Four-year prospective evaluation of the relationship between meaning in life and smoking status.

BACKGROUND: To date, all investigations on the relationship between smoking and perceived level of meaning in life have used cross-sectional designs. Therefore, the purpose of the present prospective study, conducted with a four-year time lag, was to test the predictive power of the life meaning construct concerning changes in smoking status. METHODS: The data of 4,294 respondents (40.3% male, M(age) = 54.7 ± 16.5 yrs) from the Hungarian Epidemiological Panel Survey were analyzed using the Kruskal-Wallis and Mann-Whitney U-test and structural equation modeling (SEM) with a nominal outcome variable. Gender, age, and educational level were included in the study as covariates. RESULTS: On the bivariate level, results showed that both baseline and follow-up meaning in life scores were higher in stable non-smokers when compared to stable smokers. However, quitters and starters differed from stable non-smokers in their baseline but not in follow-up life meaning scores. The other relationships (stable smokers vs. quitters; stable smokers vs. starters, starters vs. quitters) were non-significant in both time points. According to the SEM-analysis, a higher sense of meaning in life measured at baseline and follow-up is associated with a lower likelihood (OR = 0.54, z = 2.80, p = 0.005; OR = 0.64, z = 2.88, p = 0.004, respectively) of being a stable smoker compared to being a stable non-smoker, confirming the expected relationship between smoking and decreased level of meaning in life. However, neither baseline nor follow-up life meaning scores predicted significantly quitting and uptake of smoking. CONCLUSIONS: If future research from other cultures verifies the protective role of a higher level of meaning in life against smoking, then smoking prevention and cessation programs will also have to include such components that help individuals experience more meaning in their lives.

Relationship between religiosity and health: evidence from a post-communist country.

BACKGROUND: The relationship between religiosity and health has been investigated in the western world for decades. However, very little data are available from the post-communist region of Europe, where religion was suppressed for a long time. PURPOSE: The aim of the present study was to lessen this gap. METHODS: In 2002, 13 years after the regime change, 12,643 persons (mean age = 47.6 ± 17.9 years; 44.8 % male) were interviewed in a Hungarian representative survey. The relationship of mental and physical health indicators with religious worship and personal importance of religion-controlling for several psychological and lifestyle characteristics-were analyzed using the general linear model procedure. RESULTS: Our results showed that practicing religion was largely associated with better mental health and more favorable physical health status. However, persons being religious in their own way tended to show more unfavourable results across several variables when compared to those practicing religion regularly in a religious community or even to those considering themselves as non-religious. The personal importance of religion showed a mixed pattern, since it was positively associated not only with well-being but depression and anxiety as well. CONCLUSIONS: We can conclude that even after an anti-religious totalitarian political system practicing religion still remained a health protecting factor.

Mediators between bereavement and somatic symptoms.

BACKGROUND: In our research we examined the frequency of somatic symptoms among bereaved (N = 185) and non-bereaved men and women in a national representative sample (N = 4041) and investigated the possible mediating factors between bereavement status and somatic symptoms. METHODS: Somatic symptoms were measured by the Patient Health Questionnaire (PHQ-15), anxiety with a four-point anxiety rating scale, and depression with a nine-item shortened version of the Beck Depression Inventory. RESULTS: Among the bereaved, somatic symptoms proved to be significantly more frequent in both genders when compared to the non-bereaved, as did anxiety and depression. On the multivariate level, the results show that both anxiety and depression proved to be a mediator between somatic symptoms and bereavement. The effect sizes indicated that for both genders, anxiety was a stronger predictor of somatic symptoms than depression. CONCLUSIONS: The results of our research indicate that somatic symptoms accompanying bereavement are not direct consequences of this state but they can be traced back to the associated anxiety and depression. These results draw attention to the need to recognize anxiety and depression looming in the background of somatic complaints in bereavement and to the importance of the dissemination of related information.

Alcohol use in the first three years of bereavement: a national representative survey.

BACKGROUND: Earlier results concerning alcohol consumption of bereaved persons are contradictory. The aim of the present study was to analyze the relationship between bereavement and alcohol consumption accounting for time and gender differences on a nationally representative sample from Hungary ("Hungarostudy Epidemiological Panel Survey", N = 4457) METHODS: Drinking characteristics of mourning persons (alcohol consumption, dependence symptoms, and harmful consequences of alcohol use) in the first three years of grief were examined among persons between 18-75 years using the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: Men bereaved for one year scored higher on two dimensions of AUDIT (dependence symptoms and harmful alcohol use), while men bereaved for two years scored higher on all three dimensions of AUDIT compared to the non-bereaved. The rate of men clinically at-risk concerning alcohol consumption among the non-bereaved is 12.9%, and among men bereaved for one year is 18.4% (a non-significant difference), while 29.8% (p < 0.001, OR = 2,781) among men bereaved for two years. However, men bereaved for three years did not differ from the non-bereaved in their drinking habits. In case of bereaved women, again no difference was found with respect to alcohol use compared to the non-bereaved. CONCLUSION: Among bereaved men, the risk of alcohol related problems tends to be higher, which can be shown both among men bereaved for one year as well as men bereaved for two years. Considering the higher morbidity and mortality rates of bereaved men, alcohol consumption might play a mediator role. These facts draw attention to the importance of prevention, early recognition, and effective therapy of hazardous drinking in bereaved men.

Early maternal separation, nightmares, and bad dreams: results from the Hungarostudy Epidemiological Panel.

Early maternal separation is a particularly stressful experience. Current models of nightmare production emphasize negative emotionality as having a central role in determining dream affect. Our aim is to test the hypothesis that persons who experienced early maternal separation (before one year of age and lasting at least one month) report more frequent nightmare experiences and bad dreams as adults. In the frame of the Hungarostudy Epidemiological Panel, 5020 subjects were interviewed. Significant associations were found between early maternal separation and both frequent nightmare experience in adulthood and increased frequency of oppressive and bad dreams. Current depression scores fully mediated the association between early separation and nightmares, but not the association between early separation and negative dream affect. We interpret these findings as a trait-like enhancement of negative emotionality in adults who experienced early maternal separation. This enhancement influences the content of dreams and, when it takes the form of depression, also influences the frequency of nightmares.

Gender patterns of socioeconomic differences in premature mortality: follow-up of the Hungarian Epidemiological Panel.

BACKGROUND: Gender differences in premature mortality rates and in the size of socioeconomic inequalities in mortality vary across countries. PURPOSE: We aimed to quantify the gender differences in the association between socioeconomic status (SES) and premature all-cause mortality and to analyse whether psychosocial factors might associate between SES and mortality among men and women separately in the middle-aged Hungarian population. METHOD: Men (n = 1130) and women (n = 1529), aged 40-69 years, participants in the Hungarian Epidemiological Panel (2002) were followed up for 3.5 years for total mortality. Cox proportional hazard models were used to evaluate the association between several socioeconomic measures and total death. RESULTS: During the follow-up, 99 men (8.8%) and 53 women (3.5%) died. The age-adjusted hazard ratios and the Rothman's synergy indexes showed that each measure of socioeconomic position was more deleterious in men compared with women. When investigating potential explanatory factors for the SES-mortality association, we found that adjustment for severe depression resulted in the most pronounced reduction in the regression coefficients for the association between most socioeconomic factors and male premature death. There was no indication that depression would mediate between SES and mortality in women. Work stress factors, poor lifestyle and low social support also contributed to the explanation of the link between socioeconomic disadvantage and premature death in men. CONCLUSION: Middle-aged Hungarian men seem to be considerably more vulnerable to the chronic stress of material disadvantage than women. This effect modification by gender might partly be explained by a stronger connection between low SES and depressive symptoms in men.

Socio-demographic characteristics, health behaviour, co-morbidity and accidents in snorers: a population survey.

OBJECTIVE: We assessed the socio-demographic correlates of snoring and also the patterns of health behaviour and co-morbidity associated with different types of snoring in the Hungarian population. We wanted to study whether different types of snoring are associated with high-risk health behaviour, chronic illnesses, daytime consequences of poor sleep, and with frequent accidents compared with non-snoring individuals. METHOD: This is a cross-sectional study. Interviews were carried out in the homes of 12,643 people. This was the largest nationally representative study in Central Europe about health behaviour. In the Athens Insomnia Scale, questions about snoring and sleep behaviour, life-style factors and health behaviour, as well as questions on their history and current medical treatment were included in the questionnaire. RESULTS: Thirty-seven percent of males and 21% of females reported loud snoring with breathing pauses. We found a significant increasing trend for the consumption of alcohol and coffee as well as smoking among non-snorers, habitual snorers and loud snorers, respectively. In an ordinal regression model male gender, the presence of smoking, the presence of three or more co-morbid conditions and alcohol consumption were independent predictors of snoring (OR [95% CI], 1.99 [1.85-2.1], 1.76 [1.60-1.92], 1.45 [1.30-1.62] and 1.22 [1.04-1.43], respectively, P < 0.001) after controlling for multiple socio-demographic and clinical variables. The frequency of accidents was higher in the loud snoring group than among non-snoring individuals (24% vs 17%, P < 0.0001). CONCLUSIONS: Snoring is common in the Hungarian adult population. Snoring, especially loud snoring with breathing pauses, is strongly associated with high-risk health behaviour, higher co-morbidity and a higher frequency of accidents.

Psychosocial factors and major adverse cardiac and cerebrovascular events after cardiac surgery.

Our aim was to prospectively examine the association of psychosocial factors with adverse outcome after cardiac surgery. One hundred and eighty cardiac surgery patients were enrolled and contacted annually by mail. Depression [Beck depression inventory (BDI)], anxiety [state anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-S) and trait anxiety subscale in Spielberger State-Trait Anxiety Inventory (STAI-T)] were investigated annually, social support, negative affectivity, social inhibition (SI), illness intrusiveness, self-rated health and sleeping disorders were investigated by standardized tests at the second and fifth year. The end-point was the major adverse cardiac and cerebrovascular event (MACCE) including death. Twenty-eight (15.5%) patients died by the end of the fifth year. At the end of the second and fifth years, 146 (81.1%) and 118 (65.5%) patients fulfilled the tests, respectively. At the end of the second year after adjustment for medical and perioperative factors worse self-rated health [adjusted hazard ratio (AHR): 0.67, P=0.006], sleeping disorders (AHR: 1.14, P=0.001), higher illness intrusiveness (AHR: 1.03, P=0.018), higher BDI (AHR: 1.12, P=0.001), STAI-S (AHR: 1.09, P=0.001) and higher STAI-T scores (AHR: 1.08, P=0.002) showed higher risk for MACCE. Significant individual elevation in scores of sleeping disorders, illness intrusiveness and SI were observed over the three-year period in the MACCE group. Assessment of psychosocial factors could help in identifying patients at high-risk for MACCE after cardiac surgery.

Measures of stress in epidemiological research.

A comprehensive assessment of psychosocial stress often poses significant challenges due to diversity in conceptualization of stress. Consequently, a number of instruments that measure psychosocial stress, its stressors, and its impact at the individual, organizational, and societal levels have been developed. This article aims to provide a brief review of such instruments, focusing on established questionnaire and interview measures in line with the environmentalist and psychological conceptualizations of stress. This includes measures of major life events; work, marital, and social stress; the individual's coping abilities; and psychological and somatic outcomes of stress. We provide a general description of selected instruments and discuss their administration, scoring, and psychometric properties. Appropriate application of these instruments in epidemiological and clinical research, as well as in inpatient care, can aid the detection of psychosocial stress, support thorough assessment and management of the individual's illness, and ensure accurate identification of individuals who would benefit from specific behavioral (psychotherapeutic) interventions.

Relationship between meaning in life and intensity of smoking: do gender differences exist?

Little is known about the relationship between smoking and meaning in life, although the association of meaninglessness with other addictive behaviours has been widely investigated. The aim of this study is to examine whether a relationship exists between meaning in life and intensity of smoking as measured by cigarettes smoked per day. The study population was 3506 current smokers from the Hungarostudy 2002 Hungarian representative cross-sectional survey. Age, educational level, marital status, subjective financial status, household income, coffee consumption, hazardous alcohol use, general well-being, anxiety, and depressive symptomatology were included in the analyses as covariates. On the bivariate level, life meaning was associated with smoking intensity in the total sample and among women (p < 0.001), while for males, only a tendency was found (p = 0.069). In the multivariate analyses, life meaning proved to be a significant negative predictor of smoking intensity for females (p = 0.005) even after controlling for the covariates, whereas in men, meaning in life completely lost its significance (p = 0.852). In the total sample, both meaning in life (p = 0.005) and its interaction with gender (p = 0.024) related to the dependent variable. Further research is needed to confirm these explorative findings concerning the protective role of life meaning against more intense smoking among women.

Health aspirations in the context of age and self-rated health: findings from a representative Hungarian sample.

The present research examined the respondents' preferences for approach and avoidance health aspirations (i.e. health related life goals) in relation to their age and self-rated health (SRH) in a representative Hungarian sample (N = 4841). Higher age predicted stronger preference for both orientations of health aspirations while SRH attenuated this relationship for approach and amplified it for avoidance health aspiration. Bad SRH predicted elevated preference for approach health aspirations in younger age while it predicted greater preference for avoidance aspirations in older age. Results and implications are discussed with reference to aging and health.

Job insecurity and health: a study of 16 European countries.

Although the number of insecure jobs has increased considerably over the recent decades, relatively little is known about the health consequences of job insecurity, their international pattern, and factors that may modify them. In this paper, we investigated the association between job insecurity and self-rated health, and whether the relationship differs by country or individual-level characteristics. Cross-sectional data from 3 population-based studies on job insecurity, self-rated health, demographic, socioeconomic, work-related and behavioural factors and lifetime chronic diseases in 23,245 working subjects aged 45-70 years from 16 European countries were analysed using logistic regression and meta-analysis. In fully adjusted models, job insecurity was significantly associated with an increased risk of poor health in the Czech Republic, Denmark, Germany, Greece, Hungary, Israel, the Netherlands, Poland and Russia, with odds ratios ranging between 1.3 and 2.0. Similar, but not significant, associations were observed in Austria, France, Italy, Spain and Switzerland. We found no effect of job insecurity in Belgium and Sweden. In the pooled data, the odds ratio of poor health by job insecurity was 1.39. The association between job insecurity and health did not differ significantly by age, sex, education, and marital status. Persons with insecure jobs were at an increased risk of poor health in most of the countries included in the analysis. Given these results and trends towards increasing frequency of insecure jobs, attention needs to be paid to the public health consequences of job insecurity.

Comorbid depression is associated with increased healthcare utilization and lost productivity in persons with diabetes: a large nationally representative Hungarian population survey.

OBJECTIVE: To estimate the prevalence of depression among people with diabetes and to examine the association of comorbid depression with lost productivity and health resource utilization in persons with and without diabetes. METHODS: Cross-sectional survey, enrolling 12,643 individuals aged >18 years. Clustered, stratified sampling procedure was utilized. This sample represented 0.16% of the Hungarian adult population according to age, gender, and geographic regions. The severity of depressive symptoms was measured by the abbreviated Beck Depression Inventory. RESULTS: The prevalence of diabetes in the sample was 6.2% (95% Confidence Interval (CI) = 5.7-6.6), and 13.4% (95% CI = 12.8-13.9) were classified as depressed. Adults with diabetes were two times more likely to have depression (adjusted odds ratio (OR) = 1.83, 95% CI = 1.53-2.19, p < .001) versus individuals without diabetes. Compared with nondepressed people with diabetes, those with diabetes and comorbid depression were older, less educated, more likely to be female and physically inactive, less likely to be employed, and married and had more comorbidities. In multivariate regression analyses, people with diabetes and depression had significantly greater odds of prolonged bed days due to illness (>or=20 days) (OR = 2.6, 95% CI = 1.69-3.88, p < .001), prolonged length of hospital stay (>or=18 days) (OR = 2.1, 95% CI = 1.27-3.45, p = .004), and multiple hospital admissions (>or=2) (OR = 1.8, 95% CI = 1.13-2.82, p = .01) compared with nondepressed diabetic patients. CONCLUSIONS: These findings further document the association between depression and health resource utilization and lost productivity in people with diabetes. Screening and treating depression are important for everyday clinical care and public health initiatives to improve health outcomes for people with diabetes.

Effort-reward imbalance and overcommitment at work are associated with painful menstruation: results from the Hungarostudy Epidemiological Panel 2006.

OBJECTIVE: To analyze the relationship between work stress, defined according to the Effort-Reward Imbalance Model, and painful menstruation. METHODS: Data of 821 pre-menopausal and not pregnant working women from the Hungarostudy Epidemiological Panel 2006 were analyzed. The association between work stress and dysmenorrhoea was investigated using logistic regression. RESULTS: After controlling for age, occupational class, own and mother's education, marital status, parity, unsuccessfully trying to conceive for at least 1 year, previous miscarriage, smoking, body-mass index, physical activity and depressive symptoms effort-reward imbalance and overcommitment were associated with an increased risk of menstrual pain (OR [95% CI]: 1.42 [1.03 to 1.94] and 1.07 [1.02 to 1.13], respectively). CONCLUSIONS: We found work stress to be associated with dysmenorrhoea. The relationship between work-related psychosocial factors and painful menstruation needs to be further investigated to determine factors that may explain this association.

Relationship between meaning in life and smoking status: results of a national representative survey.

Very little is known about the association between cigarette use and perceived level of meaning in life, although the connection of other addictive behaviors with the feeling of meaninglessness has been widely investigated. The aim of the present study was to examine the relationship between life meaning and smoking status in a large national representative sample. A total of 12,643 people were interviewed in the Hungarostudy 2002 survey, representing the Hungarian population according to gender, age, and sub-regions of the country. Multinomial logistic regression analysis showed that meaning in life scores significantly differentiated between current and never smokers, as well as between current and former smokers. In addition, the difference in life meaning scores between never and ex-smokers was insignificant, and gender did not interact with life meaning in relation to smoking status. Further research is needed to clarify the nature and mediators of the observed relationship between life meaning and smoking in order to better understand the role of existential concerns in cigarette use.

Prevalence of diabetes in a large, nationally representative population sample in Hungary.

We examined the prevalence of diabetes in a large, Hungarian, nationally representative adult population sample. The overall prevalence of diabetes was 6.2% (95% CI: 5.7-6.6). Increasing age and body mass index (BMI), male gender, physical inactivity, lower self-reported financial status, hypertension and non-smoking were independently associated with diabetes.

Work-related stress factors and menstrual pain: a nation-wide representative survey.

While imposing research has been conducted with respect to the biological determinants of painful menstruation, little is known about the psychosocial factors, including work-related stress that might influence menstrual pain. We conducted a study in which we aimed to determine besides the prevalence of dysmenorrhoea whether menstrual pain was associated with job control, co-worker social support, job security and dissatisfaction with the job. Data of 2772 working women aged 18-55 years, participants in the Hungarostudy 2002 nation-wide representative survey was analyzed. Binary logistic regression was used to determine the association between work stress factors and menstrual pain. Altogether 15.5% of women reported to experience menstrual pain that limits their daily activity. Low job control, low co-worker social support and low job security were found to be associated with a higher risk for menstrual pain even after controlling for the effect of age, educational attainment, parity status, smoking, body-mass index and treatment for gynecological problems. Job dissatisfaction was also related to dysmenorrhoea, albeit not significantly. The relationship between work-related psychosocial factors and painful menstruation deserves further investigation in order to determine the possible pathways of this association.

Cardiovascular disease and health-care utilization in snorers: a population survey.

STUDY OBJECTIVES: We assessed the prevalence of self-reported snoring in the Hungarian population and established whether different types of snoring are associated with cardiovascular disorders and increased health-care utilization. DESIGN: Cross-sectional study. Door-to-door survey. SETTING: Nationally representative population in Hungary. PARTICIPANTS: Interviews were carried out in the homes of 12,643 persons. We used the Hungarian National Population Register as the sampling frame and implemented a clustered, stratified sampling procedure. The study population represented 0.16% of the population over the age of 18 years according to age, sex, and 150 subregions of the country. INTERVENTIONS: Not applicable. MEASUREMENTS AND RESULTS: Thirty-seven percent of men and 21% of women reported loud snoring with breathing pauses. Hypertension, myocardial infarction, and stroke were reported by 26%, 3%, and 4% of the respondents, respectively. There was a significant increase in the prevalence of hypertension, myocardial infarction, and stroke in quiet and loud snorers, as compared with nonsnorers. Multivariate analysis showed an association between loud snoring and hypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.24-1.58), myocardial infarction (OR: 1.34, CI: 1.04-1.73), and stroke (OR: 1.67, CI: 1.32-2.11) after statistical adjustment for age, sex, body mass index, diabetes, level of education, smoking, and alcohol consumption. Loud snoring was also associated with measures of health-care use in both sexes. CONCLUSIONS: Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization.

Work stress and mental health in a changing society.

BACKGROUND: The aim of this representative study in the Hungarian population was to analyse the association between work-related factors and self-reported mental and physical health after controlling for negative affect and hostility as personality traits. METHODS: The effects of job related factors on Beck Depression Score, WHO well-being score and self-rated health (SRH) were analysed in a representative sample of 3153 male and 2710 female economically active Hungarians. RESULTS: In both genders negative affect was the most important correlate of depression, well-being and SRH, whereas hostility was closely associated only with depression. Job insecurity, low control and low social support at work, weekend work hours, job-related life events and dissatisfaction with work and with boss were independent mental health risk factors, but there were important gender differences. Job related factors seem to be equally important predictors of mental health as social support from family. CONCLUSION: The results of this large national representative study indicate that independent of negative affect and hostility, a cluster of stressful work-related psychosocial conditions accounts for a substantial part of variation in self-reported mental and physical health of the economically active population in Hungary.

Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study.

OBJECTIVE: To explore the long-term effect of anxiety and depression on outcome after cardiac surgery. To date, the relationship between psychosocial factors and future cardiac events has been investigated mainly in population-based studies, in patients after cardiac catheterization or myocardial infarction. METHODS: In total, 180 patients who underwent cardiac surgery using cardiopulmonary bypass were prospectively studied and followed up for 4 years. Anxiety (Spielberger State-Trait Anxiety Inventory, STAI-S/STAI-T), depression (Beck Depression Inventory, BDI), living alone, and education level along with clinical risk factors and perioperative characteristics were assessed. Psychological self-report questionnaires were completed preoperatively and 6, 12, 24, 36, and 48 months after discharge. Clinical end-points were mortality and cardiac events requiring hospitalization during follow-up. RESULTS: Average preoperative STAI-T score was 44.6 +/- 10. Kaplan-Meier analysis showed a significant effect of preoperative STAI-T >45 points (p = .008) on mortality. In multivariate models, postoperative congestive heart failure (OR: 10.8; 95% confidence interval [CI]: 2.9-40.1; p = .009) and preoperative STAI-T (score OR: 1.07; 95% CI: 1.01-1.15; p = .05) were independently associated with mortality. The occurrence of cardiovascular hospitalization was independently associated with postoperative intensive care unit days (OR: 1.41; 95% CI: 1.01-1.96; p = .045) and post discharge 6th month STAI-T (OR: 1.06; 95% CI:1.01-1.13; p = .03). CONCLUSIONS: The results of the present study suggest that the assessment of psychosocial factors, particularly the ongoing assessment of anxiety, could help in risk stratification and identification of patients at risk of mortality and cardiovascular morbidity after cardiac surgery.