Journal of Psychosomatic Research最新文献

The interplay between obstructive sleep apnea (OSA) and psychiatric disturbances has gained increasing attention in Sleep Medicine. This study investigated the relationship of OSA with symptoms of anxiety and depression, as well as changes in these symptoms from baseline to the 8-year follow-up. Data were derived from the São Paulo Epidemiologic Sleep Study (EPISONO), a longitudinal population-based cohort with baseline assessment conducted in 2007 (N = 1042) and follow-up in 2015 (N = 712). OSA diagnosis was defined by the apnea-hypopnea index (AHI) obtained through full-night polysomnography, and OSA severity was classified according to American Academy of Sleep Medicine criteria. Anxiety and depressive symptoms were assessed using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI-I in 2007 and BDI-II in 2015). Paired analyses using Wilcoxon signed-rank tests indicated that anxiety symptoms increased significantly between baseline and the 8-year follow-up in participants with OSA (p = 0.035). No change was observed in those without OSA (p = 0.110). Depressive symptoms did not change significantly in either group over the course of the assessments. In multiple linear regression models restricted to participants with OSA (n = 347), OSA severity was inversely correlated with anxiety symptoms (β = -0.14, p = 0.014) and depressive symptoms (β = -0.13, p = 0.023) after adjustment for demographic and anthropometric covariates. Within the OSA group, male sex was independently associated with lower anxiety (β = -0.24, p = 0.003) and depressive symptom levels (β = -0.273, p < 0.001). This longitudinal study showed increased anxiety over time in individuals with OSA, while depressive symptoms remained stable. Emotional symptoms were inversely correlated with OSA severity, suggesting influences beyond respiratory disturbance severity.

Background: Placebo-induced analgesia is a robust yet incompletely understood phenomenon. Despite extensive research, it remains unclear whether, and under what circumstances, the responsiveness to placebo can be generalized. This secondary exploratory analysis examined the generalizability of placebo-responses across time, pain-models (clinical and experimental) and scale context in a cohort of chronic-back-pain patients.

Methods: Changes in clinical and experimental-pain were assessed following a single placebo injection. Clinical placebo-responses were defined as changes in self-reported pain-intensity from baseline to 30 min (immediate) and 24 h (prolonged) post-injection. Experimental placebo-responses were defined as changes in pressure pain thresholds, tolerance, and intensity from baseline to 30 min post-injection. In total, three clinical and four experimental placebo measures were assessed.

Results: The mean age of participants (n = 113, 58 females) was 56.8 years (SD = 15.3). Significant placebo-response (d = 1.01, 95% CI [0.78, 1.23]), was observed in clinical but not experimental models. Associations between placebo-responses were significant and strongest within all clinical measures (Spearman's Rho: 0.201, p < .05;0.384, p < .01;0.634, p < .01), followed by weaker associations across the experimental measures (Spearman's Rho ranged from -0.120 to.271, with two significant correlations, p < .05 and p < .01). The weakest associations were observed between the clinical and experimental placebo-models (Spearman's Rho ranged from -0.004 to.269, with only one significant correlation, p < .05).

Conclusion: Based on this exploratory analyses, clinical placebo measures show stronger associations than experimental ones, with the weakest overlap between settings. The current findings are in line with the general notion that the placebo-response is highly affected by the context. This study was registered on Clinicaltrial.gov (protocol number NCT05994118).

Background: Kinesiophobia, defined as fear of movement, has emerged as a critical psychological barrier affecting health behaviors in patients undergoing rehabilitation following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Existing research on kinesiophobia has largely focused on non-cardiac chronic conditions, with social support's mechanism in alleviating cardiac-specific kinesiophobia underexplored.

Objective: Drawing upon Social Cognitive Theory and the Health Belief Model, the present study proposes and tests a chain-mediated model linking social support to kinesiophobia through rehabilitation resource utilization and exercise self-efficacy.

Methods: A cross-sectional survey was conducted among 200 post-PCI patients to examine the proposed pathways using mediation analysis with bootstrapping.

Results: A total of 200 patients (mean age: 62.3 ± 8.5 years; 88.0% male; 97.0% married; 57.0% with one implanted stent) were included. Social support was significantly and negatively associated with kinesiophobia, with rehabilitation resource utilization and exercise self-efficacy acting as partial mediators through multiple indirect pathways. Although the full chain mediation pathway did not reach statistical significance, the overall pattern of results was consistent with a sequential process linking external support, resource access, and efficacy beliefs to fear-based avoidance.

Conclusion: The study provides both theoretical and practical implications for developing integrated rehabilitation interventions that leverage social support to reduce kinesiophobia and improve post-AMI recovery outcomes.

Background: Diabetes is a prevalent chronic condition associated with a substantial health burden. Inadequate self-care is associated with poor glycemic control and increased risk of complications, yet diabetes self-care remains suboptimal. Fear of disease progression (FoP), a broader illness-specific concern, has been underexamined in diabetes and may either motivate or hinder engagement in self-care, suggesting a potential non-linear effect. This study examined whether the relationship between FoP and self-care is moderated by perceived task difficulty and illness perceptions (threat and control).

Methods: In a two-wave longitudinal study, 259 participants with diabetes were recruited from an online diabetes patient community in Korea; 187 completed surveys three months apart. Measures included the Fear of Progression Questionnaire, the Brief Illness Perception Questionnaire, and the Summary of Diabetes Self-Care Activities Questionnaire.

Results: Polynomial regression revealed a U-shaped association between FoP and self-care, with lowest self-care at moderate FoP. Task difficulty and threat perception predicted poorer self-care but did not moderate the FoP-self-care link. In contrast, control perception significantly moderated the curvilinear relationship: at low and mean levels of control perception, FoP was linked to declines in self-care, whereas at high control, self-care remained stable across FoP levels.

Conclusions: These findings extend understanding of FoP in diabetes by demonstrating a non-linear relationship with self-care and identifying perceived control as a key moderator. FoP may act as either a motivator or a deterrent depending on its intensity and the individual's control perceptions. Interventions that assess FoP and strengthen perceived control may help sustain self-care in diabetes.

Background: Delirium is a common acute neuropsychiatric syndrome in hospitalized adults. Emerging evidence and updated guidelines increasingly discourage routine antipsychotic use in delirium due to safety concerns. This study examined temporal trends in psychotropic recommendations for delirium across two three-year epochs in a tertiary-care hospital.

Methods: This retrospective study analyzed 1812 psychiatric consultations for suspected delirium-of which 1657 were confirmed-comparing two epochs (2016-2019 vs. 2022-2025). Psychotropic recommendations, haloperidol administration routes, and clinical characteristics were compared between epochs. Binary logistic regression examined whether epoch-related differences persisted after adjustment for age, sex, and clinical setting.

Results: Mean age was significantly higher in epoch 2 (72.68 ± 14.28 vs. 70.15 ± 14.7 years, p < .001). Clinical setting distribution differed significantly between epochs, with surgical consultations declining (40.2% to 33.4%) and ICU consultations increasing (6.9% to 9.9%, p = .005). A significant shift in recommendation patterns was observed (χ²(7) = 245.57, p < .001): haloperidol and quetiapine decreased markedly, while olanzapine, melatonin, and non-pharmacological management only increased. Multi-agent recommendations declined from 17.9% to 6.3% (p < .001). Intravenous haloperidol use fell sharply (61.5% to 16.6%, p < .001). After covariate adjustment, epoch remained an independent predictor of haloperidol (OR = 0.378), quetiapine (OR = 0.634), and non-pharmacological management only (OR = 3.051).

Conclusion: Delirium consultation practice has shifted toward more conservative, guideline-concordant recommendations, characterized by reduced haloperidol use, increased reliance on olanzapine, melatonin, and non-pharmacological strategies. Whether these trends translate into improved patient outcomes remains to be established and warrants prospective investigation.

Background: Dizziness is a highly prevalent and often disabling complaint that cannot always be explained by peripheral vestibular pathology alone. Psychological factors, particularly psychological flexibility and resilience, may play an important role in shaping symptom severity and disability, yet their combined contribution remains insufficiently explored. This study aimed to examine how psychological flexibility and resilience contribute to the clinical expression of dizziness-related disability.

Methods: Ninety-eight patients with dizziness (benign paroxysmal positional vertigo, persistent postural-perceptual dizziness, chronic subjective dizziness, Ménière's disease, vestibular neuritis) and 80 matched healthy controls were included. Disability and symptom severity were assessed using the Dizziness Handicap Inventory and Vertigo Symptom Scale-Short Form. Psychological flexibility and resilience were measured with the Acceptance and Action Questionnaire-II and the Resilience Scale for Adults. Group comparisons, correlation analyses, and multivariate regression models were performed.

Results: Psychological inflexibility was significantly associated with greater disability and symptom severity and emerged as an independent predictor in multivariate models. Psychological resilience showed significant negative correlations with outcomes but did not independently predict disability or symptom severity. Among subtypes, patients with chronic subjective dizziness (CSD) exhibited lower disability levels yet showed particularly strong associations between psychological flexibility and both disability and symptom severity.

Conclusions: Psychological flexibility plays an independent role in the clinical burden of dizziness, whereas resilience appears to function as a supportive resource. These findings highlight the potential relevance of incorporating psychological flexibility-focused interventions into the clinical assessment and management, particularly functional subtypes such as CSD.

Introduction: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative treatment for many hematologic malignancies, yet patient outcomes vary significantly. Patient expectations influence recovery in other medical contexts, yet their role in allo-HSCT remains unclear. This pilot study examined whether pre-transplant treatment expectations predict psychological and immunological outcomes post-transplant.

Methods: In this prospective, single-center observational cohort study, 42 patients undergoing allo-HSCT were assessed at baseline (T0), discharge (T2), and six months post-transplant (T3). Questionnaires measured illness-related disability (PDI, primary endpoint at T3), treatment expectations (TEX-Q), quality of life (FACT-Leu), depression (PHQ-9), and anxiety (GAD-7). Immunological markers, including inflammatory markers were collected at T0 and T3. Baseline-adjusted regression analyses with full-information maximum likelihood estimation were used. P-values were corrected for multiple comparisons using a false discovery rate approach.

Results: Baseline expectations were associated with psychological outcomes at hospital discharge and immunological and inflammatory markers at six-month follow-up: For instance, negative impact expectations were associated with higher disability (β = 0.522, p < 0.001), depression (β = 0.693, p = 0.009), anxiety (β = 0.737, p = 0.003), and lower quality of life (β = -0.576, p < 0.001) at T2. Benefit expectations were associated with higher lymphocyte counts (β = 0.453, p < 0.001) and lower CRP levels at T3 (β = -0.28, p = 0.011). Positive impact expectations were associated with more favorable T-cell subsets.

Discussion: Pre-transplant expectations may influence psychological and immune recovery following allo-HSCT. Addressing expectations could enhance outcomes and should be explored in future intervention studies.