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Body affects mind? Preoperative behavioral and biological predictors for postoperative symptoms in mental health

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Abstract

The study examined differential effects of preoperative biomarkers (cotisol, C-reactive protein/CRP, and interleukin-6/IL-6) on postoperative symptoms in mental health (depressed mood, anxiety and hostility) 1 month following open-heart surgery, controlling for known predictors. Preoperative and postoperative interviews were conducted on 162 patients. Peripheral venous blood samples were collected between 8 and 10 a.m. prior to surgery. Cardiac indices were obtained from the Society of Thoracic Surgeons’ national database. Preoperative anxiety contributed to all outcomes about 1 month postoperatively. Patients with high preoperative plasma IL-6 used more avoidant coping and experienced greater depressed mood. Patients with increased plasma CRP and with hope were less depressed. Elevated plasma cortisol predicted hostility. Finally, medical comorbidities predicted anxiety and hostility. The combination of anxiety and stress-sensitive biomarkers may be one way to predict postoperative symptoms following open-heart surgery. Our findings emphasize the importance of investigating the mind–body interplay to come up with better interventions.

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References

  • Ai, A. L., Appel, H., & Pasic, J. (2008). Mental health comorbidity in cardiovascular disease: Implications for interdisciplinary intervention. In L. Sher (Ed.), Psychological factors and cardiovascular disorders: The role of psychiatric pathology and maladaptive personality features (pp. 311–338). Hauppau, NY: Nova Science Publishers.

    Google Scholar 

  • Ai, A. L., Hall, D., & Pargament, K. (2012). Posttraumatic growth in patients who survived cardiac surgery: The predictive and mediating roles of faith-based factors. Journal of Behavioral Medicine, 35.

  • Ai, A. L., Park, C., Huang, B., Rodgers, W., & Tice, T. N. (2007). Psychosocial mediation of religious coping: A prospective study of short-term psychological distress after cardiac surgery. Personality and Social Psychology Bulletin, 33, 867–882.

    Article  PubMed  Google Scholar 

  • Ai, A. L., Seymour, E. M., Kronfol, Z., & Bolling, S. (2011). Moot states, coping factors, and interleukin-6 are related to psychiatric symptoms following cardiac surgery. Biological Psychiatry and Psychopharmacology, 13, 2–9.

    Google Scholar 

  • Ai, A. L., Seymour, E. M., Tice, N. T., Kronfol, Z., & Bolling, S. F. (2009). Spiritual struggle related to plasma interleukin-6 prior to cardiac surgery. Psychology of Religion and Spirituality, 1, 112–128.

    Article  Google Scholar 

  • Anisman, H., Hayley, S., Turrin, N., & Merali, Z. (2002). Cytokines as a stressor: implications for depressive illness. International Journal of Neuropsychopharmocology, 5, 357–373.

    Article  CAS  Google Scholar 

  • Bankier, B., Barajas, J., Martinez-Rumayor, A., & Januzzi, J. L. (2009). Association between major depressive disorder and C-reactive protein levels in stable coronary heart disease patients. Journal of Psychosomatic Research, 66, 189–194.

    Article  PubMed  Google Scholar 

  • Bjorntorp, P., & Rosmond, R. (2000). The metabolic syndrome—a neuroendocrine disorder? British Journal of Nutrition, 83, S49–S57.

    Article  CAS  PubMed  Google Scholar 

  • Bremner, J. D., Cheema, F. A., Ashraf, A., Afzal, N., Fani, N., & Reed, L. (2009). Effects of a cognitive stress challenge on myocardial perfusion and plasma cortisol in coronary heart disease patients with depression. Stress and Health, 25, 267–278.

    Article  Google Scholar 

  • Bruegger-Andersen, T., Poenitz, V., Staines, H., Pritchard, D., Grundt, H., & Nilsen, D. W. T. (2008). B-type natriuretic peptide is a long-term predictor of all-cause mortality, whereas high-sensitive C-reactive protein predicts recurrent short-term troponin T positive cardiac events in chest pain patients: A prognostic study. BMC Cardiovascular Disorders, 8, 34.

    Article  Google Scholar 

  • Capuron, L., & Miller, A. H. (2011). Immune system to brain signaling: Neuropsychopharmacological implications. Pharmacology & Therapeutics, 130, 226–238.

    Article  CAS  Google Scholar 

  • Carney, R. M., Freedland, K. E., Miller, G. E., & Jaffe, A. S. (2002). Depression as a risk factor for cardiac mortality and morbidity: A review of potential mechanisms. Journal of Psychosomatic Research, 53, 897–902.

    Article  PubMed  Google Scholar 

  • Carroll, B. J., Curtis, G. C., & Mendels, J. (1976a). Limbic system-adrenal cortex regulation in depression and schizophrenia. Psychosomatic Medicine, 38, 106.

    CAS  PubMed  Google Scholar 

  • Carroll, B. J., Curtis, G. C., & Mendels, J. (1976b). Neuroendocrine regulation in depression: Limbic system-adrenocortical dysfunction. Archives of General Psychiatry, 33, 1–30.

    Google Scholar 

  • Chida, Y., & Steptoe, A. (2009). The association of anger and hostility with future coronary heart disease: A meta-analytic review of prospective evidence. Journal of American College of Cardiology, 53, 936–946.

    Article  Google Scholar 

  • Cremeans-Smith, J. K., Soehlen, S., Greene, K., Alexander, T., & Delahanty, D. L. (2009). In-hospital levels of C-reactive protein and IL-6 predict post-operative depressive symptoms among patients undergoing total knee replacement surgery. Brain, Behavioral, and Immunity, 23, 1096–1103.

    Article  CAS  Google Scholar 

  • Czarkowska-Paczek, B., Bartlomiejczyk, I., Gabrys, T., Przybylski, J., Nowak, M., & Paczek, L. (2005). Lack of relationship between interleukin-6 and CRP levels in healthy male athletes. Immunology Letters, 99, 136–140.

    Article  CAS  PubMed  Google Scholar 

  • Denollet, J., & Kupper, N. (2007). Type-D personality, depression, and cardiac prognosis: Cortisol dysregulation as a mediating mechanism. Journal of Psychosomatic Research, 62, 607–609.

    Article  PubMed  Google Scholar 

  • Derogatis, L. R. (1994). The SCL-90-R: Administration, scoring and procedures manual. Baltimore, MD: Clinical Psychometric Research.

    Google Scholar 

  • Eaker, E. D., Sullivan, L. M., Kelly-Hayes, M., D’Agostino, R. B., Sr, & Benjamin, E. J. (2005). Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: The Framingham Offspring Study. Psychosomatic Medicine, 67, 692–696.

    Article  PubMed  Google Scholar 

  • Elenkov, I. J. (2008). Neurohormonal-cytokine interactions: Implications for inflammation, common human diseases and well-being. Neurochemistry International, 52, 40–51.

    Article  CAS  PubMed  Google Scholar 

  • Elenkov, I. J., & Chrousos, G. P. (2002). Stress hormones, proinflammatory and anti-inflammatory cytokines, and autoimmunity. Annuls of New York Academy of Science, 966, 290–303.

    Article  CAS  Google Scholar 

  • Elzinga, B. M., Schmahl, C. G., Vermetten, E., van Dyck, R., & Bremner, J. D. (2003). Higher cortisol levels following exposure to traumatic reminders in abuse-related PTSD. Neuropsychopharmacology, 28, 1656–1665.

    Article  CAS  PubMed  Google Scholar 

  • ENRICHD Investigators. (2003). Effects of treating depression and low perceived social support on clinical events after -myocardial infarction: The enhancing recovery in coronary heart disease patients (ENRICHD) randomized trial. JAMA, 289, 3106–3116.

    Article  Google Scholar 

  • Frasure-Smith, N., & Lespérance, F. (2006). Recent evidence linking coronary heart disease and depression. Canadian Journal of Psychiatry, 51, 730–737.

    Google Scholar 

  • Ghiadoni, L., Donald, A. E., Cropley, M., Mullen, M. J., Oakley, G., & Taylor, M. (2000). Mental stress induces transient endothelial dysfunction in humans. Circulation, 102, 2473–2478.

    Article  CAS  PubMed  Google Scholar 

  • Howren, M. B., Lamkin, D. M., & Suls, J. (2009). Associations of depression with C-reactive protein, IL-1, and IL-6: A meta-analysis. Psychosomatic Medicine, 71, 171–186.

    Article  CAS  PubMed  Google Scholar 

  • Hoyer, J., Eifert, G. H., Einsle, F., Zimmermann, K., Krauss, S., Knaut, M., et al. (2008). Heart-focused anxiety before and after cardiac surgery. Journal of Psychosomatic Research, 64, 291–297.

    Article  PubMed  Google Scholar 

  • Kathol, R. G., Jaeckle, R. S., Lopez, J. F., & Meller, W. H. (1989). Pathophysiology of HPA axis abnormalities in patients with major depression: An update. American Journal of Psychiatry, 146, 311–317.

    CAS  PubMed  Google Scholar 

  • Kiecolt-Glaser, J. K., Preacher, K. J., MacCallum, R. C., Atkinson, C., Malarkey, W. B., & Glaser, R. (2003). Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proceedings of the National Academy of Sciences of the United States of America, 100, 9090–9095.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Kronfol, Z., & Remick, D. G. (2000). Cytokines and the brain: Implications for clinical psychiatry. American Journal of Psychiatry, 157, 683–694.

    Article  CAS  PubMed  Google Scholar 

  • Lespérance, F., Frasure-Smith, N., Koszycki, D., Laliberte, M., van Zyl, L. T., & Baker, B. (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian cardiac pandomized evaluation of antidepressant and psychotherapy efficacy. JAMA, 297, 367–379.

    Article  PubMed  Google Scholar 

  • Lichtman, J. H., Bigger, T., Jr., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., & Lespérance, F. (2008). Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association. Circulation, 118, 1768–1775.

    Article  PubMed  Google Scholar 

  • Licinio, Z., & Wong, M. L. (1997). Pathways and mechanisms for cytokine signaling of the central nervous system. Journal of Clinical Investigation, 100, 2941–2947.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Lisak, R. P., Benjamins, J. A., Bealmear, B., Nedelkoska, L., Studzinski, D., & Retland, E. (2009). Differential effects of Th1, monocyte/macrophage and Th2 cytokine mixtures on early gene expression for molecules associated with metabolism, signaling and regulation in central nervous system mixed glial cell cultures. Journal of Neuroinflammation, 6, 1–27.

    Article  Google Scholar 

  • Marsland, A., Gianaros, P. J., Abramwitch, S. M., Manuch, S. B., & Hariri, B. R. (2008a). Interleukin-6 covaries inversely with hippocampal gray matter volume in middle-aged adults. Biopsych, 64, 484–490.

    CAS  Google Scholar 

  • Marsland, A., Prather, A. A., Petersen, K. L., Cohen, S., & Manuck, S. B. (2008b). Antagonistic characteristics are positively associated with inflammatory markers independently of trait negative emotionality. Brain, Behavior, and Immunity, 22, 753–761.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Martens, E. J., Kupper, N., Pedersen, S. S., Aquarius, A. E., & Denollet, J. (2007). Type-D personality is a stable taxonomy in post-MI patients over an 18-month period. Journal of Psychosomatic Research, 63, 545–550.

    Article  PubMed  Google Scholar 

  • Miller, G. E., & Blackwell, E. (2006). Turning up the heat: Inflammation as a mechanism linking chronic stress, depression, and heart disease. Current Directions in Psychological Science, 15, 269–272.

    Article  Google Scholar 

  • Mosovich, S. A., Boone, R. T., Reichenberg, A., Bansilal, S., Shaffer, J., & Dahlman, K. (2008). New insights into the link between cardiovascular disease and depression. International Journal of Clinical Practice, 62, 423–432.

    Article  CAS  PubMed  Google Scholar 

  • Nemeroff, C. B. (1996). The corticotropin-releasing factor (CRF) hypothesis of depression: New findings and new directions. Molecular Psychiatry, 1, 336–342.

    CAS  PubMed  Google Scholar 

  • Niaura, R., Todaro, J. F., Stroud, L., Ward, K., Spiro, A., I. I. I., & Weiss, S. (2002). Hostility, the metabolic syndrome, and incident coronary heart disease. Health Psychology, 21, 588–593.

    Article  PubMed  Google Scholar 

  • Nikisch, G. (2009). Involvement and role of antidepressant drugs of the hypothalamic-pituitary-adrenal axis and glucocorticoid receptor function. Neuroendocrinology Letters, 30, 11–16.

    CAS  PubMed  Google Scholar 

  • Otte, C., Marmar, C. R., Pipkin, S. S., Moos, R., Browner, W. S., & Whooley, M. A. (2004). Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: The heart and soul study. Biological Psychiatry, 56, 241–247.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56, 519–543.

    Article  CAS  PubMed  Google Scholar 

  • Pariante, C. M., & Miller, A. H. (2001). Glucocorticoid receptors in major depression: Relevance to pathophysiology and treatment. Biological Psychiatry, 49, 391–404.

    Article  CAS  PubMed  Google Scholar 

  • Pasic, J., Levy, W. C., & Sullivan, M. D. (2003). Cytokines in depression and heart failure. Psychosomatic Medicine, 65, 181–193.

    Article  PubMed  Google Scholar 

  • Payne, L. C., Weigent, D. A., & Blalock, J. E. (1994). Induction of pituitary sensitivity to interleukin-1: A new function for corticotropin-releasing hormone. Biochemical and Biophysical Research Communications, 198, 480–484.

    Article  CAS  PubMed  Google Scholar 

  • Pignay-Demaria, V., Lesperance, F., Demaria, R. G., Frasure-Smith, N., & Perrault, L. P. (2003). Depression and anxiety and outcomes of coronary artery bypass surgery. Annals of Thoracic Surgery, 75, 314–321.

    Google Scholar 

  • Plaschke, K., Fichtenkamm, P., Schramm, C., Hauth, S., Martin, E., & Verch, M. (2010). Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6. Intensive Care Medicine, 36, 2081–2089.

    Article  CAS  PubMed  Google Scholar 

  • Raber, J., Sorg, O., Horn, T. F., Yu, N., Koob, G. F., Campbell, I. L., et al. (1998). Inflammatory cytokines: Putative regulators of neuronal and neuro-endocrine function. Brain Research Review, 26, 320–326.

    Article  CAS  Google Scholar 

  • Radley, J. J., Kabbaj, M., Jacobson, L., Heydendael, W., Yehuda, R., & Herman, J. P. (2011). Stress risk factors and stress-related pathology: Neuroplasticity, epigenetics and endophenotypes. Stress, 14, 481–497.

    Article  PubMed Central  PubMed  Google Scholar 

  • Refojo, D., & Holsboer, F. (2009). CRH signaling: Molecular specificity for drug targeting in the CNS. Annals of the New York Academy of Sciences, 1179, 106–119.

    Article  CAS  PubMed  Google Scholar 

  • Ridker, P. M. (2003a). High-sensitivity C-reactive protein and cardiovascular risk: Rationale for screening and primary prevention. American Journal of Cardiology, 92, 17K–22K.

    Article  CAS  PubMed  Google Scholar 

  • Ridker, P. M. (2003b). Connecting the role of C-reactive protein and statins in cardiovascular disease. Clinical Cardiology, 26, III39–III44

  • Riechlin, S. (1993). Neuroendocrine-immune interactions. New England Journal of Medicine, 329, 3–5.

    Google Scholar 

  • Rifai, N., & Ridker, P. M. (2003). Population distributions of C-reactive protein in apparently healthy men and women in the United States: Implication for clinical interpretation. Clinical Chemistry, 49, 666–669.

    Article  CAS  PubMed  Google Scholar 

  • Rothenbacher, D., Hahmann, H., Wusten, B., Koenig, W., & Brenner, H. (2007). Symptoms of anxiety and depression in patients with stable coronary heart disease: Prognostic value and consideration of pathogenetic links. European Journal of Cardiovascular Preventation & Rehabilitation, 14, 547–554.

    Article  Google Scholar 

  • Scheidt, S. (2000). The current status of heart-mind relationships. Journal of Psychosomatic Research, 48, 317–320.

    Article  CAS  PubMed  Google Scholar 

  • Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601–630.

    Article  PubMed Central  PubMed  Google Scholar 

  • Shaffer, J. A., Edmondson, D., Chaplin, W. F., Schwartz, J. E., Shimbo, D., & Burg, M. M. (2011). Directionality of the relationship between depressive symptom dimensions and C-reactive protein in patients with acute coronary syndromes. Psychosomatic Medicine, 73, 370–377.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Sherwood, A., Blumenthal, J. A., Trivedi, R., Johnson, K. S., O’Connor, C. M., Adams, K. F., Jr., et al. (2007). Relation of depression to death or hospitalization in patients with heart failure. Archives of Internal Medicine, 167, 367–373.

    Google Scholar 

  • Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., & Sigmon, S. (1991). The will and the ways: Development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60, 570–585.

    Article  CAS  PubMed  Google Scholar 

  • Spielberger, C. D. (1983). Manual for the state-trait anxiety inventory (Form Y: Self-evaluation questionnaires). Palo Alto, CA: Consulting Psychologists Press.

    Google Scholar 

  • Troxler, R. G., Sprague, E. A., Albanese, R. A., Fuchs, R., & Thompson, A. J. (1977). The association of elevated plasma cortisol and early atherosclerosis as demonstrated by coronary angiography. Atherosclerosis, 26, 151–162.

    Article  CAS  PubMed  Google Scholar 

  • Van der Kooy, K., van Hout, H., Marwijk, H., Marten, H., Stehouwer, C., & Beekman, A. (2007). Depression and the risk for cardiovascular diseases: Systematic review and meta-analysis. International Journal of Geriatric Psychiatry, 22, 613–626.

    Article  PubMed  Google Scholar 

  • Veen, G., Giltay, E. J., van Vliet, I. M., DeRijk, R. H., Klaassens, E. R., van Pelt, J., et al. (2011). C-reactive protein polymorphisms are associated with the cortisol awakening response in basal conditions in human subjects. Stress, 14, 128–135.

    CAS  PubMed  Google Scholar 

  • W. H. O. Study. (1987). The dexamethasone suppression test in depression. British Journal of Psychiatry, 150, 459–462.

    Article  Google Scholar 

  • Whitehead, D. L., Perkins-Porras, L., Strike, P. C., Magid, K., & Steptoe, A. (2007). Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality. Journal of Psychosomatic Research, 62, 419–425.

    Article  PubMed  Google Scholar 

  • Wieczorek, M. (2009). Various aspects of IL-1 biological activity. II. IL-1 beta in diseases and the central nervous system. Wiadomosci Parazytologiczne, 55, 115–124.

    PubMed  Google Scholar 

  • Wills, T. A. (1996). An Analysis of downward comparison in the structure of other cognitive and behavior mechanisms. In: B. P. Bunk & F. X. Gibbons (Eds.), Health, coping, and well-being. Mahwah, NJ: Lawrence Erlbaum. (Sara, this one is the 67 not Neter et al.)

  • Ziegelstein, R. (2001). Depression in patients recovering from a myocardial infarction. JAMA, 286, 1621–1627.

    Article  CAS  PubMed  Google Scholar 

  • Zimet, G. D. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

    Article  Google Scholar 

  • Zunszain, P. A., Anacker, C., Cattaneo, A., Carvalho, L. A., & Pariante, C. M. (2011). Glucocorticoids, cytokines and brain abnormalities in depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35, 722–729.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

This work was supported by National Institute on Aging Grant 1 R03 AG15686-01, National Center for Complementary and Alternative Medicine Grant P50 AT00011, and Grants from the John Templeton Foundation and Hartford Geriatric Faculty Scholars Program. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of these organizations.

Conflict of interest

There is no conflict of interest in the manuscript, including financial, consultant, institutional and other and other relationships that might lead to bias in this paper.

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  1. Department of Psychology, College of Social Work, Florida State University, 2313 University Center Building-C, Tallahassee, FL, 32306, USA

    Amy L. Ai

  2. College of Medicine, Florida State University, 1115 W Call Street-2300G, Tallahassee, FL, 32306, USA

    Mohamed Kabbaj & Lee L. Kathy

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Ai, A.L., Kabbaj, M. & Kathy, L.L. Body affects mind? Preoperative behavioral and biological predictors for postoperative symptoms in mental health. J Behav Med 37, 289–299 (2014). https://doi.org/10.1007/s10865-012-9484-3

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