Neurobiological and psychological evidence of chronic stress in prostate cancer patients.

To measure the prevalence and severity of Generalised Anxiety Disorder (GAD), hypo- and hypercortisolaemia, and their association in a sample of prostate cancer (PCa) patients, 97 Australian PCa patients completed a background questionnaire and the GAD-7, and provided a sample of saliva collected 30-45 min after waking. The mean GAD7 score was 9.67 (SD = 3.09), and prevalence rates for current anxiety were higher than those reported for non-PCa males of a similar age. Mean salivary cortisol concentrations (30.78 nmol/L, SD = 13.97 nmol/L) were also higher than for age-comparative non-PCa men. There was a significant inverse correlation between GAD and cortisol (r = -. 209, p < .05), and four subgroups of GAD-cortisol patients were able to be identified, with evidence of both hyper- and hypocortisolaemia. These findings provide initial neurobiological evidence of the chronic and profound nature of stress experienced by PCa patients, and also suggest a possible measure that might be used to identify most at-risk PCa patients.

Measuring depression in prostate cancer patients: does the scale used make a difference?

This study investigated differences in the scores, relative severity and major depressive disorder (MDD) and subsyndromal depression status from three standardised self-report scales for depression in prostate cancer (PCa) patients. The Hospital Anxiety and Depression Scale Depression subscale (HADS-D), the Self-rating Depression Scale (SDS) and the Patient Health Questionnaire (PHQ-9) for depression were administered to a sample of 138 PCa patients via mail-out self-reports in Queensland, Australia during May 2014. Despite significant correlations between the total scores from the three scales, severity classification differed across the three scales and there was evidence of considerable underestimation of depression by the HADS-D compared to the PHQ-9, and a similar tendency for the SDS. When patients were classified as fulfilling the criteria for Subsyndromal Depression on the PHQ-9, there were statistically significant differences in the proportion of patients who met those criteria using the HADS-D and the SDS, with large underestimation also present for these two scales. Scale construction and depression items included can produce different results across scales, making inter-study comparisons difficult. Implications for research and clinical practice are described.

Total depression and subtypes in prostate cancer survivors 10 years after treatment.

To describe the prevalence, severity and nature of depression in a sample of prostate cancer (PCa) survivors 10 years after diagnosis and treatment, 146 Australian patients from the RADAR trial who received their diagnosis 10 years previously completed the Zung Self-rating Depression Scale and a background questionnaire. Prevalence rates for clinically significant depression and severe depression were higher than those reported for the non-PCa men of the same age in Australia. The most common subtype of depression was Anhedonia, followed by Cognitive depression. Change in eating habits was the most powerful depression symptom predicting Anhedonia. By providing the first detailed documentation of major depression prevalence in PCa survivors, plus describing the nature of that depression, these data suggest that there is an ongoing need to provide treatments for these men and that those treatments should be focussed upon loss of previously available sources of enjoyment.

The Hot Flush Beliefs and Behaviour Scale for Men (HFBBS-Men) undergoing treatment for prostate cancer.

OBJECTIVE: Hot flushes and night sweats (HFNS) are commonly experienced by men receiving treatment for prostate cancer. Cognitive behavioural therapy (CBT) has been found to be an effective treatment for HFNS in women, but cognitions and behavioural reactions to HFNS in men are under-researched. This study describes the development of the HFNS beliefs and behaviour scale for men. METHODS: HFNS beliefs and behaviour items were generated from a qualitative study, from pilot interviews with men with prostate cancer and HFNS, and from scales used for women. 118 men with prostate cancer, aged above 18, English-speaking, who had minimum of seven HFNS weekly for at least 1 month, completed the initial measure, and measures of HFNS frequency, problem rating, anxiety and depression (HADS). Principal components analyses with orthogonal rotation determined the most coherent solution. RESULTS: Exploratory factor analysis culminated in a 17-item HFNS beliefs and behaviour scale for men (HFBBS-Men) with three subscales: (1) HFNS social context and sleep, (2) Calm/Acceptance, (3) Humour/Openness. The subscales had reasonable internal consistency (Cronbach alpha 0.56-0.83). Validity was supported, by correlations between subscale 1, HFNS frequency, problem-rating and mood; men with locally advanced cancer more likely to adopt Calm/Acceptance and those with metastatic cancer Humour/Openness. CONCLUSIONS: Preliminary analysis of the HFBBS-Men suggests that it is a psychometrically sound instrument, grounded in men's experiences. As a measure of cognitive and behavioural reactions to HF/NS, the HFBBS-Men should increase understanding of the mediators of outcomes of psychological interventions, such as CBT.

Does resilience 'buffer' against depression in prostate cancer patients? A multi-site replication study.

Although psychological resilience has been shown to 'buffer' against depression following major stressors, no studies have reported on this relationship within the prostate cancer (PCa) population, many of whom are at elevated risk of depression, health problems and suicide. To investigate the effects of resilience upon anxiety and depression in the PCa population, postal surveys of 425 PCa patients were collected from two sites: 189 PCa patients at site 1 and 236 at site 2. Background data plus responses to depression and resilience scales were collected. Results indicated that total resilience score was a significant buffer against depression across both sites. Resilience had different underlying component factor structures across sites, but only one (common) factor significantly (inversely) predicted depression. Within that factor, only some specific items significantly predicted depression scores, suggesting a focused relationship between resilience and depression. It may be concluded that measures of resilience may be used to screen depression at-risk PCa patients. These patients might benefit from resilience training to enhance their ability to cope effectively with the stress of their diagnosis and treatment. A focus upon specific aspects of overall resilience may be of further benefit in both these processes.

The incidence and causes of different subtypes of depression in prostate cancer patients: implications for cancer care.

Although depression occurs in prostate cancer patients at a higher incidence than in age-matched non-cancer peers, little is known about the relative incidence of subtypes of depression among these patients. To examine this issue, 507 prostate cancer patients completed a survey questionnaire of background factors, depression symptoms, and common prostate cancer-related stressors. Five common subtypes of depression were defined from the wider literature, and patients' depressive symptomatology was used to determine their scores on each of the five depression subtypes. Nearly half of the patients had scores which could be classified as clinically significant for at least one of the five depression subtypes, with some patients showing clinically significant scores for multiple depression subtypes. Different depression subtypes were predicted by different prostate-cancer-related stressors. Because each of the five depressive subtypes examined here has different symptomatologies and treatment recommendations, these data suggest that treatment goals for prostate cancer patients might vary according to the type of depression a patient presents.

Hair cortisol concentration differs across site and person: localization and consistency of responses to a brief pain stressor.

Although in vitro studies have shown that cortisol concentrations in human and animal hair respond to environmental stressors, few data have been reported regarding the in vivo variability of hair cortisol to brief pain stressors. As an extension of a previous study, hair was collected and assayed for cortisol concentrations from each of three sites (elbow, mid-forearm, wrist) before and after participants immersed their hand in ice water for 1 min. Results showed that the "localization" boundary of hair cortisol responses previously reported was able to be reduced to only 250 mm between sites. Furthermore, all participants showed considerable variability in hair cortisol across the three sites at each collection period, although consistency across participants in overall responsivity of hair cortisol to the pain stressor was observed.

Effects of interval between diagnosis and time of survey upon preferred information format for prostate cancer patients.

Previous data indicate that receiving adequate information about their cancer can assist patients to cope with treatment and comply with treatment regimes. The aim of the present study was to determine whether time since diagnosis affected patients' evaluations of the information they had received at the time of their diagnosis. Two hundred and thirty-seven patients who had received a diagnosis and treatment for prostate cancer 4 months earlier completed a questionnaire about their ratings of, and preferences for, various types of information, their anxiety and depression levels and some background data. The most common and preferred form of information that the patients in the current study received was verbal information during an interview with their oncologist. Demographic factors and levels of anxiety and depression did not influence patient information preferences. Time since diagnosis was associated with elevated anxiety and depression, and consequent lower recall of having received information, but also with positive inflation of the value of the material that they did recall having received. Patients may not recall information given to them early after diagnosis and may make unreliable evaluations of its value to them due to psychological state.

An initial exploration of in vivo hair cortisol responses to a brief pain stressor: latency, localization and independence effects.

Cortisol is secreted by the central hypothalamo-pituitary-adrenal axis and affects many target organs and tissues, particularly in response to stressor demands and infection. Recent data reporting cortisol synthesis in hair follicles have shown the existence of a parallel "peripheral" HPA-axis. However, although there is evidence from in vitro studies and single-observation comparisons between groups that cortisol from hair follicles reflects endocrine changes associated with stressor demands, there are no reports to date of repeated measurements of in vivo cortisol responsivity in hair to transitory stressors. This issue was investigated with three males who underwent 1 min cold pressor test (CP). Cortisol response in hair to stressor demand appears to be (a) swift but transitory, (b) localized to the site of the demand and (c) independent of central HPA-axis activity.

An exploratory analysis of the use of cognitive, adaptive and behavioural indices for cluster analysis of ASD subgroups.

BACKGROUND: Autism spectrum disorder (ASD) includes symptoms that vary in severity and frequency between children. Consequently, multiple psychometric assessment procedures are recommended to detect an ASD, including scales which asses the presence and nature of ASD-related behaviour. However, to date, few studies have examined the relative and specific contribution which such behaviourally oriented scales can make to the diagnosis of individual children with ASD. METHOD: Cluster analysis was used to explore the common characteristics of a group of 53 preschool and elementary school children with an ASD, based upon scores on tests of cognitive ability, adaptive behaviour and behavioural checklists designed to measure the presence of typical ASD. RESULTS: Data confirmed the expected variability in intelligence test scores. In addition, measures of adaptive behaviour and data from a behaviourally based rating scale suggested that children with Asperger's Disorder and autism might be reclassified into subgroups according to the presence of particular ASD-specific behaviours. CONCLUSIONS: As well as confirming that children with ASD vary in their adaptive behaviour and cognitive levels, these data emphasise the limited contribution such assessment procedures make to an understanding of the child's day-to-day behaviour and functioning, thus arguing for the inclusion of behaviourally based rating scales to develop ideographic intervention plans.

Patient information preferences among breast and prostate cancer patients.

Preferences for information about their disease and treatment were collected from 392 patients who had been treated for either breast or prostate cancer an average of 2 years previously. Type of information that they had received, their ratings of its value to them and their preferred format for further information were examined. The most common and most preferred form of information was through doctor interview, followed by educational booklets. Prostate cancer patients preferred videotapes; breast cancer patients tended to prefer individualized approaches including a tour of the department. Effects of age, educational levels, occupational backgrounds and self-reports for anxiety and depression at the time of the survey and at time of diagnosis were analysed. Prostate cancer patients who were most severely depressed showed a preference for not receiving any information at all, perhaps reflecting a tendency towards withdrawal.

An examination of the relationship between resting heart rate variability and heart rate reactivity to a mental arithmetic stressor.

Resting heart rate variability can be an index of sympathetic or parasympathetic dominance, according to the frequency of the variability studied. Sympathetic dominance of this system has been linked to increased risk of cardiovascular disease (CVD). Similarly, rapid and dramatic increases in heart rate reactivity to a stressor task have also been suggested as indicating increased risk of CVD via atherogenesis. Although both of these variables have been related to the development of cardiovascular disease, and both may be related to increased sympathetic activity or parasympathetic withdrawal, most research studies have tended to focus on either variable independently of the other. In order to investigate whether these two indices of stressor reactivity were related in relatively young and healthy subjects, resting heart rate variability data were collected from 80 volunteers for 20 minutes. In addition, heart rate reactivity data were collected during a 2-minute mental arithmetic stressor, which has been previously shown to induce significant increases in heart rate. After classifying subjects according to whether their heart rate variability data were above or below the mean for their gender, heart rate reactivity data were examined via MANOVA to detect significant differences between subject groups. Females showed significant effects, and males showed nonsignificant trends, but these two sets of data were in different directions, suggesting that gender may be a confounding factor in the relationship between heart rate reactivity and heart rate variability.

Differences between ECG and pulse when measuring heart rate and reactivity under two physical and two psychological stressors.

To test the level of agreement of heart rate and reactivity to stressor tasks as measured via noninvasive ECG and pulse, 38 healthy subjects underwent four stressor tasks: mental arithmetic, reaction time, cold pressor, and bicycling. Data on resting and stressor heart rate were collected via ECG and photoplethysmography, and heart rate reactivity was calculated via five methods noted in the wider literature. Results indicated that, although resting heart rate values did not differ significantly across the two instruments, there were some significant differences in heart rate during certain periods of mental and physical stress reactivity. Calculation of heart rate reactivity revealed that there were few significant differences between data from the two measures but that the tasks themselves produced markedly different patterns of reactivity, questioning assumptions underlying comparison of reactivity data under different stress tasks. Implications for the assessment of reactivity are discussed.

Psychosocial stress-induced heart rate reactivity and atherogenesis: cause or correlation?

The relationship between heart rate reactivity and atherogenesis is examined. Data from empirical studies are presented which support theoretical suggestions that it is the heart rate itself rather than the increase in heart rate following the onset of a stressor which is causally related to the development of arterial atherosclerosis. Several directions for research which will clarify this issue are discussed, with recent developments in the detection of atherosclerosis suggested as forming the basis of more reliable investigation of the effects of cardiac output variables upon arterial atherogenesis.

Psychometric properties of the Self-perceived Stress in Retirement Scale.

A 14-item self-report scale, Self-perceived Stress in Retirement Scale, was developed from retirees' lists of factors which caused them stress in everyday living, and then administered to 348 men and 385 women who had been retired from between six months to over five years. Analysis indicated that the scale showed satisfactory internal consistency, was sensitive to a range of scores representing participants' stress, correlated significantly with standardised measures of anxiety and depression, and showed a structure with three factors of missing work, personal health, and relationship issues. Suggestions for the use of the scale in further research are discussed.

Age and gender differences in the relationship between heart rate reactivity and elevated serum lipids.

Data on serum lipids and heart rate reactivity to a standardized mental arithmetic stressor were collected on 54 healthy men and 73 healthy women. Subjects' ages ranged from 18 to 61 years, allowing analysis of data from both young and older subgroups. MANOVA revealed that age was directly associated with elevated lipids in men and women. There was no significant relationship between reactivity and lipids for either older or younger men. Conversely, young women showed a significant direct relationship between reactivity and Total Cholesterol and LDL, but this was not present for older women. Implications of these data for the previously reported hypothetical relationship between reactivity and lipids are discussed. Limitations of the study are examined, and future directions for research suggested.

Maintenance and generalizability of laboratory-based heart rate reactivity control training.

The maintenance over time (4 months) and generalizability (to a work setting) of laboratory-based heart rate reactivity control training was investigated. Forty-three subjects received 5 weeks of biofeedback, imagery, and breathing training and 41 subjects acted as controls. Although there were no significant differences between the reactivities of the control and those of the treatment subjects at any of three pretraining tests, significant differences were noted immediately following training, 7 weeks, and 4 months later, showing maintenance effects. Data collected during work activities on the frequency of reactivity of a magnitude similar to that in the laboratory also showed that treatment subjects had significantly fewer incidents of reactivity than control subjects after training. Followup interviews with treatment subjects indicated that lifestyles were also enhanced in a variety of areas, suggesting that the training had wider benefits. Issues for further research are discussed.

Differences in pulse rate and heart rate and effects on the calculation of heart rate reactivity during periods of mental stress.

Heart rate and reactivity from pulse and ECG were compared over rest and mental arithmetic periods of 2-min duration each for 32 males and 50 females. Data from the two sources of heart rate were not significantly different during the rest period but did differ significantly during periods of heart rate acceleration and deceleration. Sex effects were also noted, with females having consistently higher heart rates from both sources of measurement. Calculation of heart rate reactivity via five procedures based upon the wider literature revealed significant differences between data from different sources of heart rate. Implications for assessment of heart rate reactivity to laboratory stressors are discussed, with suggestions for future research.

Effects of brief rest periods upon heart rate in multiple baseline studies of heart rate reactivity.

Although there has been some discussion regarding the appropriate length of time necessary for subjects to reach true resting heart rate prior to experimentation, the relevance of conclusions from that discussion for multiple baseline studies of heart rate has not been demonstrated. To investigate this issue, data were collected from 39 males and 33 females following a standard 15-minute adaptation period and then during a series of two-minute experimental phases including stressor tasks and rest periods. Results indicated that, while the group's heart rate during brief rest periods returned to postadaptation levels, there was a substantial subgroup of subjects for whom this was not the case. Implications for the use of multiple baseline procedures in research where heart rate is the dependent variable are discussed.

Developmental and gender differences in the relationship of behavior pattern to heart rate reactivity between two teenage samples.

The Type A Behavior Pattern was assessed for 122 teenagers from two age-groups. Subjects had their heart rate measured during rest and presentation of a mental arithmetic stressor under timed and competitive conditions. Data were analyzed to determine whether sex, age, task performance, and behavior pattern predicted the degree of heart rate reactivity shown by these children. Although there were no significant main effects for behavior pattern, sex, or age, there was a significant interaction among age, sex, and behavior pattern. It is suggested that the two age groups of teenagers sampled here differ in the relationships they show between behavior pattern and heart rate reactivity. This result challenges some previous assumptions with regard to the homogeneity of teenagers on this issue.