Search PubMed⌕ Search

Biomedical subjects

I C Siegler

Publications and source records attributed to I C Siegler.

At least 37 records · Page 2Linked to original sources
PubMed1999

The association between self-rated health and mortality in a well-characterized sample of coronary artery disease patients.

BACKGROUND: The relationship between self-rated health and mortality after adjustment for sociodemographic variables, physician-rated comorbidities, disease severity, health-related quality of life (HRQOL), and psychosocial measures (depression, social support, and functional ability) was examined in the Mediators of Social Support (MOSS) study. SUBJECTS: The sample consisted of 2,885 individuals (mean age, 62.5 years) who had significant heart disease based upon heart catheterization. RESULTS. Using Cox proportional survival analysis, individuals who rated their health as "fair" or "poor" had a significantly greater likelihood of all-cause mortality (OR = 2.13; CI = 1.40-3.23; OR = 4.92; CI = 3.24-7.46, respectively) across follow-up (mean, 3.5 years) than those who rated their health as "very good" after considering sociodemographic factors. After adjustment for comorbidities, disease severity, HRQOL, psychosocial factors, and demographic variables, only those who rated their health as poor had a significant greater risk of mortality (OR = 2.96, CI = 1.80-4.85). A similar pattern was observed for coronary artery disease (CAD)-related mortality; increased adjustment of variables weakened the relationship between self-rated health and mortality. Individuals who rated their health as poor had a significantly greater risk of CAD-related mortality than did those who rated their health as very good (poor vs. very good OR = 3.58, CI = 2.13-6.02) after adjustment for all available mortality risk factors. CONCLUSIONS: This study indicates that it is important to include self-rated health when studying risk factors for mortality. Not adjusting for relevant factors may provide an overestimation of the effects of self-rated health on mortality in a sample of CAD patients.

Activities of Daily Living↗
PubMed1999

The relationship between self-rated health and health status among coronary artery patients.

OBJECTIVES: This study examined the descriptive relationship of self-rated health (SRH) with various psychosocial measures, sociodemographic variables, coronary artery disease (CAD) diagnostic/clinical measures, and medically abstracted comorbidities. METHODS: The sample was 2,855 individuals from the Mediators of Social Support (MOSS) study who had at least 75% narrowing in more than one vessel, as indicated by a cardiac catheterization. RESULTS: After adjusting for sociodemographic factors, individuals who rated their health as poor/fair had significantly worse performance on all psychosocial measures and were more likely to be female, non-White, and of a lower socioeconomic status than those who rated their health as being good or better. There were few differences on SRH across various diagnostic/clinical measures of health. DISCUSSION: A single item measure of SRH may be useful; the generalizability of the item must be considered. In this sample of CAD patients, SRH was related more to psychosocial factors than to clinical and disease indicators.

Adult↗
PubMed1998

Magnetic resonance imaging correlates of depression in early- and late-onset Alzheimer's disease.

BACKGROUND: Depressive symptoms are frequent complications of Alzheimer's disease (AD). We hypothesized that AD patients with depression would be more likely than nondepressed AD patients to show deep white-matter, subcortical gray-matter, and periventricular hyperintensities on magnetic resonance imaging (MRI). METHODS: In a retrospective study of 31 AD patients, depression was characterized by clinical diagnosis (DSM-III-R major depression, depressive symptoms, or no depression), a clinician-rated depression scale, and informant ratings of premorbid (before memory disorder) as well as current depression using the NEO Personality Inventory (NEO-PI), and related to qualitative and quantitative ratings of MRI hyperintensities. RESULTS: In contrast to reports in nondemented elderly patients, there was no relationship between clinical diagnosis of major depressive episode and hyperintensities; however, clinician-rated depressive symptoms were higher in subjects with large anterior hyperintensities. In the early-onset AD group only, MRI abnormalities were related to greater premorbid depression, and less increase in depression after the onset of dementia, as rated by informants on the NEO-PI. CONCLUSIONS: Results highlight the need to consider early- and late-onset AD separately when assessing relationships between personality and MRI abnormalities, and to consider premorbid personality style when drawing conclusions about the etiology of depressive features seen in AD.

Age of Onset↗
PubMed1998

Measures of hostility as predictors of facial affect during social interaction: evidence for construct validity.

We assessed the construct validity of several self-report measures and an interview-based measure of hostility (Interpersonal Hostility Assessment Technique [IHAT]) by evaluating their associations with a behavioral indicator of hostile emotions (facial expressions during social interaction). Participants in the study were 123 volunteers (44% males and 56% females) who were recruited from local community organizations. Self-report measures (Cook-Medley Hostility Scale, Rotter Interpersonal Trust Scale, Buss-Durkee Hostility Inventory, and Spielberger Anger Expression Scale) were represented by factor scores reflecting Overt Hostility, Covert Hostility, and Hostile Beliefs. A canonical correlation analysis identified significant associations between a set of facial affect scores reflecting animosity and various measures of hostility. Specifically, increases in anger and disgust expressions and decreases in happy facial expressions were associated with high IHAT scores and high scores on self-report measures of Hostile Beliefs and Covert Hostility. Women were more expressive than men, especially concerning positive affect, and women had lower scores on self-report measures of Hostile Beliefs and Overt Hostility. IHAT scores were uncorrelated with any of the self-report factors which suggests the two assessment techniques are tapping different aspects of the hostility construct.

Adult↗
PubMed1998

Psychosocial stress moderates the relationship of cancer history with natural killer cell activity.

Data suggest that both cancer history and psychosocial stress may be associated with reductions in natural killer cell activity (NKA). Therefore, we tested whether individual differences in cancer history, chronic/perceived stress, and their interactions would be associated with decreased levels of NKA. We tested these hypotheses in 80 spouse caregivers of victims of Alzheimer's Disease (AD) (persons known to report high levels of psychosocial stress) and in 85 age- and sex-matched spouses of non-demented controls. Participants were assessed at study entry (Time 1) and 15-18 months later (Time 2). Individuals with cancer histories (N = 43) had not been treated with immune altering medications within the last year. At both Times 1 and 2, cross-sectional main effects were weak or absent for cancer history, perceived stress (e.g. high hassles, low uplifts), and caregiver status; however, interactions occurred between cancer history and perceived stress, such that persons with cancer histories and high hassles/low uplifts had the lowest NKA values (p < .05). These results occurred even after controlling for age, gender, beta-blocker use, hormone replacement therapy, alcohol, and exercise. At Time 1, an interaction also occurred between caregiver status and cancer history--caregivers with cancer histories had lower NKA than did controls with cancer histories and caregivers/controls without cancer histories (p < .05). At Time 2, this interaction only showed a trend (p < .08), primarily because caregivers with cancer histories experienced increases in NKA (p < .05) from Time 1 to Time 2, whereas in the other three groups NKA did not change. Importantly, in caregivers with cancer histories, high perceived stress at Time 1 predicted low NKA at Time 2 (p < .05). This research suggests that the combinations of biological vulnerabilities and chronic/perceived stress may have interactive effects resulting in reduced NKA.

Aged↗
PubMed1998

Trust, health, and longevity.

Scores on the Rotter Interpersonal Trust Scale were evaluated as predictors of psychological well-being, functional health, and longevity in a sample of 100 men and women who were between 55 and 80 years old at baseline (mean age 66.8). Cross-sectionally, high levels of trust were associated with better self-rated health and more life satisfaction. Follow-up over approximately 8 years found baseline levels of trust to be positively related to subsequent functional health, but not to subsequent life satisfaction. Mortality follow-up after 14 years demonstrated that those with high levels of trust had longer survival (p = .03), a finding that was somewhat weakened by controlling for baseline health ratings. These findings illustrate the health protective effects of high levels of trust and suggest the potential usefulness of the trust concept for understanding successful aging.

Activities of Daily Living↗
PubMed1998

Coronary heart disease moderates the relationship of chronic stress with the metabolic syndrome.

Metabolic syndrome levels (MSLs) were compared in caregivers (CGs) of spouses with Alzheimer's disease who had diagnoses of coronary heart disease (CHD; n = 27) with non CGs with CHD diagnoses (n = 18), and CGs (n = 44) to non CGs (n = 52) free of CHD. MSLs were greater for CGs than non CGs, but only in persons with CHD (CHD, B for CG status = -.41; non CHD, B = .12; p < .05) at study entry (Time 1 = T1) and CHD, B = -.32; non CHD, B = .14; p < .05) 15-18 months later (Time 2 = T2). In the CHD group, MSLs were associated with poorer health habits at T1 (r = .39, p < .01), uplifts (r = -.37, p < .01) at T2, and CG status (p < .05) at T1 and T2. Relationships of CG status and MSLs declined in the presence of poor health habits at T1 and uplifts at T2. Poorer health habits and fewer uplifts may be associated with elevated MSLs in CGs with CHD.

Aged↗
PubMed1998

Symptoms of depression and changes in body weight from adolescence to mid-life.

OBJECTIVE: To investigate the relationship of symptoms of depression to weight changes in healthy individuals of normal weight across a follow-up of over 20 y. PARTICIPANTS AND DESIGN: College students (3885 men and 841 women) were administered a self-report depression measure in the mid-1960s. Their baseline body mass index (BMI) was calculated from their college medical records. Participants were contacted by mail in the late 1980s and asked to report their current height and weight as well as their smoking and exercise habits. Another measure of depressive symptoms was obtained from 3560 individuals at follow-up. Multiple regression models were used to relate changes in weight to depression scores while controlling for background (gender, baseline BMI and the gender by BMI interaction) and behavioral (exercise and smoking) predictors. RESULTS: The relationship between depressive symptoms and body weight change took the form of an interaction with baseline BMI (P < 0.001). Those with high baseline depression scores gained less weight than their nondepressed counterparts if they were initially lean, but more if they were initially heavy. This trend was especially strong in those with high depression scores at both baseline and follow-up. CONCLUSIONS: The findings support the hypothesis that depression exaggerates pre-existing weight change tendencies. This pattern would not have been detected by an examination of main effects alone, illustrating the need to move toward more complicated interactive models in the study of psychological factors and weight.

Adolescent↗
PubMed1998

Differences in providers' beliefs about benefits and risks of hormone replacement therapy in managed care.

Our objective was to determine if physician beliefs about the benefits and risks of hormone replacement therapy (HRT) differ by physician gender or specialty in a managed care setting. In a cross-sectional survey of providers in a health maintenance organization in North Carolina, 105 gynecologists, internists, and family physicians and physician assistants were surveyed, and 74 providers completed and returned the survey (70.5% response rate). Providers' beliefs about the benefits and risks of HRT differed by specialty and gender of physician. Gynecologists are significantly less concerned about the potential risks of HRT on breast cancer (p = 0.004) and thromboembolic events (p = 0.005) compared with family physicians and internists. Female providers across the three specialty categories were significantly different from their male colleagues in their beliefs about the benefits of HRT with regard to the reduction in risk of heart disease (79% versus 64%, p = 0.001), osteoporosis (83% versus 75%, p = 0.045), and Alzheimer's disease (45% versus 26%, p = 0.026). There was a trend toward female physicians being more convinced about the risks of breast cancer than their male colleagues (p = 0.08). Our results suggest that providers in a managed care setting vary in their beliefs about the benefits and risks of HRT, and this may affect provider-patient discussions about HRT.

Attitude of Health Personnel↗
PubMed1997

Psychosocial correlates of job strain in a sample of working women.

BACKGROUND: This study identifies potential mediators of job strain effects on health by determining whether psychosocial factors known to predict an increased risk of cardiovascular disease and all-cause mortality are higher among women who report high levels of job strain. METHODS: Measures of job strain and other psychosocial risk factors were obtained in a sample of 152 female employees of a local corporation. Canonical correlation and analyses of covariance were used to assess relationships between job demands and decision latitude and other psychosocial risk factors. RESULTS: A significant (P = .002) solution to the canonical correlation analysis showed that high job demands and low decision latitude were correlated with a pattern of psychosocial factors consisting of (1) increased levels of negative emotions like anxiety, anger, depression, and hostility; (2) reduced levels of social support; and (3) a preponderance of negative compared with positive feelings in dealings with coworkers and supervisors. This pattern was confirmed by analyses of covariance that adjusted for demographic and specific job characteristics. CONCLUSIONS: The canonical correlation analysis results provide empirical support for the job strain construct. The most important finding is that health-damaging psychosocial factors like job strain, depression, hostility, anxiety, and social isolation tend to cluster in certain individuals.

Adult↗
PubMed1997

Surrogate assessment of coronary artery disease patients' functional capacity.

An investigation of the surrogate assessment of coronary artery disease (CAD) patients' functional capacity was conducted using 193 patient and surrogate rater dyads. Mean age of patients and surrogate raters were 60.4 and 54.4 years, respectively. Patients and surrogates independently completed a brief questionnaire that assessed health and psychosocial factors. The Duke Activity Status Index (DASI) was contained in the patients' questionnaire, while a similar form modified to assess patients' functional capacity was imbedded in the surrogates' questionnaire. Results indicated similar psychometric characteristics and clinical validity for patients' self-report and surrogates' ratings, suggesting that the Surrogate Rating Form of the Duke Activity Status Index (DASI-SRF) is a reliable and valid proxy method of assessing patient's functional capacity when this information may not be obtained directly from the patient. Further, while there were no effects of surrogates' health and psychological characteristics on their ratings of patients' functional capacity, in comparison with other surrogates, spouses were more likely to rate patients higher in functional capacity. Exploration of the patient/care provider relationship via concurrent use of the DASI and DASI-SRF is discussed.

Adult↗
PubMed1997

Stability in extraversion and aspects of social support at midlife.

This investigation used participants from the University of North Carolina Alumni Heart Study in an exploration of extraversion and aspects of social support at midlife. Results indicated that extraversion measured at college entry and at midlife was positively correlated with social activity and perceived social support measured later in middle adulthood. Multiple regression correlational analyses suggested that both the stable and changing components of extraversion influence structural and functional aspects of social support. Further, the changing component of extraversion was found to be significantly associated with greater social activity, perceived social support, and an increased likelihood of seeking support when faced with a stressful problem in middle adulthood. Overall, the development of sociability and outgoingness in interpersonal relationships during adolescence and young adulthood is suggested to be an important antecedent of the structural characteristics and functional dynamics of social support at midlife.

Adaptation, Psychological↗
PubMed1997

Perceptions of menopausal stage and patterns of hormone replacement therapy use.

In 1994, as part of their participation in the University of North Carolina Alumni Heart Study, 1101 women aged 45-51 years answered questions about their menopausal status and current use of hormone replacement therapy (HRT). Little is known about the use of HRT in younger women. We were interested in determining both patterns of HRT use and patient characteristics associated with HRT use in this cohort of women approaching the average age of menopause. After excluding women with breast, endometrial, and ovarian cancer, we studied 1080 women. These women identified themselves as: "There is no indication that I am near menopause" (stage 1, n = 326), "I think I may be close to or in the beginning stages of menopause but am not sure" (stage 2, n = 410), "I have begun menopause" (stage 3, n = 202), and "I have been through menopause" (stage 4, n = 142). The overall rate of HRT use was 22% (0% in stage 1, 8% in stage 2, 52% in stage 3, and 76% in stage 4). Both patterns of HRT use and patient characteristics associated with HRT use differed based on the woman's perception of her menopausal stage. In logistic regression models, where HRT use was the outcome variable, independent predictors of HRT use included stage of menopause, having had a hysterectomy, having had a bilateral oophorectomy, no family history of breast cancer, having had a pelvic examination in the last year, being married, and not participating regularly in physical exercise. A woman's perception of her stage in the process of reproductive aging correlates with her use of HRT. Informed decision making about HRT use should be tailored to the individual's perception of her menopausal stage.

Data Collection↗
PubMed1997

Relation of mood ratings and neurohormonal responses during daily life in employed women.

Diurnal variations in urinary norepinephrine, epinephrine, cortisol, and self-reported mood states were examined in 101 employed women. Urine was collected on 2 consecutive workdays at 3 time periods: (1) overnight, (2) daytime, and (3) evening. Self-reports of 14 mood states were combined to correspond with the urinary collection periods. Factor analyses revealed 3 mood factors: Pressured (rushed, busy, stressed, hassled, and tense), Distressed (afraid, depressed, bored, and nervous), and Contented (satisfied, thoughtful, excited, and calm). The Distressed factor was significantly associated with norepinephrine excretion (p <.001). The Pressured factor was significantly associated with cortisol, epinephrine, and norepinephrine excretion (p <.001) independent of age, ethnicity, marital status, parental status, department within the company and activity level. Secretion of urinary hormones and the Pressured factor followed the same diurnal pattern. Specifically, as women's self-ratings of feeling pressured initially increased and then decreased over the course of the workday, urinary hormones also peaked and then dropped. Once time of day was statistically controlled, however, the mood factors were no longer significantly related to the urinary hormones.

Journal Article↗
PubMed1996

Depression and long-term mortality risk in patients with coronary artery disease.

Previous research has established that patients with coronary artery disease (CAD) have an increased risk of death if they are depressed at the time of hospitalization. Follow-up periods have been short in these studies; therefore, the present investigation examined this phenomenon over an extended period of time. Patients with established CAD (n = 1,250) were assessed for depression with the Zung Self-Rating Depression Scale (SDS) and followed for subsequent mortality. Follow-up ranged up to 19.4 years. SDS scores were associated with increased risk of subsequent cardiac death (p = 0.002) and total mortality (p < 0.001) after controlling for initial disease severity and treatment. Patients with moderate to severe depression had a 69% greater odds of cardiac death and a 78% greater odds of mortality from all causes than nondepressed patients. Increased risk was not confined to the initial months after hospitalization. Patients with high SDS scores at baseline still had a higher risk of cardiac death > 5 years later (p < 0.005). Compared with the nondepressed, patients with moderate to severe depression had an 84% greater risk 5 to 10 years later and a 72% greater risk after > 10 years. Patients with mild depression had intermediate levels of risk in all models. The heightened long-term risk of depressed patients suggests that depression may be persistent or frequently recurrent in CAD patients and is associated with CAD progression, triggering of acute events, or both.

Coronary Disease↗
PubMed1996

Correlates of perceived social support and equality of interpersonal relationships at mid-life.

An investigation into the correlates of perceived social support and the equality of interpersonal relationships at mid-life was conducted using a sample of 3954 adults from the University of North Carolina Alumni Heart Study (UNCAHS). Participants ranged in age from forty to fifty years. Results suggested that while the number of family roles and social activities are the same for men and women, women perceive a greater availability of social support and report they give more than they take in relationships with family. There was no association found between the perceived availability of social support and global indices of equality of interpersonal relationships; suggesting an independence between these two psychological aspects of social support. Further, multiple regression correlational analyses indicated gender, level of social activity, and self-esteem as significant predictors of perceived social support; with self-esteem being the best single predictor. Relatedly, gender and number of children were found to be significant predictors of the perceived equality of relationships with family. These findings suggest differences in mid-life men and women's psychological perception of the availability of social support, and the give and take of relationships with family.

Adult↗