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Background: The presence of depressive symptoms after myocardial infarction (MI) is associated with worsened cardiovascular (CV) prognosis. To date, it remains unclear to what extent the relationship between post-MI depression and prognosis is confounded by factors related to prognosis. We assessed the relationship between depression and prognosis while adjusting for a well validated risk score for mortality after a MI., Methods: Data of 494 MI patients were derived from the Depression after Myocardial Infarction study (DepreMI). Scores on the Beck Depression Inventory (BDI) (cut-off ≥ 10) were used to relate depressive symptoms (divided in somatic/affective and cognitive/affective symptoms) to the Global Registry of Acute Coronary Events (GRACE) risk score, using Pearson correlations. Cox regression analysis was performed to investigate the predictive value of depressive symptoms for prognosis after adjusting for GRACE score., Results: Overall, depressive symptoms were significantly correlated with GRACE score (r=0.12, p=0.008). Specifically, somatic/affective symptoms were positively correlated (r=0.23, p<0.001), whereas cognitive/affective symptoms tended to be negatively correlated (r=-0.08, p=0.097) with GRACE score. Adjusting for GRACE score did not affect the HR for recurrent CV events associated with total BDI- score (adjusted hazard ratio (HR) per point increase in BDI score 1.05 p=0.002 95% CI 1.02-1.08 n=463). Furthermore GRACE score attenuated the HR associated with 1 SD increase in somatic/affective depressive symptoms from 1.44 (1.20-1.72) to 1.31 (1.08-1.58)., Conclusion: GRACE score was positively associated with somatic/affective depressive symptoms. GRACE score explained only partly the association between (somatic/affective) depressive symptoms and CV prognosis., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Self-reported depressive symptoms and clinical depression after myocardial infarction (MI) are both associated with poor cardiac prognosis. It is important to distinguish between the two when assessing cardiac prognosis, but few studies have done so. The present article evaluates the independent prognostic impact of self-reported depressive symptoms and clinical depression on cardiac outcomes after MI., Methods: 2704 MI-patients were administered the Beck Depression Inventory (BDI) and underwent the Composite International Diagnostic Interview at 3 months post-MI. All-cause mortality, cardiac mortality and cardiovascular readmissions were evaluated up till 10 years post-MI (mean: 6 years), representing 16,783 persons-years of follow-up. Event-free survival was evaluated using Cox regression analysis., Results: Analyses on mortality and cardiovascular readmissions included 2493 and 2434 patients respectively. Compared to patients scoring <5 on the BDI, those scoring ≥ 19 had age- and sex-adjusted HR's (95% CI) of 3.20 (2.16-4.74, p<0.001) for all-cause mortality, 3.97 (2.06-7.65, p<0.001) for cardiac mortality, and 1.45 (1.08-1.95, p<0.05) for cardiovascular readmissions. Cardiac disease severity and cardiac risk factors explained one third to half of the relationship. The presence of clinical depression was associated with all-cause (HR: 1.72 (1.29-2.30, p<0.001)) and cardiac mortality (HR: 1.67 (1.01-2.77, p<0.05)). However, adjusting for BDI-scores decreased these HR's with 53% and 72% respectively, rendering them non-significant. Dichotomized BDI-scores remained to predict cardiac prognosis independently from the presence of clinical depression., Conclusions: After MI, self-reported depressive symptoms are a more accurate predictor of cardiac morbidity and mortality than clinical depression. This association is confounded largely by cardiac disease severity., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Low intelligence is a risk factor for functional somatic symptoms (FSSs) in adults, but it is unknown whether a similar association exists in adolescents. We hypothesized that low intelligence may lead to FSS, and that this association is mediated by low school performance. In addition, we hypothesized that this mediation is particularly present in adolescents who perceive high parental expectations., Methods: This study was performed in a general population cohort from the TRacking Adolescents' Individual Lives Survey, using data from the first wave (n = 2,230, mean age = 11.09 years, SD = .56, 50.8% girls), second wave (n = 2,149, mean age = 13.65 years, SD = .53, 51.0% girls), and third wave (n = 1,816, mean age = 16.25 years, SD = .72, 53.3% girls). Intelligence was measured using the Wechsler Intelligence Scale for Children-Revised, which resulted in an intelligence quotient (IQ) for each participant. FSSs were measured by the Somatic Complaints Scale of the Youth Self-Report. School performance was assessed by teacher reports and perceived parental expectations by adolescent reports. Structural equation modeling was used to test our hypotheses., Results: We found a significant negative association between IQ and FSS in the whole group (β = -.24). This association was significant in the group perceiving high parental expectations (β = -.37), but not in the group perceiving low parental expectations. The association between IQ and FSS was not mediated by school performance., Conclusions: Low intelligence is associated with a higher predisposition for FSS in adolescents, especially in those adolescents perceiving high parental expectations., (Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to investigate associations between specific mental health problems and pubertal stage in (pre)adolescents participating in the Dutch prospective cohort study TRAILS (first assessment: N=2230, age 11.09±0.56, 50.8% girls; second assessment: N=2149, age 13.56±0.53, 51.0% girls). Mental health was assessed by the Youth Self-Report, pubertal (Tanner) stage by parent-rated drawings of secondary sex characteristics. Overall, higher Tanner stages were related to more reported tiredness, irritability, rule-breaking behaviors, and substance use; and fewer fears and somatic complaints. Girls showed increases in social uncertainty, depressed mood, and worries; boys a decrease in self-criticism. Increasing problems during puberty were mostly related to the process of physical maturation, whereas decreasing problems were rather related to general age-related developments. Pubertal timing was associated with different symptoms than pubertal status or age. Puberty seems to affect girls more negatively than boys., (Copyright © 2010 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background: The three-way interaction between the functional polymorphism in the serotonin transporter gene linked promoter region, the val66met polymorphism in the brain-derived neurotrophic factor gene, and childhood adversity in the prediction of depression in children, reported by Kaufman and colleagues in 2006, has only been confirmed in adult samples. This study examines the gene-by-gene-by-environment interaction in an adolescent sample., Methods: In a longitudinal population-based study, depression scores were assessed with the Youth Self Report at ages 11, 13.5, and 16. Pre- and perinatal adversities and childhood events were assessed in a parent interview at age 11. Long-term difficulties until age 11 were assessed with a parent questionnaire at age 13.5. Blood or buccal cells were collected for genotyping at age 16. The study included 1096 complete data sets., Results: Depression score over the three measurements was not significantly predicted by any interaction between genotypes and childhood adversities., Conclusions: We were unable to confirm the three-way interaction in a representative, population-based sample of adolescents. The large sample resulted in adequate power, which in combination with the reliability of our measures gives confidence in our findings., (Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Purpose: This study tested two hypotheses about gender-specific mental health effects of peer stressors during early adolescence: (1) boys and girls are sensitive to different types of peer stressors, and (2) peer stress is associated with different mental health problems in boys and girls., Methods: These two hypotheses were tested in a prospective large population cohort of 2,084 Dutch young adolescents. Internalizing and externalizing problems were measured at baseline and follow-up, whereas stressful life events in the period between baseline and follow-up were measured retrospectively at follow-up. We performed the analyses with two types of peer stressors; victimization at school and relationship losses., Results: Relationship losses were more strongly associated with internalizing and externalizing problems in girls than boys, supporting the first hypothesis. Peer victimization at school was also associated with both types of mental health problems, but equally strong in boys and girls., Conclusions: Peer stress is unlikely to be associated with different mental health problems in boys and girls. Instead, boys and girls are more likely to be susceptible to different types of peer stressors., (Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.)

Functional somatic symptoms (FSS) are symptoms unexplained in terms of underlying organic pathology. Alterations in the immune system function may be associated with FSS via induction of sickness behavior. We aimed to investigate whether low-grade immune system activation is positively associated with FSS in a population-based cohort of 881 adults (46% male, mean age 53.0, SD 11.4). Participants completed the somatization section of the Composite International Diagnostic Interview surveying the presence of 43 FSS. Innate immune function was assessed by measuring high-sensitive C-reactive protein (hs-CRP). Follow-up measurements of hs-CRP and FSS were performed approximately 2years later. Regression analyses, with adjustments for gender, age, body mass index, anxiety, depression, smoking, alcohol use, and frequency of exercise, did not reveal a cross-sectional association (beta=0.01, t=0.40, p=0.693) or longitudinal association (beta=-0.03, t=-0.93, p=0.352) between hs-CRP and the total number of FSS. When examining different bodily clusters of FSS, hs-CRP was not associated with the gastrointestinal FSS cluster, but the association approached statistical significance for the general FSS cluster (OR 1.08, 95% CI 0.98-1.18) and musculoskeletal FSS cluster (OR 1.08, 95% CI 0.99-1.17). For the latter association, exploratory analyses revealed that mainly the pure musculoskeletal complaints were responsible (OR 1.12, 95% CI 1.03-1.21). We conclude that the level of hs-CRP is not a biomarker for the total number of FSS in the general population. The association between hs-CRP and musculoskeletal and general FSS needs further study.

Background: The stimulation-seeking theory posits that individuals with low habitual autonomic arousal levels will seek stimulation to increase their arousal to more optimal levels. Because of their assumed high optimal stimulation levels, persons characterized by low autonomic arousal may be better able to endure stressors than those with higher levels. In this study, we tested the hypothesis that low resting heart rate (HR) and high respiratory sinus arrhythmia (RSA) protect against the detrimental effects of stressors on mental health in early adolescents from the general population., Methods: Data were collected as part of TRacking Adolescents' Individual Lives Survey (TRAILS), a large prospective cohort of Dutch (pre)adolescents (N = 1478), with measurements at approximately age 11 (T1) and age 13.5 (T2). Internalizing and externalizing mental health problems were assessed at both waves, using multiple informants. Resting HR and RSA were assessed at T1 and the amount of parent-reported stressors and long-term difficulties at T2., Results: Stressors predicted mental health problems in adolescents with intermediate and high HR, but not in those with low HR. These findings were consistent regardless of the measure used to assess stressors and of adjustment for T1 mental health problems. Furthermore, the stress-buffering effects of low HR pertained to both externalizing problems and internalizing problems. No stress-buffering effects were found for RSA, suggesting predominantly sympathetic influences., Conclusions: Our study, which linked physiologic measures to stress sensitivity in real life, suggests that low HR is a marker of resilience to the effects of environmental challenges in early adolescence.