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Academy of Psychosomatic Medicine |
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 Home > Media Relations > Press Releases 2007 |
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2007 PRESS RELEASES
Diabetic Veterans with Lower Psychological Functioning Are More Likely to Have Limbs Amputated Lower limb amputation is a known complication of vascular disease in diabetic patients, and poorer psychological functioning may increase this risk. This is according to a recent study conducted by a team of VA researchers who examined 114,890 veterans with diabetes who were asked to complete a measure of mental health functioning. Poorer mental-health functioning increased the risk for amputations even when controlling for known risk factors for amputation such as poor control over diabetes, smoking, lesser utilization of health-care resources, and obesity. In fact, a 5-point improvement in mental-health functioning correlated with a 5% lower rate of major amputations. Although causality cannot be inferred in a cross-sectional study, these data suggest that mental-health functioning is an independent risk factor for amputation in diabetes. Clinicians (and patients) should be aware of this relationship. Veterans who had above high school education, who were not obese and who were not considered poor (they had a co-pay) had better mental health functioning, according to the study that appears in the November-December issue of General Hospital Psychiatry.
Doctors Who Criticize or Confront Patients May Be Trying to Help When a patient consults a doctor for a symptom but all tests come back as negative, the potential for frustration builds. Both parties may find the situation unsatisfying. Patients need emotional support when there is no apparent medical reason for a symptom and providing such support may be a challenge for doctors who are, after all, supposed to have an explanation and cure for every affliction. A study of doctor-patient communication in the September/October issue of General Hospital Psychiatry examined which doctors are more likely to criticize or confront their patients when medical symptoms are unexplained. Are doctors who favor sharing information and responsibility for problems with their patients more likely to criticize? Are critical doctors those who have personal relationship problems and, by extrapolation, have difficulty handling emotional patients? Are male doctors more likely to be critical than females or are female patients more likely to be criticized? These are some of the questions that this study addressed. The study was conducted amongst 24 general practitioners in Liverpool, England who identified 249 patients with medically unexplained symptoms. Consultations were recorded and transcribed and then each utterance was painstakingly coded for criticism. An example of a critical comment might be a doctor who says, “I think that you are reading more into those symptoms than you ought to.” The researchers, led by Dr. Peter Salmon of the University of Liverpool, found that 27% of these consultations had critical utterances and that these were indeed more likely when patients sought emotional support. Surprisingly, it was those doctors who were more secure and confident in their own personal relationships who were more confrontational and critical in reassuring patients with medically unexplained symptoms. This debunks the theory that insecure doctors are the ones more likely to be critical of their patients. Criticism was also more common amongst doctors who believed in sharing responsibility with their patients but there was no relationship between either physician or patient gender and levels of criticism. This data suggests that doctors may be trying to act in their patients' best interests when they use a confrontational style in trying to reassure patients who have medically unexplained symptoms.
Heart Patients All Around the World Are More Likely to Be Patients with heart disease, regardless of their culture or where they live, are more likely to report depression and anxiety and, to a lesser extent, alcohol abuse. The study to be released in the July/August edition of General Hospital Psychiatry surveyed 43,249 cardiac patients, spanning 17 culturally diverse countries. These included the United States, Columbia, Mexico, Japan, China, New Zealand, France, Germany, Italy, Ukraine, Lebanon, Israel, Nigeria, and South Africa. The study was designed to see whether the association between mental disorders and heart disease occurs across different cultures around the world, or whether it is only seen in specific cultures. The researchers, led by Dr. Johan Ormel of the Netherlands, found that depression and anxiety were over twice as common in patients with heart disease, no matter where they came from in the world. Alcohol abuse was also significantly associated with heart disease but to a lesser extent. The study suggests that universal mechanisms may underlie the association between these mental disorders and heart disease. The researchers caution that because of the cross-sectional design of the study, it cannot be concluded that heart disease causes depression, anxiety, or alcohol abuse or the opposite, that depression, anxiety, or alcohol abuse increases the chances of heart disease. They conclude that the association between depression and heart disease, well known from research in western countries, was replicated here on an international scale for the first time. That anxiety is similar to depression in its association with heart disease is a unique finding of this large, well-designed study. The authors point out that depression, anxiety, alcohol abuse and heart disease are all leading sources of burden worldwide and that their inter-relationships have consequences for sufferers whether they live in Nigeria or Italy or anywhere else in the world.
Anxious or Depressed Asthmatic Youth Report Worse School, Family & Social Functioning and Less Exercise
Asthmatic youth who are depressed or anxious have more difficulty functioning, independent of objective asthma severity, according to a recent report published in the May/June edition of the journal General Hospital Psychiatry (click here for abstract). The researchers from the University of Washington, led by Drs. Wayne Katon and Elizabeth McCauley, surveyed 767 youth with asthma between ages 11 and 17 and their parents using a telephone interview and computerized medical records. They found that 16% of youth with asthma were depressed or anxious which is approximately a two-fold higher rate than found in non-asthmatic control youth. Depressed or anxious youth reported worse asthma specific outcomes such as "shortness of breath," "wheezing without a cold," "upset about having asthma," feeling "left out by others because of my asthma" and anger at having to take their medications. Perhaps more importantly from the viewpoint of parents and teachers, they reported being more likely to have been limited from participating in gym classes, running or playing hard, biking and even milder activities such as walking. The anxious or depressed youth also reported worse general function on questions such as "getting into trouble," "getting along with other kids" and "doing your school work." Active management of depression and anxiety may reduce the burden of asthma and improve outcomes for youth coping with asthma. The researchers emphasized that treating comorbid anxiety and depression could potentially curtail a loss of confidence in asthmatic youth that might undermine self-management strategies such as avoiding smoking and optimizing medication and asthma monitoring.
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