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Stress and anger may exacerbate heart failure

Mental stress and anger may have clinical implications for patients with heart failure according to a new report published in the Journal of Cardiac Failure.
Heart failure is a life-threatening cardiovascular disease in which the heart is damaged or weakened. This can lead to a reduced ejection fraction, in which the heart muscle pumps out a lower amount of blood than is typical with each contraction.
In this study of patients who had heart failure with reduced ejection fraction, the authors -- including researchers at Yale -- evaluated the effects of stress and anger on diastolic function. Diastolic function describes the ability of the heart to relax and refill between muscle contractions and is predictive of mortality risk.

For one week, participants completed daily questionnaires about their experiences of stress, anger, and negative emotions during the previous 24 hours. Participants then completed a standardized "mental stress" protocol in which they solved challenging arithmetic problems and described a recent stressful experience. Echocardiograms were performed to assess diastolic function at rest and during the stress task.

Patients who reported experiencing anger in the week prior to the laboratory mental stress protocol exhibited worse baseline resting diastolic pressure, the researchers said. Furthermore, most patients demonstrated stress-provoked changes in diastolic function, including decreased early relaxation and increased diastolic pressure.

"Mental stress is common in patients with heart failure due in part to the complexities of disease self-management, progressively worsening functional limitations, and frequent symptom exacerbations and hospitalizations," said the lead author Kristie Harris, a postdoctoral associate in cardiovascular medicine at Yale.

"We have evidence that patients who experience chronically elevated levels of stress experience a more burdensome disease course with diminished quality of life and increased risk for adverse events. Clarifying the relevant behavioral and physiological pathways is especially important in the era of COVID-19 when the typical stressors of heart failure may be further compounded by pandemic-related stressors," Harris said. "Factors such as mental stress and anger often go unrecognized and are under- addressed," said Matthew Burg, a Yale clinical psychologist and senior author of the study. "This study contributes to the extensive literature showing that stress and anger affect clinical outcomes for patients with heart disease, adding chronic heart failure to the list that includes ischemic heart disease (narrowed arteries) and arrhythmic disease." Burg said that while anger management and stress management techniques have been shown to reduce risk for adverse events among patients with ischemic heart disease (narrowed arteries), further work is needed to identify factors that increase vulnerability to the effects of stress in heart failure, and to determine whether stress management can improve outcomes for these patients.

Materials provided by Yale UniversityOriginal written by Elisabeth Reitman.

From this month’s NAMA

Teens who think their parents are loving are less likely to be cyberbullies

Adolescents who perceive their parents to be loving and supportive are less likely to engage in cyberbullying, according to a new study by researchers at NYU Rory Meyers College of Nursing.

The findings, published in the International Journal of Bullying Prevention, are especially relevant given changes in family life created by the COVID-19 pandemic.
"With remote learning replacing classroom instruction for many young people, and cell phones and social media standing in for face-to-face interaction with friends, there are more opportunities for cyberbullying to occur," said Laura Grunin, a doctoral student at NYU Meyers and the study's lead author. "New family dynamics and home stressors are also at play, thanks to higher unemployment rates and more parents working from home."

More than half of U.S. teens report having experience with cyberbullying, or online behavior that may involve harassment, insults, threats, or spreading rumors.

"Understanding what factors are related to a young person's cyberbullying of peers is important for developing ways that families, schools, and communities can prevent bullying or intervene when it occurs," said Sally S. Cohen, clinical professor at NYU Meyers and the study's senior author.
Gary Yu, associate research scientist and adjunct associate professor at NYU Meyers, coauthored the study with Grunin and Cohen.

Using data from the World Health Organization (WHO) Health Behavior in School-Aged Children survey, the researchers analyzed responses from 12,642 U.S. pre-teens and teens (ages 11 to 15 years old) surveyed in 2009-2010, the most recent WHO data on school-aged children collected in the United States. The adolescents were asked about their bullying behaviors, as well their perceptions of certain family characteristics, including their relationship with their parents.

The researchers found that the more adolescents perceived their parents as loving, the less likely they were to engage in cyberbullying. When asked if their parents are loving, youth who said "almost never" were over six times more likely to engage in high levels of cyberbullying than those who answered that their parent is "almost always" loving. Other types of emotional support, including how much teens feel their parents help and understand them, also contributed to the likelihood of whether young people engaged in cyberbullying behavior.

"Our findings point to the importance of parental emotional support as a factor that may influence whether teens cyberbully -- and more importantly, it is how teens perceive the support they receive from their parents," said Grunin. "I would stress to parents it is not necessarily if they think they are being supportive, but what their adolescent thinks. Parents should strive to discern their teen's perception of parental emotional support as it might be associated with youth cyberbullying behavior."

Certain demographic factors were also related to teens' likelihood of cyberbullying. Girls were much less likely than boys to exhibit high levels of cyberbullying. Race also played a role: Asian American adolescents were the least likely to be cyberbullies, while African American teens were less likely than white teens to engage in lower levels of cyberbullying and more likely to engage in higher levels.

Cohen added, "Since 2010, when the survey was conducted, technology and social media have become increasingly ubiquitous in teens' lives; the increase in screen time during the current pandemic poses new challenges. Online access and anonymity in posts create widespread opportunities for cyberbullying."
The researchers note that educators, health professionals, social media experts, and others working in youth development should take family dynamics into account when creating programs to address cyberbullying.

"While our study doesn't prove that a lack of parental support directly causes cyberbullying, it does suggest that children's relationships with their parents might influence their bullying behaviors. These relationships should be considered when developing interventions to prevent cyberbullying," said Grunin.
Source: Materials provided by New York University.