Health-related quality of life and psychological factors in treatment of hypertension.
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Anger↗
Biomedical subjects
J Julkunen
Publications and source records attributed to J Julkunen.
Psychometric properties of the Finnish 20-item Toronto Alexithymia Scale.
The aim of this study was to examine the factor structure and the validity of the Finnish version of the 20-item Toronto Alexithymia Scale (TAS-20). As part of the Northern Finland 1966 Birth Cohort Project, the TAS-20 was presented to a sample of 5034 31-year old persons. A confirmatory factor analysis showed that the three-factor model, earlier established with the original TAS-20, was in agreement with the Finnish version of the scale. Three criteria of goodness-of-fit met the standards for adequacy of fit. For the total scale, internal reliability (Cronbach's alpha) was 0.83 and for the three subscales (factors 1, 2, and 3) it was 0.81, 0.77, and 0.66, respectively. Two- and one-factor models for TAS-20 were also examined, but the other models did not perform as well as the three-factor model. The factor model also worked well with a sample of 516 students with a mean age of 24.8 years. In conclusion, the TAS-20 scale is useful in the Finnish version, too.
Adult↗
Difficulties in changing the diet in relation to dietary fat intake among patients with coronary heart disease.
OBJECTIVE: To study barriers in following nutritional advice among coronary heart disease patients in relation to dietary fat intake. DESIGN: A cross-sectional study using 4-day food records and a questionnaire with regard to barriers to or difficulties in following dietary advice. SUBJECTS: Altogether, 362 male subjects with coronary heart disease from two separate patient populations (91 + 271) were included in the study, with the mean age of 50 years and 60 years, respectively. The patients were classified into low (< or = 30 E%) or high (> 30 E%) fat intake groups. The patients with low dietary fat intake obtained on an average 10 E% less energy from fat as compared to the high dietary fat intake group. RESULTS: Overall, most patients with coronary heart disease reported difficulties in following nutritional advice when eating in social situations. Patients with high dietary fat intake reported more frequently than patients with low fat intake that they eat like other people without thinking about what they eat. On the other hand, there were no differences between the high and low fat intake groups in the barriers: eating at work, food price, shopping, taste or knowledge of nutrition. CONCLUSIONS: Our results suggest that the sensitivity to social influence is an important factor explaining noncompliance with dietary advice among patients with high dietary fat intake.
Coronary Disease↗
Association of sociodemographic factors with barriers reported by patients receiving nutrition counseling as part of cardiac rehabilitation.
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Adult↗
Hostility and increased risk of mortality and acute myocardial infarction: the mediating role of behavioral risk factors.
Cynical hostility has been associated with increased cardiovascular morbidity and mortality; yet few studies have investigated this relation in population-based samples, and little is known about underlying mechanisms. This study examined the association between hostility, measured by the eight-item Cynical Distrust Scale, and risk for all-cause and cardiovascular mortality and incident myocardial infarction. Subjects were 2,125 men, ages 42-60 years, from the Kuopio Ischemic Heart Disease Risk Factor Study, a longitudinal study of unestablished and traditional risk factors for ischemic heart disease, mortality, and other outcomes. There were 177 deaths (73 cardiovascular) in 9 years of follow-up. Men with hostility scores in the top quartile were at more than twice the risk of all-cause mortality (relative hazards (RH) 2.30, 95% confidence interval (CI) 1.47-3.59) and cardiovascular mortality (RH 2.70, 95% CI 1.27-5.76), relative to men with scores in the lowest quartile. Among 1,599 men without previous myocardial infarction or angina, high scorers also had an increased risk of myocardial infarction (RH 2.18, 95% CI 1.01-4.70). Biologic and socioeconomic risk factors, social support, and prevalent diseases had minimal impact on these associations, whereas adjustments for the behavioral risk factors of smoking, alcohol consumption, physical activity, and body mass index substantially weakened the relations. Simultaneous risk factor adjustment eliminated the observed associations. Results show that high levels of hostility are associated with increased risk of all-cause and cause-specific mortality and incident myocardial infarction and that these effects are mediated primarily through behavioral risk factors.
Adult↗
Alexithymia and risk of death in middle-aged men.
We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men (N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death (p < 0.001) and a threefold greater risk of death from accidents, injury, or violence (p < 0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity). physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup (N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.
Adult↗
Components of Type A behavior pattern and occupational stressor-strain relationship: testing different models in a sample of industrial managers.
The authors analyzed empirically the roles of impatience-irritability and ambition-energy components of the Type A behavior pattern (TABP) in the occupational stressor-strain relationship. They tested three models, using a sample of 659 industrial managers to determine whether the TABP components affected strain independently from perceived stressors (the direct effects model); or indirectly, by moderating effects of perceived stressors (the moderated effects model); or whether perceived stressors provoked TABP components, which influenced the number of strain symptoms (the mediated effects model). Multiple regression procedures showed, as expected, that the two TABP components acted quite differently in the stress process. With the direct effects model, the impatience-irritability component consistently increased numbers of psychological and physiological symptoms, regardless of perceived occupational stressors. The ambition-energy component, on the other hand, was activated by an abundance of development possibilities experienced at work. This, in turn, partly explained the decrease in perceived levels of psychological and physiological symptoms. The results relating to the ambition-energy component supported the mediated effects model and demonstrated a positive effect on subjective health perceptions.
Adult↗
Components of Type A behavior and the first-year prognosis of a myocardial infarction.
This study examined prospectively the role of Type A behavior and its subcomponents in the first-year prognosis of myocardial infarction (MI). Anger expression, irritability, and cynicism were assessed as traits related to the hostility component of the construct. The sample comprised 92 patients, less than 65 yr old, who survived the acute phase of their first MI. Psychological data was collected by self-report questionnaires during the initial hospital stay. Type A behavior was measured by the Jenkins Activity Survey and by the Finnish Type A Scale. Factors were controlled for age, sex, social status, and the MI severity. The results showed that patient who had a reinfarction or died during the first year reported more irritability and experienced anger more often than patients surviving without any complications. From the standard subcomponents only the Speed-Impatience factor of the JAS predicted poor prognosis. Our results indicated that the global Type A scores were not associated with the prognosis of MI.
Achievement↗
Validity and reliability of the Toronto Alexithymia Scale (TAS) in a population study.
Alexithymia refers to the difficulties an individual has to experience and express his feelings. Various self-report questionnaires have been introduced to measure alexithymia, but only a few rigorous validity studies of this concept have been carried out in nonclinical populations. The aim of this study was to evaluate the psychometric properties of the Toronto Alexithymia Scale (TAS) in a population sample of 1560 middle-aged men from eastern Finland. The modified version of the TAS applied in this study had a factor structure that matched the previous results and the theoretical concept of alexithymia. Internal consistency of the total TAS scale, as well as the 8 month retest reliability, were adequate. The TAS correlated fairly well with an interview-based evaluation of alexithymic features. The results suggest that the TAS could be a useful screening instrument for alexithymic features in a population study, but the scale would probably need some revisions.
Adult↗
Coping with inner feelings and stress: heavy alcohol use in the context of alexithymia.
The authors conducted a population study to assess the relationship between heavy alcohol consumption and alexithymia, defined as difficulty in identifying and expressing feelings. The study sample consisted of 2,297 middle-aged men from eastern Finland. The proportion of men who reported either frequent intoxication or unpleasant aftereffects of heavy drinking increased linearly with alexithymia. Alexithymia and the heavy acute intake of different sorts of alcoholic drinks were also consistently associated. Long-term heavy use, taking into account both the dose and frequency, was also linearly related to the alexithymia measure. In multivariate models to assess whether high alcohol consumption in alexithymic individuals might relate to stress, the authors found nothing to support the stress-dampening hypothesis.
Adaptation, Psychological↗
Alexithymia and perceived symptoms: criterion validity of the Toronto Alexithymia Scale.
The associations between alexithymia and somatization, perceived symptoms and subjective health, were investigated in a population sample of 2,297 middle-aged Finnish men. A modified translated version of the Toronto Alexithymia Scale (TAS) was used to assess alexithymia. A graded and statistically significant relationship was observed between the TAS score for alexithymia and self-reported recent symptoms. The alexithymia score, adjusted for age, smoking and socioeconomic status, was also positively associated with the MMPI hypochondriasis index and inversely with perceived level of health. One of the factors of the TAS appeared to have a weak but significant correlation with a variety of diagnosed disorders that previously have been considered psychosomatic.
Adult↗
Cook-Medley hostility, anger, and the Type A behavior pattern in Finland.
According to research, hostility is a reliable predictor of coronary heart disease. Cook-Medley-defined hostility in particular has been seen as a significant precursor of coronary disease. It is important to specify the kind of hostility measured by the Cook-Medley scale. The present study examined the construct validity of the Cook-Medley scale for a sample of 219 university students in Finland, a country with a high incidence of coronary heart disease. The results supported the interpretation of the Cook-Medley scale primarily as a measure of cynicism and distrust. On the basis of our previous research, a subscale of the Cook-Medley scale was formed. This 9-item scale, a measure of Cynical Distrust, correlated positively with cynicism and negatively with trust. Moreover, the over-all pattern of correlations between the new 9-item factor, cynical distrust, and other variables assessing hostility, anger, and trust, was similar to the one obtained for our previous sample of students. It is suggested that this new 9-item scale is a shorter and more specific alternative to the longer Cook-Medley scale as a measure of cynical distrust.
Adult↗
Psychological factors in the treatment of chronic low back pain. Follow-up study of a back school intervention.
The aim of the study was to investigate the role of certain psychological factors (e.g. neurotic features, alexithymia, and hostility) as intervening variables modifying the outcome of the back school intervention or correlating with spontaneous recovery. The results indicated that those patients who reacted favorably to the back school intervention could be described as emotionally well adjusted and controlled showing relatively good cognitive capacity with undisturbed reality testing. The poor responders in the treatment group were less capable cognitively and not so well balanced emotionally. Patients showing spontaneous recovery in the control group were characterized by a more lively and less controlled way of expressing emotions and affects. In contrast to these, patients who showed increasing disability during the 1-year follow-up were characterized by restricted expression of emotions and affects indicating alexithymia.
Adult↗
Social factors in alexithymia.
Social characteristics of alexithymic individuals were examined in a population-based study of 2,682 middle-aged men from Eastern Finland. Alexithymia, referring to difficulties in identifying and verbally describing inner feelings, was assessed using the Toronto Alexithymia Scale (TAS). Men whose high TAS score suggested reduced ability in verbal emotional expression were more often unmarried and had low levels of social contacts and acquaintances. Education, income, and occupational status were inversely related to the TAS score. These associations remained statistically significant after adjustment for confounding factors. The results suggest that alexithymia could be viewed not only as a psychological phenomenon, but also partly as a socially determined one.
Adult↗
Hostility and the progression of carotid atherosclerosis.
We studied prospectively the association of hostility and anger suppression by the use of ultrasonographically assessed 2-year progression of carotid atherosclerosis (PCA) in a sample of 119 middle-aged men from eastern Finland. Based on measures of cynical distrust, impatience-irritability, anger-in, and anger-control, four variants of hostility-by-anger suppression model were tested with multiple regression analysis. In addition to the previously established risk factors (i.e., serum low-density lipoprotein cholesterol concentration, smoking, and old age), cynical distrust and anger-control significantly predicted PCA. There was about a two-fold accelerated PCA in the group with high cynical distrust and high anger-control even after we controlled for the established biological risk factors and possible confounding background variables. The impact of the independent variables on PCA seemed to be additive rather than synergistic. These results, based on a relatively small, but nonselected population sample, extend previous results of angiographic studies.
Adult↗
Anger expression and incident hypertension.
OBJECTIVE: It has long been thought that anger is important in the development of essential hypertension. However, tests of this hypothesis have yielded conflicting findings. This study prospectively examined the relationship between anger expression style and incident hypertension in a population sample of middle-aged men. METHODS: Participants were 537 initially normotensive men from eastern Finland, who completed a medical examination and series of psychological questionnaires at baseline and at 4-year follow-up. Anger expression was assessed by Spielberger's Anger-out and Anger-in scales. RESULTS: At follow-up, 104 men (19.4%) were hypertensive (blood pressure > or = 165 mm Hg systolic and/or 95 mm Hg diastolic). Age-adjusted logistic regression analyses revealed that each 1-point increase in Anger-out was associated with a 12% increase in risk of hypertension after 4 years of follow-up (p < .002), which corresponded to a two-fold increased risk of hypertension among men with scores in the top tertile of the Anger-out scale, relative to those with scores in the bottom tertile (odds ratio = 2.00, 95% confidence interval 1.20-3.38). Each 1-point increase on the Anger-in scale also was related to a 12% increased risk of hypertension (p < .01). Adjustments for body mass index, smoking, alcohol consumption, physical activity, a positive parental history of hypertension, and baseline resting diastolic blood pressure had little impact on the findings. CONCLUSIONS: These data provide strong epidemiological evidence for a positive relationship between anger expression style and subsequent hypertension, independent of known risk factors. Findings support the hypothesis that extreme expression of anger in either direction has adverse cardiovascular consequences.
Adult↗