to engage in activities of daily living and discretionary activities," Luyster said.
Luyster noted that treating sleep disturbances in RA patients might have beneficial effects beyond improving sleep.
The study, "Sleep Quality and Functional Disability in Patients with Rheumatoid Arthritis," was supported by grants from the National Institute of Health.
Patients Hospitalized For Mental Illness In Ontario See Decrease In Signs Of Depression, Aggression
In 2007-2008, there were more than 52,000 admissions to mental health beds in Ontario, and new data show that the vast majority of these showed improvements during their hospital stay. For example, the analysis found that 83% of people hospitalized for mental illness were showing signs of depression at the time of their admission. Of those, 75% showed a decrease in signs of depression by the time they were discharged. Likewise, the majority of patients who showed signs of aggression at the time of admission for a mental illness (representing 29% of mental health hospitalizations) saw a decrease in aggressive behaviour at the time of discharge.
The analysis released on March 31st by the Canadian Institute for Health Information (CIHI) presents new information relating to the characteristics and care needs of people 15 years of age and older admitted to a mental health bed in Ontario. Four out of five admissions were for people who had been living in a private residence before being admitted to hospital, and almost 9 out of 10 (89%) of those returned to that living setting upon discharge.
Exploring Hospital Mental Health Service Use in Ontario, 2007-2008 also demonstrates differences in life situations faced by those hospitalized for mental illness. People admitted to a mental health bed in Ontario were less likely than the general population to be employed (24% versus 64%), less likely to be married or living with a partner (29% versus 60%) and less likely to have received postsecondary education (39% versus 59%).
About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.
Source
Canadian Institute for Health Information
The analysis released on March 31st by the Canadian Institute for Health Information (CIHI) presents new information relating to the characteristics and care needs of people 15 years of age and older admitted to a mental health bed in Ontario. Four out of five admissions were for people who had been living in a private residence before being admitted to hospital, and almost 9 out of 10 (89%) of those returned to that living setting upon discharge.
Exploring Hospital Mental Health Service Use in Ontario, 2007-2008 also demonstrates differences in life situations faced by those hospitalized for mental illness. People admitted to a mental health bed in Ontario were less likely than the general population to be employed (24% versus 64%), less likely to be married or living with a partner (29% versus 60%) and less likely to have received postsecondary education (39% versus 59%).
About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada's federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI's goal: to provide timely, accurate and comparable information. CIHI's data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.
Source
Canadian Institute for Health Information
Skin Condition Associated With Depression, Anxiety And Suicidal Feelings
Individuals with psoriasis appear to have an increased risk of depression, anxiety and suicidality, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis affects 1 percent to 3 percent of the general population, and estimates suggest 0.4 percent to 2.3 percent of adults have the condition but have not been diagnosed. "Psoriasis has long been recognized to be associated with potentially adverse effects on mental health," the authors write. "In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the 'heartbreak of psoriasis.' However, there have been relatively few studies evaluating psychological outcomes in patients with psoriasis."
Shanu Kohli Kurd, M.D., M.S.C.E, M.H.S., and colleagues at the University of Pennsylvania, Philadelphia, studied data from electronic medical records in the United Kingdom from 1987 to 2002. The analyses included 146,042 patients with mild psoriasis, 3,956 patients with severe psoriasis and 766,950 patients without psoriasis (five control patients for each patient with psoriasis, selected from the same practice and similar entry dates). Patients were defined as having new-onset depression, anxiety or suicidality if corresponding diagnostic codes appeared in their records after follow-up began.
Of patients with mild or severe psoriasis, 25.9 per 1,000 individuals per year were diagnosed with depression, 20.9 per 1,000 per year with anxiety and 0.9 per 1,000 per year with suicidality. The rate of these cases attributable to psoriasis was 11.8 per 1,000 individuals per year for depression, 8.1 per 1,000 per year for anxiety and 0.4 per 1,000 per year for suicidality.
"Stated another way, the excess risk attributable to psoriasis is one case of depression for every 39 patients with severe psoriasis per year (or per 87 patients in patients with mild psoriasis per year)," the authors write. "The excess risks associated with psoriasis for anxiety and suicidality correspond to one case per 123 and 2,500 patients with psoriasis per year, respectively." Considering this data and the prevalence of psoriasis in the U.K., the authors estimate that there are more than 10,400 diagnoses of depression, 7,100 of anxiety and 350 of suicidality related to psoriasis each year.
"It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and non-pharmacological approaches," the authors conclude. "Recent data suggest that psychiatric co-morbidity may negative affect response to certain psoriasis treatments (e.g., photochemotherapy), while other studies suggest that control of psoriasis is associated with improvements in psychological symptoms. Future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis."
Arch Dermatol. 2010;146[8]:848-855. 2010;146[8]:891-895.
Psoriasis affects 1 percent to 3 percent of the general population, and estimates suggest 0.4 percent to 2.3 percent of adults have the condition but have not been diagnosed. "Psoriasis has long been recognized to be associated with potentially adverse effects on mental health," the authors write. "In the 1960s, a popular ad campaign labeled the emotional burden of this skin disease as the 'heartbreak of psoriasis.' However, there have been relatively few studies evaluating psychological outcomes in patients with psoriasis."
Shanu Kohli Kurd, M.D., M.S.C.E, M.H.S., and colleagues at the University of Pennsylvania, Philadelphia, studied data from electronic medical records in the United Kingdom from 1987 to 2002. The analyses included 146,042 patients with mild psoriasis, 3,956 patients with severe psoriasis and 766,950 patients without psoriasis (five control patients for each patient with psoriasis, selected from the same practice and similar entry dates). Patients were defined as having new-onset depression, anxiety or suicidality if corresponding diagnostic codes appeared in their records after follow-up began.
Of patients with mild or severe psoriasis, 25.9 per 1,000 individuals per year were diagnosed with depression, 20.9 per 1,000 per year with anxiety and 0.9 per 1,000 per year with suicidality. The rate of these cases attributable to psoriasis was 11.8 per 1,000 individuals per year for depression, 8.1 per 1,000 per year for anxiety and 0.4 per 1,000 per year for suicidality.
"Stated another way, the excess risk attributable to psoriasis is one case of depression for every 39 patients with severe psoriasis per year (or per 87 patients in patients with mild psoriasis per year)," the authors write. "The excess risks associated with psoriasis for anxiety and suicidality correspond to one case per 123 and 2,500 patients with psoriasis per year, respectively." Considering this data and the prevalence of psoriasis in the U.K., the authors estimate that there are more than 10,400 diagnoses of depression, 7,100 of anxiety and 350 of suicidality related to psoriasis each year.
"It is important to identify these psychiatric disorders because they represent substantial morbidity that can be improved with a variety of pharmacological and non-pharmacological approaches," the authors conclude. "Recent data suggest that psychiatric co-morbidity may negative affect response to certain psoriasis treatments (e.g., photochemotherapy), while other studies suggest that control of psoriasis is associated with improvements in psychological symptoms. Future studies are necessary to determine the mechanisms by which psoriasis is associated with depression, anxiety and suicidality as well as approaches to prevent such adverse outcomes in patients with psoriasis."
Arch Dermatol. 2010;146[8]:848-855. 2010;146[8]:891-895.
Physical And Psychological Torture Have Similar Mental Effects
Forms of ill treatment during captivity that do not involve physical pain - such as psychological manipulation, deprivation, humiliation and forced stress positions - appear to cause as much mental distress and traumatic stress as physical torture, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Most widely accepted definitions of torture encompass both physical and mental pain and suffering, according to background information in the article. "After reports of human rights abuses by the U.S. military in Guantanamo Bay, Iraq and Afghanistan, a U.S. Defense Department working group report on detainee interrogations and a U.S. Justice Department memorandum on U.S. torture policy argued for a fairly narrow definition of torture that excludes mental pain and suffering caused by various acts that do not cause severe physical pain," the study authors write. The detention and interrogation procedures that are excluded from this definition include blindfolding and hooding, forced nudity, isolation and psychological manipulations.
Metin Basoglu, M.D., Ph.D., King's College, University of London, and colleagues interviewed 279 survivors of torture from Sarajevo in Bosnia and Herzegovina, Luka in Republica Srpska, Rijeka in Croatia and Belgrade in Serbia between 2000 and 2002. The survivors (average age 44.4, 86.4 percent men) were asked which of 54 war-related stressors and 46 different forms of torture they had experienced. Each participant then rated each event on scales of zero to four for distress (where zero was not at all distressing and four was extremely distressing) and loss of control (where zero was completely in control and four was not at all in control or completely helpless). Then, they reported how distressed or out of control they felt overall during the torture. Clinicians also assessed the survivors for post-traumatic stress disorder (PTSD) and other psychiatric conditions.
The participants reported an average of 19 war-related stressors and 19.3 types of torture. An average of 96.3 months had passed since their last torture experience. More than three-fourths (174) of the survivors had PTSD related to their torture at some point in their lives, 55.7 percent (128) had current PTSD, 17 percent (39) were currently depressed and 17.4 percent (40) had a past episode of major depression.
To more easily compare forms of torture, the researchers divided events into seven broad categories: sexual torture; physical torture; psychological manipulations, such as threats of rape or witnessing the torture of others; humiliating treatment, including mockery and verbal abuse; exposure to forced stress positions, such as bondage with rope or other restrictions of movement; loud music, cold showers and other sensory discomforts; and deprivation of food, water or other basic needs.
Participants who had undergone physical torture rated their experiences from 3.2 to 3.8 on the distress scale. Sixteen of the 33 stressors from other categories were rated in the same range of distress. "Sham executions, witnessing torture of close ones, threats of rape, fondling of genitals and isolation were associated with at least as much if not more distress than some of the physical torture stressors," the authors write. "There was thus substantial overlapping between physical torture and other stressors in terms of associated distress. The control ratings also showed a similar pattern."
Physical torture was not significantly associated with PTSD or depression, suggesting that both physical and non-physical treatments caused the conditions at similar rates. "The traumatic stress impact of torture (physical or non-physical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors," the authors continue.
The authors concluded that aggressive interrogation techniques or detention procedures involving deprivation of basic needs, exposure to adverse environmental conditions, forced stress positions, hooding or blindfolding, isolation, restriction of movement, forced nudity, threats, humiliating treatment and other psychological manipulations do not appear to be substantially different from physical torture in terms of the extent of mental suffering they cause, the underlying mechanisms of traumatic stress and their long-term traumatic effects. These findings do not support the distinction between torture versus "other cruel, inhuman and degrading treatment." Although international conventions prohibit both types of acts, "such a distinction nevertheless reinforces the misconception that cruel, inhuman and degrading treatment causes lesser harm and might therefore be permissible under exceptional circumstances. These findings point to a need for a broader definition of torture based on scientific formulations of traumatic stress and empirical evidence rather than on vague distinctions or labels that are open to endless and inconclusive debate and, most important, potential abuse."
(Arch Gen Psychiatry. 2007;64:277-285.)
This study was supported by grants from the Bromley Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: No Difference Between Torture, Other Forms of Maltreatment
The distinction between torture and degrading treatment is not only useless, but also dangerous, writes Steven H. Miles, M.D., University of Minnesota, Minneapolis, in an accompanying editorial.
"Ba??o?°lu and colleagues show that the severity of long-lasting adverse mental effects is unrelated to whether the torture or degrading treatment is physical or psychological and unrelated to objective measures of the severity of techniques," Dr. Miles writes.
"The wrongness of these inflicted harms is compounded by the fact that most abused prisoners, including those in the present war on terror, are innocent or ignorant of terrorist activities. Innocent or not, torture survivors rarely get the mental health treatment they need. In addition, soldiers who participate in atrocities are themselves at increased risk of post-traumatic stress disorder."
Human rights - respecting nations and medical societies must band together to reinforce international authority against torture, he concludes. "In the 18th century, Europe abandoned legal interrogational torture on the twin conclusions that it was an affront to human dignity and a poor way to acquire information. Empirical research such as the article by Basoglu and colleagues can help us find that persuasive holding ground again."
(Arch Gen Psychiatry. 2007;64:275-276.)
Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Contact: Metin Basoglu
JAMA and Archives Journals
Most widely accepted definitions of torture encompass both physical and mental pain and suffering, according to background information in the article. "After reports of human rights abuses by the U.S. military in Guantanamo Bay, Iraq and Afghanistan, a U.S. Defense Department working group report on detainee interrogations and a U.S. Justice Department memorandum on U.S. torture policy argued for a fairly narrow definition of torture that excludes mental pain and suffering caused by various acts that do not cause severe physical pain," the study authors write. The detention and interrogation procedures that are excluded from this definition include blindfolding and hooding, forced nudity, isolation and psychological manipulations.
Metin Basoglu, M.D., Ph.D., King's College, University of London, and colleagues interviewed 279 survivors of torture from Sarajevo in Bosnia and Herzegovina, Luka in Republica Srpska, Rijeka in Croatia and Belgrade in Serbia between 2000 and 2002. The survivors (average age 44.4, 86.4 percent men) were asked which of 54 war-related stressors and 46 different forms of torture they had experienced. Each participant then rated each event on scales of zero to four for distress (where zero was not at all distressing and four was extremely distressing) and loss of control (where zero was completely in control and four was not at all in control or completely helpless). Then, they reported how distressed or out of control they felt overall during the torture. Clinicians also assessed the survivors for post-traumatic stress disorder (PTSD) and other psychiatric conditions.
The participants reported an average of 19 war-related stressors and 19.3 types of torture. An average of 96.3 months had passed since their last torture experience. More than three-fourths (174) of the survivors had PTSD related to their torture at some point in their lives, 55.7 percent (128) had current PTSD, 17 percent (39) were currently depressed and 17.4 percent (40) had a past episode of major depression.
To more easily compare forms of torture, the researchers divided events into seven broad categories: sexual torture; physical torture; psychological manipulations, such as threats of rape or witnessing the torture of others; humiliating treatment, including mockery and verbal abuse; exposure to forced stress positions, such as bondage with rope or other restrictions of movement; loud music, cold showers and other sensory discomforts; and deprivation of food, water or other basic needs.
Participants who had undergone physical torture rated their experiences from 3.2 to 3.8 on the distress scale. Sixteen of the 33 stressors from other categories were rated in the same range of distress. "Sham executions, witnessing torture of close ones, threats of rape, fondling of genitals and isolation were associated with at least as much if not more distress than some of the physical torture stressors," the authors write. "There was thus substantial overlapping between physical torture and other stressors in terms of associated distress. The control ratings also showed a similar pattern."
Physical torture was not significantly associated with PTSD or depression, suggesting that both physical and non-physical treatments caused the conditions at similar rates. "The traumatic stress impact of torture (physical or non-physical torture and ill treatment) seemed to be determined by perceived uncontrollability and distress associated with the stressors," the authors continue.
The authors concluded that aggressive interrogation techniques or detention procedures involving deprivation of basic needs, exposure to adverse environmental conditions, forced stress positions, hooding or blindfolding, isolation, restriction of movement, forced nudity, threats, humiliating treatment and other psychological manipulations do not appear to be substantially different from physical torture in terms of the extent of mental suffering they cause, the underlying mechanisms of traumatic stress and their long-term traumatic effects. These findings do not support the distinction between torture versus "other cruel, inhuman and degrading treatment." Although international conventions prohibit both types of acts, "such a distinction nevertheless reinforces the misconception that cruel, inhuman and degrading treatment causes lesser harm and might therefore be permissible under exceptional circumstances. These findings point to a need for a broader definition of torture based on scientific formulations of traumatic stress and empirical evidence rather than on vague distinctions or labels that are open to endless and inconclusive debate and, most important, potential abuse."
(Arch Gen Psychiatry. 2007;64:277-285.)
This study was supported by grants from the Bromley Trust. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: No Difference Between Torture, Other Forms of Maltreatment
The distinction between torture and degrading treatment is not only useless, but also dangerous, writes Steven H. Miles, M.D., University of Minnesota, Minneapolis, in an accompanying editorial.
"Ba??o?°lu and colleagues show that the severity of long-lasting adverse mental effects is unrelated to whether the torture or degrading treatment is physical or psychological and unrelated to objective measures of the severity of techniques," Dr. Miles writes.
"The wrongness of these inflicted harms is compounded by the fact that most abused prisoners, including those in the present war on terror, are innocent or ignorant of terrorist activities. Innocent or not, torture survivors rarely get the mental health treatment they need. In addition, soldiers who participate in atrocities are themselves at increased risk of post-traumatic stress disorder."
Human rights - respecting nations and medical societies must band together to reinforce international authority against torture, he concludes. "In the 18th century, Europe abandoned legal interrogational torture on the twin conclusions that it was an affront to human dignity and a poor way to acquire information. Empirical research such as the article by Basoglu and colleagues can help us find that persuasive holding ground again."
(Arch Gen Psychiatry. 2007;64:275-276.)
Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Contact: Metin Basoglu
JAMA and Archives Journals
Transcendental Meditation Shown To Reduce Depression: New Studies
The Transcendental Meditation® technique may be an effective approach to reduce symptoms of depression, according to two new studies to be presented at the 31st Annual Meeting of the Society of Behavioral Medicine in Seattle, Washington April 9th, 2010.
The studies, conducted at Charles Drew University in Los Angeles and University of Hawaii in Kohala included African Americans and Native Hawaiians, 55 years and older, who were at risk for cardiovascular disease. Participants were randomly allocated to the Transcendental Meditation program or health education control group, and assessed with a standard test for depression - the Center for Epidemiological Studies-Depression (CES-D) inventory over 9-12 months.
"Clinically meaningful reductions in depressive symptoms were associated with practice of the Transcendental Meditation program," said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. "The findings of these studies have important implications for improving mental health and reducing the risk of cardiovascular morbidity and mortality," said Dr. Nidich.
Participants in both studies who practiced the Transcendental Meditation program showed significant reductions in depressive symptoms compared to health education controls. The largest decreases were found in those participants who had indications of clinically significant depression, with those practicing Transcendental Meditation showing an average reduction in depressive symptoms of 48%.
"These results are encouraging and provide support for testing the efficacy of Transcendental Meditation as a therapeutic adjunct in the treatment of clinical depression," said Hector Myers, PhD, study co-author and professor and director of Clinical Training in the Department of Psychology at U.C.L.A.
The results of these studies are timely. For older Americans, depression is a particularly debilitating disease, with approximately 20% suffering from some form of depression. Overall, 18 million men and women suffer from depression in the United States. Depression is a major risk factor for cardiovascular disease, with even a moderate level of depressive symptoms associated with increased cardiac events.
"The clinically significant reductions in depression without drugs or psychotherapy in these studies suggest the Transcendental Meditation program may improve mental and associated physical health in older high risk subjects," said Robert Schneider MD FACC, director of MUM's Institute for Natural Medicine and Prevention.
"The importance of reducing depression in the elderly at risk for heart disease cannot be overestimated," said Gary P. Kaplan MD PhD, Clinical Associate Professor of Neurology NYU School of Medicine. "Any technique not involving extra medication in this population is a welcome addition. I look forward to further research on the Transcendental Meditation technique and prevention of depression in other at-risk elderly populations, including those with stroke and other chronic diseases."
The studies were funded by grants from the National Institutes of Health - National Heart Lung and Blood Institute and National Center for Complementary and Alternative Medicine.
Facts on Study Design
The first study was conducted in collaboration with Dr. Hector Myers at the Charles R. Drew University of Medicine and Science in Los Angeles. It included a subgroup of 59 African American men and women, 55 years and older, with a minimum carotid artery wall thickness of 0.65 for women and 0.72 for men.
The second study was conducted in collaboration with Dr. Andrew Grandinetti at the University of Hawaii. Data was collected on 53 Native Hawaiian men in Kohala, Hawaii, 55 years and older, who had at least one additional major risk factor for cardiovascular disease.
Measurements with the Center for Epidemiological Studies Depression (CES-D) Rating Scale were taken at baseline, 3-month posttest, and 9-12 month posttest, comparing Transcendental Meditation to health education controls.
Both African Americans and Native Hawaiians suffer from higher rates of cardiovascular disease compared to whites. African Americans have approximately 1.5 times the rate of cardiovascular morbidity and mortality and Native Hawaiians have 2 to 4 times the rate of cardiovascular disease compared to the whites.
Facts on Depression
12.4 million women and 6.4 million men in the U.S. suffer from depression.
Approximately 20% of the elderly suffers from some form of depression according the National Institutes of Health.
Depression is an important risk factor for the development and progression of cardiovascular disease (CVD). Research has found that a dose-response effect exists whereby the level of depressive symptoms is linearly associated with the prevalence of cardiac events. Even a moderate level of depressive symptoms increases the risk for cardiac events.
The Medical Outcomes Study determined that depression was more impairing in terms of patient functioning and well being than arthritis, diabetes mellitus, and hypertension, among others, and is more disruptive for social functioning than all of the chronic medical conditions.
Research has shown that approximately 50% of patients suffering from major depression can be left undiagnosed by general practitioners.
Depression accounts for $83.1 billion in medical care and workplace costs.
The studies, conducted at Charles Drew University in Los Angeles and University of Hawaii in Kohala included African Americans and Native Hawaiians, 55 years and older, who were at risk for cardiovascular disease. Participants were randomly allocated to the Transcendental Meditation program or health education control group, and assessed with a standard test for depression - the Center for Epidemiological Studies-Depression (CES-D) inventory over 9-12 months.
"Clinically meaningful reductions in depressive symptoms were associated with practice of the Transcendental Meditation program," said Sanford Nidich, EdD, lead author and senior researcher at the Institute for Natural Medicine and Prevention at Maharishi University of Management. "The findings of these studies have important implications for improving mental health and reducing the risk of cardiovascular morbidity and mortality," said Dr. Nidich.
Participants in both studies who practiced the Transcendental Meditation program showed significant reductions in depressive symptoms compared to health education controls. The largest decreases were found in those participants who had indications of clinically significant depression, with those practicing Transcendental Meditation showing an average reduction in depressive symptoms of 48%.
"These results are encouraging and provide support for testing the efficacy of Transcendental Meditation as a therapeutic adjunct in the treatment of clinical depression," said Hector Myers, PhD, study co-author and professor and director of Clinical Training in the Department of Psychology at U.C.L.A.
The results of these studies are timely. For older Americans, depression is a particularly debilitating disease, with approximately 20% suffering from some form of depression. Overall, 18 million men and women suffer from depression in the United States. Depression is a major risk factor for cardiovascular disease, with even a moderate level of depressive symptoms associated with increased cardiac events.
"The clinically significant reductions in depression without drugs or psychotherapy in these studies suggest the Transcendental Meditation program may improve mental and associated physical health in older high risk subjects," said Robert Schneider MD FACC, director of MUM's Institute for Natural Medicine and Prevention.
"The importance of reducing depression in the elderly at risk for heart disease cannot be overestimated," said Gary P. Kaplan MD PhD, Clinical Associate Professor of Neurology NYU School of Medicine. "Any technique not involving extra medication in this population is a welcome addition. I look forward to further research on the Transcendental Meditation technique and prevention of depression in other at-risk elderly populations, including those with stroke and other chronic diseases."
The studies were funded by grants from the National Institutes of Health - National Heart Lung and Blood Institute and National Center for Complementary and Alternative Medicine.
Facts on Study Design
The first study was conducted in collaboration with Dr. Hector Myers at the Charles R. Drew University of Medicine and Science in Los Angeles. It included a subgroup of 59 African American men and women, 55 years and older, with a minimum carotid artery wall thickness of 0.65 for women and 0.72 for men.
The second study was conducted in collaboration with Dr. Andrew Grandinetti at the University of Hawaii. Data was collected on 53 Native Hawaiian men in Kohala, Hawaii, 55 years and older, who had at least one additional major risk factor for cardiovascular disease.
Measurements with the Center for Epidemiological Studies Depression (CES-D) Rating Scale were taken at baseline, 3-month posttest, and 9-12 month posttest, comparing Transcendental Meditation to health education controls.
Both African Americans and Native Hawaiians suffer from higher rates of cardiovascular disease compared to whites. African Americans have approximately 1.5 times the rate of cardiovascular morbidity and mortality and Native Hawaiians have 2 to 4 times the rate of cardiovascular disease compared to the whites.
Facts on Depression
12.4 million women and 6.4 million men in the U.S. suffer from depression.
Approximately 20% of the elderly suffers from some form of depression according the National Institutes of Health.
Depression is an important risk factor for the development and progression of cardiovascular disease (CVD). Research has found that a dose-response effect exists whereby the level of depressive symptoms is linearly associated with the prevalence of cardiac events. Even a moderate level of depressive symptoms increases the risk for cardiac events.
The Medical Outcomes Study determined that depression was more impairing in terms of patient functioning and well being than arthritis, diabetes mellitus, and hypertension, among others, and is more disruptive for social functioning than all of the chronic medical conditions.
Research has shown that approximately 50% of patients suffering from major depression can be left undiagnosed by general practitioners.
Depression accounts for $83.1 billion in medical care and workplace costs.
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