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Objective The aim of this study was to examine the concurrent effects of vital exhaustion and depression on the development of cardiovascular disease (CVD) morbidity. Method The sample of this representative, 4-year longitudinal study comprised 2,725 participants (43.56% male, Mage = 58.39 years, SDage = 14.39 years). Individuals being treated for hypertension (n = 277) and cardio- and/or cerebrovascular incidents (n = 131) for the first time during the follow-up period were compared with participants never treated for CVD (n = 2,317). Joint principal component analysis was conducted on the items of the vital exhaustion (shortened Maastricht Questionnaire) and depression (shortened Beck Depression Inventory) measures simultaneously resulting in 3 components representing depression, vital exhaustion, and sleep difficulties. The role of these 3 components in predicting the incidence of CVD morbidity was examined using logistic regression-controlling for traditional risk factors such as sex, age, education, body mass index, smoking, alcohol use, and physical inactivity. Results In the multivariate analyses, vital exhaustion (OR = 1.20, CI = 1.03-1.39, p = .021) and sleep-related problem (OR = 1.16, CI = 1.00-1.33, p = .044) scores proved to be independent predictors of treatment initiation for hypertension, while sleep-related difficulties predicted CVD event incidence (OR = 1.27, CI = 1.06-1.52, p = .009). However, depressive symptomatology factor scores were not associated with either cardiovascular outcome in the regression analyses. Conclusions Vital exhaustion and depressive symptomatology showed a different pattern in their relationship with CVD incidence, with vital exhaustion being the more robust predictor. These results suggest that the 2 constructs are not identical and that vital exhaustion deserves consideration when planning and implementing interventions to reduce CVD risk. (PsycINFO Database Record

Objective The effects of a short intervention on behavioral risk factor modification in patients with coronary artery disease (CAD) on Type A behavior, vital exhaustion, and depression were studied in a randomized controlled trial. Methods Acute myocardial infarction patients or patients who underwent coronary artery bypass grafting (CABG) were randomly assigned to an 8-week multiple risk modification group program ( n =94) or to a control group ( n =90) that received usual care with standard physical exercise training. Patients were assessed before intervention, directly after intervention, and at 9-month follow-up. Results The intervention was effective in reducing hostility and total Type A behavior at postintervention ( P =.01) and at 9-month follow-up ( P =.03). The intervention had no overall impact on vital exhaustion and depression, measured by the Beck Depression Inventory (BDI), whereas we unexpectedly found that the percentage of patients with major depression was reduced in the control group but not in the intervention group. Conclusion The results indicate that a short behavioral intervention for coronary patients can result in relatively large and persistent reductions in cognitive aspects of Type A behavior and hostility, in particular. In view of the unwanted findings on the diagnosis of depression, however, we do not unequivocally advise the intervention to the general population of AMI and CABG patients.

Coronary heart disease (CHD) is still the main cause of death in developed countries. Because of improved treatment, many patients survive the acute phase of a myocardial infarction, which makes secondary prevention of CHD of major importance. Most risk factors responsible for the development and progression of CHD are associated with behavior. Therefore, interventions aimed at behavior change may contribute to risk factor modification and secondary prevention of CHD. The effects of separate risk factor modification efforts by means of randomized, controlled clinical trials of nonpharmacological interventions in patients suffering from CHD are reviewed. Interventions aimed at healthy lifestyles may stimulate smoking cessation rates, reduce elevated serum total and low-density lipoprotein (LDL)-cholesterol concentrations, and favorably modify type A behavior in CHD patients. Moreover, reduction of coronary atherosclerosis has been reported after intensive lifestyle and exercise interventions, whereas exercise and type A interventions may also lead to reduced CHD morbidity and mortality. As for hypertension and obesity, studies aimed at secondary prevention are lacking.

In this study, 147 Dutch Resistance veterans from WW II are evaluated on psychometric instruments for anxiety, depression and anger. Resistance veterans appeared to be more anxious, depressive and angry on these instruments compared to controls from the validation studies of the respective instruments. Veterans currently suffering from PTSD (56%) were significantly more anxious, depressed, and angry than veterans without PTSD. With respect to staying in Nazi concentration camps, which is an extremely severe stressor, and in which half of the veterans were imprisoned, no difference on the three instruments was found. Anxiety, depression and anger were observed to be highly interrelated in PTSD. The close interrelationship between anxiety and depression, anxiety and danger, and depression and anger mediated by way of anxiety is, however, not unique for traumatized subjects. It is argued that for Resistance veterans only the intrusive reminiscences of the stressful events discriminate this constellation of symptoms from subjects with an anxious-depressive symptomatology.

The extraordinary trauma experienced by Resistance veterans from World War II (WW II) and other veterans may be associated with an increased incidence of posttraumatic stress disorder (PTSD) and somatic morbidity, including cardiovascular disease (CVD). This study explored some relationships between current PTSD and CVD risk factors in 147 male Dutch WW II Resistance veterans. They were compared to 65 same-aged male patients with a recent myocardial infarction and 79 surgical patients. Of these subjects, WW II Resistance veterans scored highest on CVD risk factors (i.e., angina pectoris, type A behavior, life stressors, and vital exhaustion), except smoking. Fifty-six percent of these veterans were currently suffering from PTSD. They reported CVD risk factors, in particular type A behavior and vital exhaustion, more often than veterans without PTSD; they also reported more premorbid adverse living conditions. These data suggest that early sensitization to environmental stressors may be associated with a high prevalence of current PTSD and excess CVD risk factors in subjects exposed to extraordinary war-time trauma and that this may lead to vital exhaustion.

In order to estimate the present occurence of Post Traumatic Stress Disorder (PTSD) in Dutch World War II Resistance veterans, 147 male resistance veterans, aged 60 to 65 years, were assessed by means of the SCID and by means of a clinical rating based on DSM-III. According to the SCID ratings, 56% of the sample investigated was identified as currently suffering from PTSD. This study demonstrates that participation in the Resistance in the Netherlands during World War II has a life-long impact. Although 44% of the subjects did not meet the criteria for current PTSD, only 4% did not show any symptoms of PTSD at all

As a first step in a nation-wide study about psychiatric complaints in Dutch Resistance veterans, a feasibility study was conducted to test the instruments. The complaints of eight war victims, aged 61 to 73, were analyzed by means of questionnaires, a psychiatric survey, and a life history interview. All subjects met the DSM-III-R criteria for PTSD, with symptoms ranging from mild to very severe. The occurrence of manifest PTSD differed considerably over the years. Highly prevalent complaints included sleep disturbances, anxiety, and vital exhaustion. An increase in psychiatric complaints was often positively associated with the occurrence of stressful life events.

Objective: Studying the rates of posttraumatic stress disorder (PTSD) in people who experienced World War II, but who have subsequently lived in different environments is a way of looking at the impact of recovery environment on PTSD. Immigrants had less support in terms of the social cohesion in their home country, but were not subjected to the same triggers of war-related intrusions. Method: Posttraumatic stress disorder was investigated in citizens from the Netherlands who emigrated to Australia in the post-World War II years (n = 251). Immigrants born between 1920 and 1930 (n = 171) were compared with a same-aged group living in Holland (n = 1461) for stressful war experiences and the extent of PTSD. Results: Those who had been exposed to the most severe war stress were over-represented in the immigrant group. Immigrants with current PTSD more often stated that motives for migration were threat of a third world war, disappointment with Dutch society and personal problems. We were unable to demonstrate specific effects of emigration on the prevalence of current PTSD. Conclusions: This study suggests that exposure to severe war stress promoted the need to emigrate. The comparable PTSD scores of the groups of war victims living in Australia and the Netherlands support the notion that extreme war stress may be considered the primary determining factor in the development of PTSD, and that actual post-war living circumstances are, in the long term, of subordinate importance.

This study proposes to assess the differences of two psychosocial risk indicators for coronary artery disease (CAD), ie, depressive symptoms and vital exhaustion.In a representative, stratified, nation-wide sample of the population of Hungary over the age of 16 years (N = 12,640), analyses were made of whether those risk indicators were differentially related to several illness behaviors (including history of cardiovascular treatment and cardiovascular sick days), cognitions, mood states, and socioeconomic characteristics that may generally be associated with increased CAD risk. The sample was stratified by age, sex, and composition of the population of all counties in Hungary.Although depressive symptoms and vital exhaustion correlated strongly, there were clear and significant differences in strength of association between depressive symptoms, vital exhaustion and several variables under study. Dysfunctional cognitions, hostility, lack of purpose in life, low perceived self-efficacy, illegal drug use, alcohol and drug abuse, several forms of subjective disability complaints and history of treatment because of congenital disorders, and chronic skin and hematological disorders were more often associated with depressive symptoms, whereas loss of energy, use of stimulants, chest-pain-related disabilities, history of treatment because of cardiovascular disorders, and self-reported cardiovascular sick days were significantly more often associated with vital exhaustion.Vital exhaustion and depressive symptomatology are differentially associated with relevant external criteria. Vital exhaustion is associated with perceived cardiovascular complaints and history of cardiovascular treatment, whereas depressive symptomatology seems to be more closely connected to disabilities and complaints related to alcohol, drug, and congenital-disorder, and to dysfunctional cognitions and hostility.

To test the hypothesis that 'vital exhaustion' (VE), a state characterized by unusual fatigue, increased irritability, and feelings of demoralization, precedes the onset of myocardial infarction (MI) in females, 79 females hospitalized with a first MI (mean age: 59.3; SD = 9.3) and 90 females hospitalized in the departments of general and orthopaedic surgery (mean age: 57.4; SD = 9.1), were compared on the retrospective form of the Maastricht Questionnaire (MQ). Defining 'exhaustion' as a score above the median of the MQ, 63% of the cases and 39% of the controls were exhausted before hospitalization (chi 2 = 10.02; p0.00). The relative risk associated with exhaustion, after controlling for age, smoking, coffee consumption, diabetes, hypertension, non-anginal pain, and menopausal status, was estimated as 2.75 (95% CI:I.28-5.81; p0.01), thus corroborating the hypothesis. Exploratory analyses of the origins of exhaustion in these females showed that of all biographical characteristics, holding a job and simultaneously taking care of the household was most strongly associated with elevated exhaustion scores.

In a case-control study in adult men from The Netherlands, the associations of work stressors with both exhaustion prior to first acute myocardial infarction (AMI) and with first AMI itself were explored. The 133 AMI-cases reported more exhaustion, work stressors, and smoking than the controls (i.e. 133 neighborhood controls and 192 hospital controls). After controlling for smoking, exhaustion constituted a firm risk indicator for first AMI; it was also positively associated with work stressors, in particular conflicts at work. Work stressors that may disrupt one's occupational career, and increased responsibility (in younger AMI-cases), were directly associated with elevated risk for first AMI. Conflicts at work were conducive to first AMI through their associations with exhaustion.