Severe Stressful Events Research Articles

Comparison of psychosocial risk factors between patients who experience acute myocardial infarction before and after 40 years of age

Several studies have shown that psychosocial risk factors such as stress and depression make substantial contribution to the pathogenesis of coronary artery disease. This study aimed to investigate acute stress factors prior to acute myocardial infarction (AMI), and stress, depression, and anxiety levels during the subacute period in AMI patients aged ≤ 40 years, in comparison with AMI patients aged >40 years. The study included 200 first-time AMI patients aged ≤ 40 years (n=100; mean age 35 ± 4 years) and >40 years (n=100; mean age 54 ± 9 years). The DASS 21 scale (Depression Anxiety Stress Scales) was administered via face-to-face interviews in the early recovery period of AMI. The patients were also questioned whether they had experienced acute stress factors such as severe emotional or physical stressful events within two hours before the onset of chest pain. In addition, coronary angiography results were assessed based on the two age groups. Comparison of the two age groups showed significantly higher frequencies of family history of CAD and smoking in the younger group, and significantly higher frequencies of hypertension, diabetes mellitus, and dyslipidemia in the older group (p<0.05). History of acute stress factors was significantly more common (52% vs. 20%, p<0.01) and stress, depression, and anxiety scores of the DASS 21 scale were all significantly higher in the younger group (p<0.01). On coronary angiography, younger patients predominantly had normal coronary arteries and single-vessel disease, whereas multi-vessel disease was more prevalent in the older age group (p<0.01). Triggers of acute stress and psychosocial risk factors may contribute to the occurrence of AMI in individuals younger than 40 years.

Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South

A history of traumatic and/or stressful experiences is prevalent among HIV-infected individuals and has been consistently associated with poorer health outcomes. However, little is known about incident stressful experiences and the factors that predict these experiences among HIV-infected individuals. Data from a longitudinal study of 611 HIV-infected individuals in the Southeastern USA were used to examine the frequency and types of incident stress reported in a 27-month period and to determine predictors associated with three incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences frequently occurred among study participants, as 91% reported at least one stressful experience (median=3.5 experiences) and 10% of study participants reported traumatic stress in any given nine-month reporting period. Financial stressors were the most frequently reported by study participants. Greater emotional distress, substance use, and a higher number of baseline stressful experiences were significantly associated with reporting a greater number of incident stressful experiences and any traumatic experiences. Study results indicate that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors, including mental health and substance abuse, that contribute to these experiences.

Stressful Life Events, Genetic Liability, and Onset of an Episode of Major Depression in Women

Objective:This study was undertaken to clarify how genetic liability and stressful life events interact in the etiology of major depression. Method:Information about stressful life events and onset of major depressive episodes in the past year was collected in a population-based sample of female-female twin pairs including 2,164 individuals, 53,215 person-months of observation, and 492 onsets of depression. Results:Nine “personal” and three aggregate “network” stressful events significantly predicted onset of major depression in the month of occurrence, four of which predicted onset with an odds ratio of >10 and were termed “severe”: death of a close relative, assault, serious marital problems, and divorce/breakup. Genetic liability also had a significant impact on risk of onset of depression. Four severe stressful events, as well as for 10 of the 12 individuals stressful events, the best-fitting model for the joint effect of stressful events and genetic liability on onset of major depression suggested ge...

The interaction between perinatal factors and childhood abuse in the risk of developing anorexia nervosa

Perinatal factors seem to be implicated in the pathogenesis of anorexia nervosa (AN) and may be involved in the programming of stress response systems in humans. Our aim was to explore one of the possible pathways to explain the association between perinatal complications and a psychiatric disorder. In particular, we tested the hypothesis that neonatal immaturity may confer an enhanced vulnerability to AN after exposure to a severe stressful event, such as childhood abuse. The sample was composed of subjects who took part in a prevalence study carried out on a representative sample of the general population and cases of AN referred to an out-patient specialist unit. All subjects (n=663) were born in the two obstetric wards of Padua Hospital between 1971 and 1979. We analysed data using both a case-control and a cohort design. We found that functional signs of neonatal dysmaturity, but not a low birthweight or prematurity, had a significant additive interaction with childhood abuse in determining the risk for this illness. In normal subjects, but not in subjects with AN, neonatal dysmaturity was associated with being small, short or thin for gestational age at birth. The synergistic effect of neonatal dysmaturity and childhood abuse in increasing the risk for AN provides evidence for the hypothesis that a prenatal programming of stress response systems can result in an impairment of the individual's resilience to severe stressful events.

Do stressful life events predict medical treatment outcome in first episode of depression?

It is unclear whether medical treatment outcome in first episode depression differ for patients with and without stressful life events prior to onset of depression. Patients discharged with a diagnosis of a single depressive episode from a psychiatric in- or outpatient hospital setting were consecutively sampled from the Danish Psychiatric Central Research Register. Patients participated in an extensive interview including the schedules for clinical assessment in neuropsychiatry (SCAN), the Structured Clinical Interview for DSM-IV axis II personality disorders (SCID-II) and the interview of recent life events (IRLE). Medical treatment history was assessed in detail using standardised procedures (TRAQ). Remission was defined as a score <or= 7 on the Hamilton Depression Rating Scale, 17 items and a score >or= 4 on TRAQ following (1) first trial of antidepressant treatment (2) two adequate trials of antidepressant treatment. A total of 399 patients participated in the interview and among these 301 patients obtained a SCAN diagnosis of a single depressive episode. A total of 62.8% of the 301 patients experienced at least one moderate to severe stressful life event in a 6 months period prior to symptom onset. The presence of a stressful life event or the number of stressful life events did not predict remission from first or second antidepressant drug trial-nor when adjusted for differences in age, gender or prevalence of co-morbid personality disorders. Medical treatment outcome in first episode depression does not depend on the prevalence of moderate to severe stressful life events prior to symptom onset.

Takotsubo cardiomyopathy in two female patients: two case reports

BackgroundTako-tsubo cardiomyopathy (idiopathic apical ballooning syndrome or ampulla cardiomyopathy) has recently been described. First recognised in Japanese patients, tako-tsubo refers to the end-systolic appearance of the left ventricle on ventriculography and its resemblance to the round bottomed, narrow necked Japanese fishing pots used to trap octopusCase presentationWe present two cases of female caucasian patients aged 40 and 63 years respectively admitted following severe stressful events who met the diagnostic criteria of tako-tsubo cardiomyopathy, namely acute chest pain, transient akinesis or dyskinesia of the left ventricle, new dynamic electrocardiogram changes and no significant epicardial coronary artery disease in the absence of recent head trauma, intracranial bleeding, phaeochromocytoma, myocarditis and hypertrophic cardiomyopathy. Both had elevated cardiac biomarkers. Characteristically the condition is transient and the abnormal akinesia/dyskinesia of the left ventricle has been observed to normalise within 1-month as in our patients who made full recoveries.ConclusionPatients with tako-tsubo cardiomyopathy present with features consistent with an acute coronary syndrome and as such the syndrome is probably under-diagnosed. It may be with the introduction of primary percutaneous coronary intervention more cases are identified, sparing patients the risks of unnecessary thrombolytic therapy. Tako-tsubo cardiomyopathy should be considered in all patients presenting with acute onset chest pain and elevated cardiac biomarkers.

Influence of Stress in the Onset of Eating Disorders: Data From a Two-Stage Epidemiologic Controlled Study

We explore the role of stress in the onset of eating disorders (EDs) in a community sample of adolescents, the mediating role of psychiatric comorbidity and the quantitative evolution of stress in the year preceding the onset of an ED. The Life Events and Difficulties Schedule interview was applied to a sample with 32 cases and 32 controls selected from a two-phase epidemiologic study among a representative population of adolescents, followed by a decay model to assess acute and chronic stress in the year preceding the onset of ED. Psychiatric comorbidity was assessed using the SCAN interview. Cases (46.9%) and 9.4% of controls were found to have associated psychiatric comorbidity (chi2 = 11.74, p = .001). Of cases, 6.3% and none of the controls had at least one severe stressful event (N.S). Of cases, 18.8% and 3.1% of controls had at least one major difficulty (Fisher exact test = 0.05). Of cases, 25% and 3.1% of controls had a provoking stressful agent (Fisher exact test = 0.026). Psychiatric comorbidity partially mediated the relationship between stress and EDs. The Structural Equation Modeling Analysis shows that chronic stress is strongly associated with the onset of EDs, both directly (r(2) = 0.38) and indirectly, through psychiatric comorbidity (r2 = 0.56). Chronic stress and psychiatric comorbidity are strongly associated with the onset of EDs. Psychiatric comorbidity is a partial mediating factor in the association of stress with eating disorders.

Severe Stress Events and Use of Stress-Management Behaviors Are Associated with Nutrition-Related Parameters in Men with HIV/AIDS

Objective To determine whether severe stress events and more frequent use of stress-management behaviors among men with human immunodeficiency virus (HIV) infection are associated with more desirable nutrition-related parameters. Design Data on sociodemographic variables, severe stress events, stress management, and nutrition-related parameters were obtained from interviews, venipunctures, medical record reviews, bioelectrical impedance analysis, and questionnaires from the baseline wave of a three-wave longitudinal study. Subjects/Setting The sample consisted of 226 men with HIV who were attending one of three infectious disease clinics. Statistical Analyses Performed Multivariable linear and logistic regression were used to determine the association of severe stress events and mean stress-management subscore with nutrition-related parameters when controlling for CD4 + T cells, age, income, and race. Results Men with more severe stress events were more likely to experience nausea (odds ratio=1.4, P<.01) and change in appearance (odds ratio=1.25, P=.02). Men who more frequently used stress-management behaviors had a lower body mass index (β=–1.14, P=.02), lower percent body fat (β=–1.12, P=.05), more frequent use of nutritional-health promoting behaviors (β=.52, P<.01), and were less likely to experience a change in appearance (odds ratio=0.63, P=.05) and have unintentional weight loss (odds ratio=0.54, P=.05). Conclusions Men with more severe stress events are more likely to experience undesirable symptoms that could adversely influence nutritional health. More frequent use of stress-management behaviors may provide a coping mechanism for stress associated with HIV and ultimately improve nutritional health of men with HIV/acquired immunodeficiency syndrome.

How Trauma, Recent Stressful Events, and PTSD Affect Functional Health Status and Health Utilization in HIV-Infected Patients in the South

In addition to biological markers of human immunodeficiency virus (HIV) disease progression, physical functioning, and utilization of health care may also be important indicators of health status in HIV-infected patients. There is insufficient understanding of the psychosocial predictors of health-related physical functioning and use of health services among those with this chronic disease. Therefore, the current study examines how trauma, severe stressful events, posttraumatic stress disorder (PTSD), and depressive symptoms are related to physical functioning and health utilization in HIV-infected men and women living in rural areas of the South. We consecutively sampled patients from 8 rural HIV clinics in 5 southern states, obtaining 611 completed interviews. We found that patients with more lifetime trauma, stressful events, and PTSD symptoms reported more bodily pain, and poorer physical, role, and cognitive functioning. Trauma, recent stressful events, and PTSD explained from 12% to 27% of the variance in health-related functioning, over and above that explained by demographic variables. In addition, patients with more trauma, including sexual and physical abuse, and PTSD symptoms were at greater risk for having bed disability, an overnight hospitalization, an emergency room visit, and four or more HIV outpatient clinic visits in the previous 9 months. Patients with a history of abuse had about twice the risk of spending 5 or more days in bed, having an overnight hospital stay, and visiting the emergency room, compared with those without abuse. The effects of trauma and stress were not explained by CD4 lymphocyte count or HIV viral load; however, these effects appear to be largely accounted for by increases in current PTSD symptoms. These findings highlight the importance of addressing past trauma, stress, and current PTSD within clinical HIV care.

Functional MR Imaging of Psychogenic Amnesia: A Case Report

We present here a case in which functional MR imaging (fMRI) was done for a patient who developed retrograde psychogenic amnesia for a four year period of her life history after a severe stressful event. We performed the fMRI study for a face recognition task using stimulation with three kinds of face photographs: recognizable familiar faces, unrecognizable friends' faces due to the psychogenic amnesia, and unfamiliar control faces. Different activation patterns between the recognizable faces and unrecognizable faces were found in the limbic area, and especially in the amygdala and hippocampus.

An unusual case with relapsing neuromyelitis optica associated with undifferentiated connective tissue disease

A case is presented with attacks of optic neuritis followed by severe myelitis 15 years later, in coincidence with a severe stressful life event. This female patient was also affected by undifferentiated connective tissue disease. This case presents some unusual and atypical findings such as: the association of a relapsing neuromyelitis optica with an undifferentiated connective tissue disease, a very long interval between optic neuritis and myelitis, and the important role of a stressful event in developing a relapse.

Problems of breast cancer diagnosis during pregnancy and lactation

This review focuses on the effects of psychosocial interventions on psychological and biological functioning of breast cancer patients. Once in their lifetime, one out of eleven women receive a diagnosis of breast cancer. A diagnosis of breast cancer is a severe stressful life event with profound consequences on all aspects of human life. Whether a woman will regain emotional balance and accept the idea of living with a potentially life threatening disease depends on her psychological resiliency. Provision of psychosocial interventions can improve these women's coping abilities and reduce emotional distress and feelings of isolation, and improve psychosexual functioning. Additionally, there exists some evidence that psychotherapy may prolong survival. Prolongation of survival may be related, in part, to an increase in certain aspects of immune function (e.g., natural killer cell activity). This is plausible because the function of the immune system seems to be related to mammary tumor growth. Therefore, future research should examine the degree to which the effects on mammary tumor growth relate to immune system changes.

The stress of metropolitan general practice.

To identify the work-related stressors of Australian metropolitan general practitioners (GPs). A descriptive postal survey of metropolitan GPs from all States and Territories selected at random from the Health Insurance Commission database. 296 of 464 GPs (64%) surveyed in June 1996; 67% were male; 87% worked full-time (more than 6 sessions per week). Frequency and severity of work stressors in general practice; overall feelings of stress at work in the past 12 months; effects of the stressors on work satisfaction; contribution of work stress to overall life stress; responses to the 12-item General Health Questionnaire (GHQ) as potential correlates of occupational stress. "Time pressure to see patients" was the most frequently reported stressor. Threat of litigation was perceived as the most severe stressor. Of the top 10 severe stressors, seven were also in the top 10 for stressor frequency. Work was the major stressor in GPs' lives. The GHQ scores did not correlate significantly with major stress outcome measures, but 12.8% of GPs had scores indicative of severe psychiatric disturbance. Fifty per cent of respondents had considered leaving their current workplace and 53% had considered abandoning general practice because of occupational stress. GPs working 6 or more sessions per week were more likely to be moderately or severely stressed than those working part-time (P< 0.02, Fisher's exact test). Those who had considered leaving their current workplace or careers were also more likely to be moderately or severely stressed (P< 0.0001, Fisher's exact test). The most frequent and relatively severe stressful events in general practice involved time pressures. There are implications for government, which, through remuneration policies, might influence GPs to work at a rate beyond their capacity to cope. Strategies are required to manage or prevent stress in metropolitan GPs.

Prolonged trauma and subsequent suicidal behavior: Child abuse and combat trauma reviewed

AbstractStressful events have long been acknowledged as important risk factors for suicidal behavior. Although suicide research has generally focused on less severe stressful events, a long‐standing vulnerability for suicidal behavior may be a sequela of prolonged traumatic stressors. The present paper discusses the relationship between prolonged traumatic stress and subsequent suicidality by reviewing studies that have examined suicidal behavior in relationship to child abuse and combat trauma. Traumatic stress is conceptualized according to a person‐environment interactional paradigm, and this paradigm is used to discuss the characteristics of traumatic events, recovery environments, and individuals that may contribute to subsequent suicidality.

Prolonged trauma and subsequent suicidal behavior: child abuse and combat trauma reviewed.

Stressful events have long been acknowledged as important risk factors for suicidal behavior. Although suicide research has generally focused on less severe stressful events, a long-standing vulnerability for suicidal behavior may be a sequela of prolonged traumatic stressors. The present paper discusses the relationship between prolonged traumatic stress and subsequent suicidality by reviewing studies that have examined suicidal behavior in relationship to child abuse and combat trauma. Traumatic stress is conceptualized according to a person-environment interactional paradigm, and this paradigm is used to discuss the characteristics of traumatic events, recovery environments, and individuals that may contribute to subsequent suicidality.

Adjustment to breast cancer: the psychobiological effects of psychosocial interventions.

This review focuses on the effects of psychosocial interventions on psychological and biological functioning of breast cancer patients. Once in their lifetime, one out of eleven women receive a diagnosis of breast cancer. A diagnosis of breast cancer is a severe stressful life event with profound consequences on all aspects of human life. Whether a woman will regain emotional balance and accept the idea of living with a potentially life threatening disease depends on her psychological resiliency. Provision of psychosocial interventions can improve these women's coping abilities and reduce emotional distress and feelings of isolation, and improve psychosexual functioning. Additionally, there exists some evidence that psychotherapy may prolong survival. Prolongation of survival may be related, in part, to an increase in certain aspects of immune function (e.g., natural killer cell activity). This is plausible because the function of the immune system seems to be related to mammary tumor growth. Therefore, future research should examine the degree to which the effects on mammary tumor growth relate to immune system changes.

Stressful life events, genetic liability, and onset of an episode of major depression in women.

This study was undertaken to clarify how genetic liability and stressful life events interact in the etiology of major depression. Information about stressful life events and onset of major depressive episodes in the past year was collected in a population-based sample of female-female twin pairs including 2,164 individuals, 53,215 person-months of observation, and 492 onsets of depression. Nine "personal" and three aggregate "network" stressful events significantly predicted onset of major depression in the month of occurrence, four of which predicted onset with an odds ratio of > 10 and were termed "severe": death of a close relative, assault, serious marital problems, and divorce/breakup. Genetic liability also had a significant impact on risk of onset of depression. For severe stressful events, as well as for 10 of the 12 individual stressful events, the best-fitting model for the joint effect of stressful events and genetic liability on onset of major depression suggested genetic control of sensitivity to the depression-inducing effects of stressful life events. In individuals at lowest genetic risk (monozygotic twin, co-twin unaffected), the probability of onset of major depression per month was predicted to be 0.5% and 6.2%, respectively, for those unexposed and exposed to a severe event. In those at highest genetic risk (monozygotic twin, co-twin affected), these probabilities were 1.1% and 14.6%, respectively. Linear regression analysis indicated significant Genotype by Environment interaction in the prediction of onset of major depression. Genetic factors influence the risk of onset of major depression in part by altering the sensitivity of individuals to the depression-inducing effect of stressful life events.

Anxiety of asthmatic pupils in Israel during the Persian Gulf War: treatment and counseling implications

The aim was to study the increase in anxiety of asthmatic pupils during a state of war in comparison with healthy pupils. Twenty-five asthmatic adolescents completed Spielberger' STAI during three periods: (1) 4 months before the war; (2) during the second week of the war: and (3) 4 months after the end of the war. The comparison group included 54 health pupils visiting the same school. The results showed that the level of state and trait anxiety of the asthmatic and comparison group remained constant, without any significant increase, even during the war. The anxiety was not influenced by gender nor by socioeconomic level. It is concluded that during severe stressful events, there is no need for special medication for asthmatic patients.

Ten Years' Experience with the "Sticky Platelet Syndrome"

We describe a 10-year experience with a con genital platelet abnormality characterized by hyperaggre gability with ADP and/or epinephrine. The syndrome has so far been identified in &gt;200 patients and their families. Clinical symptoms are transient or permanent arterial oc clusions, thrombotic in nature, affecting especially the coronary and cerebral vasculature, including ophthalmic vessels. The patients have no identifiable risk factors and are usually young (5-45 years), and other hypercoagula ble states are excluded. In many cases the vascular acci dent is precipitated by severe stressful events. Occasion ally the syndrome is found in patients with recurrent ve nous thromboembolism while they are on optimal oral anticoagulant therapy. In the laboratory the patients' platelets are hyperaggregable with decreasing ADP and/ or epinephrine concentrations added to platelet-rich plasma. Two forms are identified: Type I is marked by hyperaggregability with ADP and epinephrine, while Type II evidences hyperaggregability only with epineph rine. No abnormalities are found when other aggregation stimulators are used. By electron microscopy the plate lets are more readily activated by surface contact, with a greater tendency toward aggregate formation. Plasma lev els of platelet release proteins, platelet factor 4, and β-thromboglobulin are not elevated. The syndrome is treated with low-dose aspirin, which reverses the hyper aggregability and improves clinical symptoms. We hy pothesize that in vivo adrenaline release leads to in creased platelet clumping, which can transiently or per manently occlude small vessels. It is conceivable that altered surface receptors on the platelets might be respon sible for this congenital problem.

Biphasic alterations of nociceptive thresholds induced by food deprivation

Acute exposure to such stressful events as inescapable footshock, rotation, or cold-water swims produces a transient analgesia. The physiological effects of food deprivation resemble those of an environmental stressor, in that corticosterone levels increase during food restriction and fall following meals. The present study investigated whether food deprivation, like other stressors, would produce a transient analgesia. Flinch-jump thresholds of 16 rats, maintained on a 14-h-light/10-h-dark cycle, were tested twice daily for 4 baseline, 3 food-deprivation, and 2 recovery days. Deprivation was initiated for eight animals at the beginning of the dark cycle (p.m. group), and for eight animals at the end of the dark cycle (a.m. group). Nociceptive thresholds of the p.m. group increased after 12 h of deprivation and decreased after 36 and 60 h. Thresholds of the a.m. group were increased for up to 36 h of deprivation and decreased after 72 h. Thresholds were higher after the dark cycle on the 1st deprivation day, and lower on the 3rd deprivation day, indicating an important circadian rhythmicity. Changes in weight, water intake, or activity levels could not account for the nociceptive alterations. These results provide further support for the contention that initial exposure to severe environmental stressful events produces a transient analgesia.