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Neuroticism and maladaptive coping among patients with functional somatic syndromes
Abstracts / Journal of Psychosomatic Research 78 (2015) 588–634
both recruited in those with CG when exposed to images of their deceased loved one. Reward evaluation in OFC may be functionally related to approach behaviors, and amygdala activation may drive avoidance behaviors. These neuroanatomical data will be discussed in relation to implications for treatment of CG, building on existing clinical trials of psychotherapy for this disorder. doi:10.1016/j.jpsychores.2015.03.100
One-off screen predicts future symptoms of depression and anxiety in Coronary Heart Disease J.E. Palacios, M. Khondoker, A. Tylee, M. Hotopf Institute of Psychiatry, Psychological Medicine, London, UK Background: There is a lack of evidence among longitudinal analysis than can accurately assess just how persistent symptoms of depression and anxiety are in the course of CHD, and whether an initial screen for these symptoms can predict this persistence. Currently, there is controversy surrounding the alleged benefits of screening for depression. We report on a longitudinal, multi-wave analysis of a primary care cohort of CHD patients, with the aim of determining the differences of reporting positive symptoms of depression and anxiety amongst people with a baseline positive and negative screen. Method: The population used for this study is the cohort conducted by the UPBEAT UK research programme, consisting of 803 patients on CHD registers in general practices throughout South London. Baseline measures using the Hospital Anxiety and Depression Scale (HADS) for depression and anxiety were then repeated at 6, 12, 18, 24, 30, and 36 months. Using a multi-level, mixed effects model, we determined the positive and negative predictive values (PPV and NPV) for baseline screen of depression and anxiety symptoms using a cutoff of 13 on the HADS-total, and also determined the PPV and NPV for two consecutive screens (baseline + 6 months). Results: Patients who had increased anxiety and depression at baseline (cutoff of 8 on HADS-D, HADS-A) continued to have high scores on the HADS in 61.2 and 59.7% of time points, respectively. Among patients who had low scores at baseline the values were 9.7 and 9.3%. The PPV of a baseline screen for symptoms of distress (HADS-total) was 67.8%, and the NPV was 95.7%. When measuring both baseline and 6-month positive screens for HADS-total, the PPV rose to 86.7%, whilst the NPV dropped to 79.5%. Conclusion: There is a large difference of the continuing reporting of symptoms between patients with scores above and below the cut-off on the HADS at baseline. Results suggest that a single, one-off screen can be used both to identify and follow-up at-risk patients who screen positive, and to remove from follow-up those patients who screen negative. Two consecutive positive screens further suggest the strong predictive value of this measure. We believe these results show that screening for depression and anxiety symptoms in CHD population is a valid and necessary measure to identify patients at risk for the detrimental outcomes associated with this comorbidity. doi:10.1016/j.jpsychores.2015.03.101
Neuroticism and maladaptive coping among patients with functional somatic syndromes H.F. Pedersen, L.B. Frostholm, E. Oernboel, J. Jensen, Søndergaard, A. Schröder Aarhus University Hospital, Research Clinic for Functional Disorders and Psychosomatics, Aarhus N, Denmark Background: The etiology of functional somatic syndromes (FSS) such as fibromyalgia, chronic fatigue syndrome, and irritable bowel
617
syndrome is considered multi-factorial consisting of predisposing, precipitating, and perpetuating factors. In this study, we sought to investigate three questions that can be drawn from the cognitivebehavioural model of FSS: 1) Do patients with FSS show higher levels of neuroticism than healthy individuals? 2) Does neuroticism affect physical health and illness worry, either directly or indirectly through coping strategies? 3) Does more adaptive coping mediate the effect of CBT on physical health and illness worry? Method: We used data from a randomized controlled trial in which 120 patients with a range of FSS were randomized to group CBT or enhanced usual care. Patients completed questionnaires at referral, baseline, and 4, 10, and 16 months after randomization. Our hypotheses were explored through a series of cross-sectional (linear regression and structural equation models) and longitudinal (multiple mediation) analyses. Results: Patients with FSS had significantly higher levels of neuroticism than the general population, Cohen's d = 1.13 (95% CI: 0.87; 1.38), and neuroticism was cross-sectionally associated with more illness worrying and higher catastrophizing. Mediation analyses at baseline found catastrophizing to mediate the association between neuroticism and illness worry and between neuroticism and poorer physical health. Finally, decreased symptom catastrophizing and increased experience of control partially mediated the long-term effect of CBT on both improved physical health, SIE = 1.994 (BCa 95% CI: 0.435; 3.983) and reduced illness worry, SIE = −0.214 (BCa 95% CI: −0.423; −0.053). Conclusion: The results support a cognitive-behavioural model of FSS. Targeting symptom catastrophizing may be an essential component in CBT for patients with a range of FSS. doi:10.1016/j.jpsychores.2015.03.102
WEB-based distress management program for implantable CARdioverter dEfibrillator patients (WEBCARE): Results and lessons learnt S. Pedersena,b, M. Habibovicd, J. Denolletd, P. Cuijperse, V.R.M. Spekd, K.C. Van Den Broekd, L. Warmerdame, P.H. Van Der Voortf, J.-P. Herrmang, L. Bouwelsh, S.D. Valki, M. Alingsj, D. Theunsc a University of Southern Denmark, Dept. of Psychology, Odense, Denmark, b Odense University Hospital, Dept. of Cardiology, Odense, Denmark, c Thoraxcenter, Erasmus Medical Center, Dept. of Cardiology, Rotterdam, The Netherlands, d Tilburg University, CoRPS-Dept. of Medical and Clinical Psychology, Tilburg, The Netherlands, e Vrije University, Dept. of Clinical Psychology, Amsterdam, The Netherlands, f Catharina Hospital, Dept. of Cardiology, Eindhoven, The Netherlands, g Onze Lieve Vrouwe Gasthuis Hospital, Dept. of Cardiology, Amsterdam, The Netherlands, h Canisius-Wilhelmina Hospital, Dept. of Cardiology, Nijmegen, The Netherlands, i Vlietland Hospital, Dept. of Cardiology, Schiedam, The Netherlands, j Amphia Hospital, Dept. of Cardiology, Breda, The Netherlands Background: The implantable cardioverter defibrillator (ICD) is the mainstay of treatment for the prevention of sudden cardiac death due to life-threatening tachyarrhythmias. Although the device is generally well accepted, one in four patients suffer from anxiety and depression. Distress in ICD patients is associated with a 2-fold risk for premature death, warranting intervention. We will present the results of WEBCARE – the first e-health trial in ICD patients – and discuss lessons learnt and how to move the field forward to optimise patient care. Method: Consecutive patients (n = 289) implanted with a first-time ICD and recruited from six implanting centres were randomised to
both recruited in those with CG when exposed to images of their deceased loved one. Reward evaluation in OFC may be functionally related to approach behaviors, and amygdala activation may drive avoidance behaviors. These neuroanatomical data will be discussed in relation to implications for treatment of CG, building on existing clinical trials of psychotherapy for this disorder. doi:10.1016/j.jpsychores.2015.03.100
One-off screen predicts future symptoms of depression and anxiety in Coronary Heart Disease J.E. Palacios, M. Khondoker, A. Tylee, M. Hotopf Institute of Psychiatry, Psychological Medicine, London, UK Background: There is a lack of evidence among longitudinal analysis than can accurately assess just how persistent symptoms of depression and anxiety are in the course of CHD, and whether an initial screen for these symptoms can predict this persistence. Currently, there is controversy surrounding the alleged benefits of screening for depression. We report on a longitudinal, multi-wave analysis of a primary care cohort of CHD patients, with the aim of determining the differences of reporting positive symptoms of depression and anxiety amongst people with a baseline positive and negative screen. Method: The population used for this study is the cohort conducted by the UPBEAT UK research programme, consisting of 803 patients on CHD registers in general practices throughout South London. Baseline measures using the Hospital Anxiety and Depression Scale (HADS) for depression and anxiety were then repeated at 6, 12, 18, 24, 30, and 36 months. Using a multi-level, mixed effects model, we determined the positive and negative predictive values (PPV and NPV) for baseline screen of depression and anxiety symptoms using a cutoff of 13 on the HADS-total, and also determined the PPV and NPV for two consecutive screens (baseline + 6 months). Results: Patients who had increased anxiety and depression at baseline (cutoff of 8 on HADS-D, HADS-A) continued to have high scores on the HADS in 61.2 and 59.7% of time points, respectively. Among patients who had low scores at baseline the values were 9.7 and 9.3%. The PPV of a baseline screen for symptoms of distress (HADS-total) was 67.8%, and the NPV was 95.7%. When measuring both baseline and 6-month positive screens for HADS-total, the PPV rose to 86.7%, whilst the NPV dropped to 79.5%. Conclusion: There is a large difference of the continuing reporting of symptoms between patients with scores above and below the cut-off on the HADS at baseline. Results suggest that a single, one-off screen can be used both to identify and follow-up at-risk patients who screen positive, and to remove from follow-up those patients who screen negative. Two consecutive positive screens further suggest the strong predictive value of this measure. We believe these results show that screening for depression and anxiety symptoms in CHD population is a valid and necessary measure to identify patients at risk for the detrimental outcomes associated with this comorbidity. doi:10.1016/j.jpsychores.2015.03.101
Neuroticism and maladaptive coping among patients with functional somatic syndromes H.F. Pedersen, L.B. Frostholm, E. Oernboel, J. Jensen, Søndergaard, A. Schröder Aarhus University Hospital, Research Clinic for Functional Disorders and Psychosomatics, Aarhus N, Denmark Background: The etiology of functional somatic syndromes (FSS) such as fibromyalgia, chronic fatigue syndrome, and irritable bowel
617
syndrome is considered multi-factorial consisting of predisposing, precipitating, and perpetuating factors. In this study, we sought to investigate three questions that can be drawn from the cognitivebehavioural model of FSS: 1) Do patients with FSS show higher levels of neuroticism than healthy individuals? 2) Does neuroticism affect physical health and illness worry, either directly or indirectly through coping strategies? 3) Does more adaptive coping mediate the effect of CBT on physical health and illness worry? Method: We used data from a randomized controlled trial in which 120 patients with a range of FSS were randomized to group CBT or enhanced usual care. Patients completed questionnaires at referral, baseline, and 4, 10, and 16 months after randomization. Our hypotheses were explored through a series of cross-sectional (linear regression and structural equation models) and longitudinal (multiple mediation) analyses. Results: Patients with FSS had significantly higher levels of neuroticism than the general population, Cohen's d = 1.13 (95% CI: 0.87; 1.38), and neuroticism was cross-sectionally associated with more illness worrying and higher catastrophizing. Mediation analyses at baseline found catastrophizing to mediate the association between neuroticism and illness worry and between neuroticism and poorer physical health. Finally, decreased symptom catastrophizing and increased experience of control partially mediated the long-term effect of CBT on both improved physical health, SIE = 1.994 (BCa 95% CI: 0.435; 3.983) and reduced illness worry, SIE = −0.214 (BCa 95% CI: −0.423; −0.053). Conclusion: The results support a cognitive-behavioural model of FSS. Targeting symptom catastrophizing may be an essential component in CBT for patients with a range of FSS. doi:10.1016/j.jpsychores.2015.03.102
WEB-based distress management program for implantable CARdioverter dEfibrillator patients (WEBCARE): Results and lessons learnt S. Pedersena,b, M. Habibovicd, J. Denolletd, P. Cuijperse, V.R.M. Spekd, K.C. Van Den Broekd, L. Warmerdame, P.H. Van Der Voortf, J.-P. Herrmang, L. Bouwelsh, S.D. Valki, M. Alingsj, D. Theunsc a University of Southern Denmark, Dept. of Psychology, Odense, Denmark, b Odense University Hospital, Dept. of Cardiology, Odense, Denmark, c Thoraxcenter, Erasmus Medical Center, Dept. of Cardiology, Rotterdam, The Netherlands, d Tilburg University, CoRPS-Dept. of Medical and Clinical Psychology, Tilburg, The Netherlands, e Vrije University, Dept. of Clinical Psychology, Amsterdam, The Netherlands, f Catharina Hospital, Dept. of Cardiology, Eindhoven, The Netherlands, g Onze Lieve Vrouwe Gasthuis Hospital, Dept. of Cardiology, Amsterdam, The Netherlands, h Canisius-Wilhelmina Hospital, Dept. of Cardiology, Nijmegen, The Netherlands, i Vlietland Hospital, Dept. of Cardiology, Schiedam, The Netherlands, j Amphia Hospital, Dept. of Cardiology, Breda, The Netherlands Background: The implantable cardioverter defibrillator (ICD) is the mainstay of treatment for the prevention of sudden cardiac death due to life-threatening tachyarrhythmias. Although the device is generally well accepted, one in four patients suffer from anxiety and depression. Distress in ICD patients is associated with a 2-fold risk for premature death, warranting intervention. We will present the results of WEBCARE – the first e-health trial in ICD patients – and discuss lessons learnt and how to move the field forward to optimise patient care. Method: Consecutive patients (n = 289) implanted with a first-time ICD and recruited from six implanting centres were randomised to