Article Summaries for November–December 2019 Psychosomatic Medicine, Volume 81, Issue 9 No abstract available

The Effect of Probiotic Supplementation on Depressive Symptoms and Quality of Life in Patients After Myocardial Infarction: Results of a Preliminary Double-Blind Clinical Trial Objective Evidence indicates that probiotic supplements may improve or prevent depression. Little is known about the effects of probiotic supplementation on symptoms of depression and quality of life (QOL) in patients with myocardial infarction (MI). Methods This randomized, double-blind, and placebo-controlled clinical trial was performed in 44 patients with a recent diagnosis of MI who underwent percutaneous coronary intervention. Patients were randomly assigned to receive either capsules containing 1.6 × 109 colony-forming units of Lactobacillus rhamnosus capsules with their lunch (the active intervention group) or capsules that contained maltodextrin (the placebo control group) for 12 weeks. The Beck Depression Inventory, QOL, and biomarkers of oxidative stress (serum total antioxidant capacity), and malondialdehyde), and high-sensitivity C-reactive protein (hs-CRP) as inflammation marker were assessed. These measures were obtained at baseline and at 12 weeks’ follow-up. Results The total Beck Depression Inventory score decreased significantly in patients who received probiotic supplements compared with the placebo group (−5.57 [6.1] versus −0.51 [2.8], p = .045). Improvements in the mean QOL score were also stronger in the probiotic versus the placebo group (23.6 [39.1] versus 0.44 [42.6], p = .023). In addition, increases in total antioxidant capacity (93.7 [88.4] versus 27.54 [64.7] mmol/l, p = .009) and decreases in malondialdehyde (−40.7 [63.73] versus −4.2 [67.6] nmol/ml, p = .033) and high-sensitivity C-reactive protein (−1.74 [0.70] versus 0.67 [1.27] mg/l, p = .040) levels were stronger in patients receiving probiotic supplementation than the placebo group. Conclusion These data provide preliminary evidence that probiotic supplementation in patients with percutaneous coronary intervention post-MI has beneficial effects on depressive symptoms and markers of oxidative stress and inflammation. Multicenter studies with larger sample sizes are needed to replicate these findings and identify patient subgroups with the most benefit from probiotic supplementation. Trial Registration:www.irct.ir identifier: IRCT20121028011288N15.

Longer Sleep Duration and Endothelial Cell Health Among a Multiethnic Sample of Adolescents Objective Adverse endothelial cell health, an early pathogenic process underlying atherosclerosis and cardiovascular disease, is evident in childhood and adolescence. Sleep duration, a modifiable cardiovascular health behavior, may be an important cardiovascular disease prevention target that may affect endothelial cell health. We examined the associations of longer sleep duration with endothelial cell injury among youth. Methods In a multiethnic sample of 235 children (63.0% female, mean age = 13.9 years), we conducted multivariable linear regressions to test the cross-sectional association of sleep duration and circulating levels of endothelial cell–derived microparticles (EMPs), phenotypic for endothelial cell activation and apoptosis (CD62E+ EMPs, CD31+/CD42b− EMPs, and CD31+/Annexin V+ EMPs). Sleep duration and EMPs were both treated as continuous variables. Models were adjusted for age, sex, race, pubertal status, household economic resources, and waist circumference. Results Overall, 69.2% had short sleep duration (<8 hours of sleep per night). Longer sleep duration was significantly associated with lower levels of CD62E+ EMPs and CD31+/CD42b− EMPs. A 60-minute increase in sleep duration was associated with an 8.40 (95% confidence interval = −205.20 to −1.80, p = .046) decrease in CD62E+ EMPs and a 9.00 (95% confidence interval = −153.60 to −9.60, p = .027) decrease in CD31+/CD42b− EMPs. Sleep duration was not associated with CD31+/Annexin V+ EMPs. Conclusions Our results support the hypothesis that sleeping longer has beneficial effects on endothelial cell health during childhood. Primordial prevention efforts might incorporate sleep extension to offset cardiovascular risk in youth.

Sleep and Parasympathetic Activity During Rest and Stress in Healthy Adolescents and Adolescents With Bipolar Disorder Objective Sleep disruption contributes to the pathophysiology of mental disorders, particularly bipolar illness, but the biobehavioral mechanisms of this relationship are insufficiently understood. This study evaluated sleep duration, timing, and variability as prospective predictors of parasympathetic nervous system activity during rest and social stress in adolescents with bipolar disorder, reflecting sleep-related interference in stress regulatory systems that may confer vulnerability to mood episodes. Method Participants were adolescents with bipolar disorder (n = 22) and healthy adolescents (n = 27). Sleep duration and timing were measured by actigraphy for 1 week before a laboratory social stress task, during which high-frequency heart rate variability (HF-HRV) was indexed using electrocardiography. Multilevel models were used to evaluate group, sleep characteristics, and their interactions as predictors of initial HF-HRV and change in HF-HRV during rest and stress. Results Associations between group and changes in HF-HRV during stress were moderated by sleep duration mean (z = 2.24, p = .025) and variability (z = −2.78, p = .006). There were also main effects of mean sleep duration on initial HF-HRV during rest (z = −5.37, p < .001) and stress (z = −2.69, p = .007). Follow-up analyses indicated that, in bipolar adolescents during stress, shorter and longer sleep durations were associated with lower initial HF-HRV (z = −5.44, p < .001), and greater variability in sleep duration was associated with less change in HF-HRV (z = −2.18, p = .029). Conclusions Sleep durations that are relatively short or long, which are characteristic of mood episodes, are associated with parasympathetic vulnerability to social stress in adolescents with bipolar disorder. Obtaining regular sleep of moderate duration may favorably affect responses to stress in bipolar youth.

The Longitudinal Association of Reduced Vagal Tone With Burnout Objective Previous research indicates a link between burnout symptoms and reduced vagally mediated heart rate variability (HRV); however, the directionality of this relationship is still largely unknown. The objective of the present study was to examine the longitudinal relationship between HRV and burnout symptoms for 1 year, with a special focus on the emotional exhaustion (EE) burnout subdimension, which remains inadequately distinguished from overlapping with depressive symptoms. Methods Here we present HRV and behavioral data from 167 individuals (mean [SD] age = 43.43 [11.78] years; 30.5% male) who attended two biomarker samplings (T1 and T2) of the Dresden Burnout Study approximately 12 months apart. Results In hierarchical linear regression analyses, T1 HRV significantly inversely predicted T2 overall burnout symptoms (β = −.16; p = .03) and EE (β = −.23; p = .02), adjusting for age, sex, body mass index, adverse health behaviors, and depressive symptoms. Importantly, only high EE at T1 (β = −.22; p = .04), and not the T1 Maslach Burnout Inventor total score, predicted reductions in HRV from T1 to T2. Conclusions We report for the first time longitudinal evidence that HRV is associated with changes in burnout symptoms, independently of depressive symptoms. Results suggest vagal dysfunction being predictive and specific for burnout symptoms, making HRV a promising starting point for the explanation of biophysiological mechanisms underlying burnout symptoms and cardiovascular diseases. The finding of only EE at T1 being predictive for changes in HRV underscores the importance of exhaustion for modulations in autonomic regulation.

Neuroticism as a Predictor of Frailty in Old Age: A Genetically Informative Approach Objective Neuroticism is associated with poor health outcomes, but its contribution to the accumulation of health deficits in old age, that is, the frailty index, is largely unknown. We aimed to explore associations between neuroticism and frailty cross-sectionally and longitudinally, and to investigate the contribution of shared genetic influences. Methods Data were derived from the UK Biobank (UKB; n = 274,951), the Australian Over 50’s Study (AO50; n = 2849), and the Swedish Twin Registry (Screening Across the Lifespan of Twins Study [SALT], n = 18,960; The Swedish Adoption/Twin Study of Aging [SATSA], n = 1365). Associations between neuroticism and the frailty index were investigated using regression analysis cross-sectionally in UKB, AO50, and SATSA and longitudinally in SALT (25–29 years of follow-up) and SATSA (6 and 23 years of follow-up). The co-twin control method was applied to explore the contribution of underlying shared familial factors (SALT, SATSA, AO50). Genome-wide polygenic risk scores for neuroticism were used in all samples to further assess whether common genetic variants associated with neuroticism predict frailty. Results High neuroticism was consistently associated with greater frailty cross-sectionally (adjusted β [95% confidence intervals] in UKB = 0.32 [0.32–0.33]; AO50 = 0.35 [0.31–0.39]; SATSA = 0.33 [0.27–0.39]) and longitudinally up to 29 years (SALT = 0.24 [0.22–0.25]; SATSA 6 years = 0.31 [0.24–0.38]; SATSA 23 years = 0.16 [0.07–0.25]). When adjusting for underlying shared genetic and environmental factors, the neuroticism-frailty association remained significant, although decreased. Polygenic risk scores for neuroticism significantly predicted frailty in the two larger samples (meta-analyzed total β = 0.059 [0.055–0.062]). Conclusions Neuroticism in midlife predicts frailty in late life. Neuroticism may have a causal influence on frailty, whereas both environmental and genetic influences, including neuroticism-associated common genetic variants, contribute to this relationship.

Personality and Hearing Acuity: Evidence From the Health and Retirement Study and the English Longitudinal Study of Ageing Objective Several determinants of age-related hearing impairment have been identified, but little is known about the predictive value of psychological factors. The present study examined whether five-factor model personality traits are prospectively associated with hearing acuity in middle-aged and older adults. Methods Participants were adults aged 50 to 97 years (N > 10,000) drawn from the Health and Retirement Study (2012–2016) and the English Longitudinal Study of Ageing (2010–2014). In each sample, personality, demographic factors, health-related behaviors, body mass index, and memory function were assessed at baseline, and objective hearing acuity was measured 4 years later. Results In both samples, higher conscientiousness and openness were associated with better hearing acuity and lower risk of impairment, whereas neuroticism was associated with a higher risk of hearing impairment. In the Health and Retirement Study and English Longitudinal Study of Ageing, respectively, 1 standard deviation (1-SD) higher conscientiousness, 1-SD higher openness, and 1-SD lower neuroticism were related to 13% to 10%, 8% to 6%, and 10% to 13% lower likelihoods of hearing impairment, respectively. In both samples, additional analyses revealed that physical activity and memory mediated the association between personality and hearing. Conclusions The present study provides robust evidence for an association between personality traits and hearing function. The findings broaden knowledge on risk and mitigating factors for age-related hearing impairment, which has implications for the quality of life of middle-aged and older adults.

Stress-Induced Suppression of Food Intake in Overweight and Obese Adolescents Objective Overweight adolescents exhibit greater cortisol reactivity in response to acute stress and are more likely to eat in response to emotional cues, which suggest an increased susceptibility to stress-induced eating. The purpose of this study was to examine the biological (cortisol and α-amylase reactivity) and behavioral (caloric intake) responses to an acute stressor in overweight adolescents. Methods Fifty-one adolescents ages 14 to 19 years (47% female, 55% white; body mass index, 31.2 ± 0.8 kg/m2) were exposed to the Trier Social Stress Test and a control condition on separate days. Immediately after each condition, participants were provided with snacks to eat at their leisure. Reactivity was assessed via salivary cortisol and α-amylase area under the curve (AUC), and adolescents were categorized as high or low reactors. Results Cortisol AUC was higher during the stress condition (19.6 ± 0.2 μg/dl · min) compared with the control condition (11.4 ± 0.9 μg/dl · min, p < .001). α-Amylase AUC was not different during the stress condition (9999 ± 987 U/ml · min) compared with the control condition (8762 ± 865 U/ml · min, p = .145). Overall, adolescents consumed fewer calories during the stress condition (488 ± 51 kcal) compared with the control condition (637 ± 42 kcal, p = .007). High cortisol reactors decreased their calorie consumption from the control condition (716 ± 52 kcal) to the stress condition (457 ± 53 kcal, p = .001), whereas low cortisol reactors did not change their consumption (stress: 518 ± 87 kcal versus control: 561 ± 62 kcal, p = .574). Conclusion High cortisol reactivity in overweight adolescents resulted in decreased calorie consumption after an acute stressor. Further research is needed to understand the mechanisms underlying stress-induced suppression of food intake in overweight adolescents.

Social Role–Related Stress and Social Role–Related Reward as Related to Subsequent Subclinical Cardiovascular Disease in a Longitudinal Study of Midlife Women: The Study of Women's Health Across the Nation Objective The purpose of this study was to determine if midlife social role quality, defined by the stress and rewards associated with four social roles, is related to later-life subclinical cardiovascular disease (SCVD) in a cohort of women transitioning through menopause. Methods The Study of Women's Health Across the Nation (SWAN) is a longitudinal cohort study of midlife women. Stress and reward from four social roles (spouse, parent, employee, caregiver) were assessed at seven early visits. Later-life SCVD was assessed via carotid ultrasound and brachial-ankle pulse wave velocity at two later visits. We tested whether ever reporting an “extremely” or “quite a bit” stressful role was related to SCVD. We also tested whether cumulative stress and reward, as well as baseline and change in stress and reward were related to SCVD, adjusting for demographics and cardiovascular risk factors. Results Among 1602 women, reporting a stressful role during midlife (between ages 47 and 52 years) was associated with later-life (age 61 years) carotid intima-media thickness, which was 21 μm thicker than never reporting a stressful role. No significant relationships between stressful roles and other SCVD measures were identified. Cumulative and baseline change models of stress and reward were not related to SCVD. Conclusion A stressful social role in midlife was associated with greater atherosclerotic burden in later-life in a cohort of women transitioning through menopause. Social role rewards were unrelated to better later-life SCVD. These findings extend the knowledge of stress and cardiovascular disease in women by using measures of stress and reward for multiple social roles over the years of midlife.

Social Integration, Marital Status, and Ovarian Cancer Risk: A 20-Year Prospective Cohort Study Objective Low social integration and divorce/widowhood are chronic psychosocial stressors that may affect health. When assessed after cancer diagnosis, they have been associated with poorer survival, but their role in cancer development, particularly ovarian cancer (OvCA), is less understood. We investigated whether social integration and marital status were related to OvCA risk in a large population-based study. Methods Women from the Nurses’ Health Study completed the Berkman-Syme Social Network Index and reported their marital status every 4 years starting in 1992 (N = 72,206), and were followed up until 2012 (20-year follow-up period). Multivariate Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of OvCA risk, considering relevant potential confounders, in lagged analyses whereby psychosocial indicators were assessed 4 to 8 years (n = 436 cases) and 8 to 12 years (n = 306 cases) before diagnosis to account for the effects of prediagnostic symptoms on social measures. Secondary analyses evaluated the stability of and cumulative exposure to these social factors on OvCA risk. Results Being socially isolated versus integrated was related to an increased OvCA risk 8 to 12 years later (HR = 1.51, 95% CI = 1.07–2.13), but not 4 to 8 years later. Compared with married women, OvCA risk was significantly higher in widowed but not in separated/divorced individuals, with both time periods (e.g., 8–12 years later: HRwidowed = 1.57 [95% CI = 1.15–2.14] versus HRseparated/divorced = 1.13 [95% CI = 0.74–1.72]). Estimates were comparable or stronger when investigating stability in and cumulative effects of social indicators. Conclusions Results suggest higher OvCA risk among socially isolated and widowed women, particularly when such psychosocial stressors were experienced a decade before diagnosis or were sustained over time.