Biomedical subjects

I C Siegler

Publications and source records attributed to I C Siegler.

82 records · Page 5Linked to original sources

PubMedDate not supplied

Predicting personality in adulthood from college MMPI scores: implications for follow-up studies in psychosomatic medicine.

To assess the long-term predictive utility of Minnesota Multiphasic Personality Inventory (MMPI) content scales, 1,960 individuals who had completed the MMPI in college in 1964 or 1965 were administered two measures of adult personality, the NEO Personality Inventory (NEO-PI) and the Cook and Medley MMPI Hostility scale, in 1988. A comparison group of 274 men and women in the Baltimore Longitudinal Study of Aging were given both MMPI and NEO-PI between 1981 and 1987. Predictive correlations between MMPI scales and NEO-PI factors were qualitatively similar to concurrent correlations, but approximately half as large in magnitude. Theoretically, these correlations were interpreted to mean that about half the variance in basic dimensions of personality is stable from college age into middle adulthood. Practically, the relatively modest correlations suggest that predictive studies of medical outcomes probably require large samples, and that baseline data from adults (e.g., over age 30) may be more useful for future studies. The combination of stability and change suggests that the decade of the 20s may be a particularly fruitful time to conduct research on interventions to alter personality and their effects on health outcomes.

Adolescent↗

PubMedDate not supplied

Caffeine and cholesterol: interactions with hostility.

The consumption of caffeinated beverages has been linked to elevated serum cholesterol and an increased risk of coronary disease, although the relationships are inconsistent across studies and remain controversial. The effect of caffeine on cholesterol and coronary disease risk may be modulated by other factors. Using cohort data from a subsample of the University of North Carolina Alumni Heart Study, we investigated whether the relationships between caffeinated beverage consumption and serum lipid and lipoprotein levels in middle-aged men and women were modulated by levels of trait hostility. After adjustment for other risk factors, higher caffeinated beverage intake was associated with higher low-density lipoprotein cholesterol levels and a higher ratio of total to high-density lipoprotein cholesterol, both indicative of greater coronary disease risk. The interactive effects of hostility and caffeine intake were ambiguous, although there were trends for caffeine intake to have stronger effects on low-density lipoprotein and on total cholesterol in people with less hostility. Additional studies of personality characteristics and other factors that can modulate the cholesterol-raising effects of coffee drinking may be warranted because they might clarify the health consequences associated with coffee drinking and lead to the identification of individuals who would benefit most from changes in their coffee drinking.

Adult↗

PubMedDate not supplied

Stress in employed women: impact of marital status and children at home on neurohormone output and home strain.

OBJECTIVE: To evaluate the biological and psychological effects of role overload, we examined the effects of marital (or partnership) status and parental status (defined as having children at home) on daily excretion of urinary catecholamines and cortisol in a sample of 109 employed women. Other measures included work and home strain, and social support. METHODS: Urine collection was conducted on two consecutive workdays in three separate aliquots, a) overnight, b) daytime, and c) evening. Repeated-measures analysis of covariance with age and caffeine consumption as covariates was conducted on levels of epinephrine, norepinephrine, and cortisol in the three aliquots averaged across the 2 days. RESULTS: We found a significant main effect of parental status on 24-hour cortisol excretion, (p < .01) such that women with at least one child living at home excreted significantly more cortisol, independent of marital status or social support. Women with children at home also reported higher home strain (p < .001) but not work strain. A significant period of day effect for catecholamine levels was found (norepinephrine, p < .001; epinephrine, p < .0001) with all subjects showing an increase during the workday and little or no decline in levels during the evening. Catecholamine levels were unrelated to marital status, parental status, or social support. CONCLUSIONS: These findings indicate that working women with children at home, independent of marital status or social support, excrete greater amounts of cortisol and experience higher levels of home strain than those without children at home.

Adult↗

PubMedDate not supplied

Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study.

OBJECTIVE: Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients. METHOD: A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age. RESULTS: Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age. CONCLUSIONS: Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.

Adult↗

PubMedDate not supplied

Depressive symptoms and survival of patients with coronary artery disease.

OBJECTIVE: Multiple studies have shown that high levels of depressive symptoms increase the mortality risk of patients with established coronary disease. This investigation divided depressive symptoms into groups to assess their relative effectiveness in predicting survival. METHODS: Questionnaires about the presence of depressive symptoms were administered to 1250 patients with significant coronary disease while they were hospitalized for diagnostic coronary angiography. Follow-up for mortality due to cardiac disease was conducted annually for up to 19.4 years. Factor analysis was used to divide items on the Zung Self-Rating Depression Scale into four groups: Well-Being, Negative Affect, Somatic, and Appetite. In addition, responses to a single item regarding feelings of hopelessness were available for 920 patients. RESULTS: Well-Being and Somatic symptoms significantly predicted survival (p < or = .01). Negative Affect items were also related to survival (p = .0001) and interacted with age. A 2-SD difference in the Negative Affect term was associated with a relative risk of 1.29 for patients >50 years old and 1.70 for younger ones. Only Negative Affect remained significant in a model with the other symptom groups. Hopelessness also predicted survival with a relative risk of 1.5. Both the Hopelessness and Negative Affect items remained as independent predictors in the same model. All models controlled for severity of disease and treatment. With one exception (income and Hopelessness), results were essentially unchanged by additional controls for age, gender, and income. CONCLUSIONS: Depressive symptoms differentially predicted survival, with depressive affect and hopelessness being particularly important. These effects were independent of disease severity and somatic symptoms and may be especially important in younger patients.

Coronary Disease↗

PubMedDate not supplied

Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality.

OBJECTIVES: Social isolation has been linked to poor survival in patients with coronary artery disease (CAD). Few studies have closely examined the psychosocial characteristics of CAD patients who lack social contact. METHODS: Social isolation was examined as a predictor of mortality in 430 patients with significant CAD. More isolated patients were compared with their less isolated counterparts on factors that might help explain the association between isolation and survival. RESULTS: The mortality rate was higher among isolated individuals. Those with three or fewer people in their social support network had a relative risk of 2.43 (p = .001) for cardiac mortality and 2.11 (p = .001) for all-cause mortality, controlling for age and disease severity. Adjustments for income, hostility, and smoking status did not alter the risk due to social isolation. With the exception of lower income, higher hostility ratings, and higher smoking rates, isolated patients did not differ from nonisolated patients on demographic indicators, disease severity, physical functioning, or psychological distress. Isolated patients reported less social support and were less pleased with the way they got along with network members, but they did not report less satisfaction with the amount of social contact received. CONCLUSIONS: Patients with small social networks had an elevated risk of mortality, but this greater risk was not attributable to confounding with disease severity, demographics, or psychological distress. These findings have implications for mechanisms linking social isolation to mortality and for the application of psychosocial interventions.

Aged↗

PubMedDate not supplied

Central nervous system serotonin function and cardiovascular responses to stress.

OBJECTIVE: The objective of this study was to evaluate the impact of indices of central nervous system (CNS) serotonin function on cardiovascular reactivity to mental stress. METHODS: Lumbar puncture was performed on 54 healthy volunteers to obtain cerebrospinal fluid (CSF) for determination of 5-hydroxyindoleacetic acid (5HIAA) levels. Genotypes were determined with respect to a functional polymorphism of the serotonin transporter gene promoter region (5HTTLPR). Subjects then underwent mental stress testing. RESULTS: Persons with one or two long (l) 5HTTLPR alleles had CSF levels of the major serotonin metabolite, 5HIAA, that were 50% higher than those of persons with the s/s 5HTTLPR genotype. Persons with one or two l alleles or higher CSF 5HIAA levels also exhibited greater blood pressure and heart rate responses to a mental stress protocol. CONCLUSIONS: These findings suggest the 5HTTLPR polymorphism affects CNS serotonin function, and they are consistent with the general hypothesis that CNS serotonin function is involved in the regulation of potentially health-damaging biobehavioral characteristics. In particular, the l allele could contribute, through its association with increased cardiovascular reactivity to stress, to increased risk of cardiovascular disease.

Adult↗

PubMedDate not supplied

Depressive symptoms, menopausal status, and climacteric symptoms in women at midlife.

OBJECTIVE: Previous studies have found increased rates of depression in women aged 45 to 54 years, but the factors that influence these rates are not understood. It was assessed whether higher rates of depressive symptoms were associated with menopausal status, climacteric symptoms, and use of hormone replacement therapy. DESIGN: Cross-sectional survey. SETTING: Community sample. METHODS: Data are from 581 women ages 45 to 54 years who were interviewed by telephone between October 1998 and February 1999. MEASURES: Depression was measured with the abbreviated CES-D, a depressive symptoms screening measure. Women's reported perception of menopausal stage, frequency of periods in the preceding 12 months, and history of oophorectomy were used to classify their menopausal status into four categories: (1) no indication of menopause; (2) close to menopause; (3) had begun menopause; and (4) had completed menopause. RESULTS: There were 168 women (28.9%) who reported a high level (> or = 10) of depressive symptoms when the abbreviated CES-D was used. In a logistic-regression analysis, significant factors associated with increased depressive symptoms included physical inactivity, inadequate income, use of estrogen/progesterone combination, and presence of climacteric symptoms (trouble sleeping, mood swings, or memory problems). Menopausal status was not associated with depressive symptoms. CONCLUSIONS: In this sample of women age 45 to 54 years, climacteric symptoms but not menopausal status were associated with higher rates of depressive symptoms.

Climacteric↗

PubMedDate not supplied

Individual and community: normative conflicts in the development of a new therapeutic community for older persons.

This paper examines the role of ideology in the establishment of a new therapeutic community for geriatric patients in a state mental hospital. Contradictory role expectations, reflected both in staff-staff and in staff-patient relationship, interfered with the program's achieving its stated goals. In order to apply a humanistic approach to programs for elderly patients, realistic goals-encompassing the range of patient competence-must be set within a reasonable time framework, and the program must provide for an appropriate range of structure.

Aged↗

PubMedDate not supplied

Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease.

OBJECTIVE: To evaluate the hypothesis that diminished social and economic resources impact adversely on cardiovascular mortality in patients with coronary artery disease. DESIGN: Inception cohort study of patients undergoing cardiac catheterization from 1974 through 1980 and followed up through 1989. SETTING: Tertiary care university medical center. PATIENTS: Consecutive sample of 1965 medically treated patients with stenosis 75% or greater of at least one major coronary artery. Five hundred patients were not enrolled due to logistic problems; 33 refused; 64 had missing data on key medical variables. The final study population included 1368 patients, 82% male, with a median age of 52 years. MAIN OUTCOME MEASURE: Survival time until cardiovascular death. RESULTS: Independent of all known baseline invasive and noninvasive medical prognostic factors, patients with annual household incomes of $40,000 or more had an unadjusted 5-year survival of 0.91, compared with 0.76 in patients with incomes of $10,000 or less (Cox model adjusted hazard ratio, 1.9; 95% confidence interval, 1.57 to 2.32; P = .002). Similarly, unmarried patients without a confidant had an unadjusted 5-year survival rate of 0.50, compared with 0.82 in patients who were married, had a confidant, or both (adjusted hazard ratio, 3.34; 95% confidence interval, 1.84 to 6.20; P less than .0001). CONCLUSIONS: Low levels of social and economic resources identify an important high-risk group among medically treated patients with coronary artery disease, independent of important medical prognostic factors. Additional study will be required to see if interventions to increase these resources improve prognosis.

Cardiac Catheterization↗