Current Issue Highlights

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    Mental Health, Type D Personality, Health Status, and Recurrent Health Care Utilization in Patients With Nonobstructive Coronary Artery Disease

    October 2026: 88(8):703-712

    Objective:

    Recurrent cardiac health care utilization (HCU) is common in patients with nonobstructive coronary artery disease (NOCAD), yet long-term mental health, personality, and health status contributing to repeated emergency department visits (ED) and diagnostic testing remain unclear. This study examined 10-year patterns and predictors of recurrent cardiac HCU in patients with NOCAD.

    Methods:

    In total 546 patients (52% women) were followed with ED visits or repeat diagnostic tests. Baseline assessments included anxiety, depressive symptoms, type D personality, fatigue, health status, and disease-specific quality of life. Negative binomial regression evaluated associations between baseline mental health and health status and total HCU, with adjustment for age, sex, education, obesity, diabetes, and major adverse cardiac events (MACE). Sex-stratified and MACE-stratified analyses were explored.

    Results:

    During follow-up, 24% of the patients experienced a single, and 26% multiple HCU. Higher anxiety, fatigue, poorer physical health, more frequent angina, and lower quality of life were associated with greater HCU, in age and sex-adjusted models. After full adjustment, lower baseline quality of life, diabetes, and subsequent MACE remained independent predictors. Sex-stratified analyses showed that baseline angina frequency and lower quality of life predicted HCU in women. Most patients with recurrent HCU did not develop MACE, suggesting that subjective symptom burden, rather than disease progression, was the main driver of long-term HCU.

    Conclusions:

    Recurrent HCU is frequent in NOCAD and is strongly influenced by baseline quality of life and cardiometabolic risk. These findings highlight the need to address symptom burden in NOCAD to reduce recurrent testing and improve long-term outcomes.

    Clinical Trial Registration

    ClinicalTrials.gov (NCT01788241) https://clinicaltrials.gov/study/NCT01788241.

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    Effect of Short-Term Psychological Intervention on Depression Dynamics in Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Implantation

    October 2026: 88(8):699-702

    Objective:

    Because depression has been identified as a relevant comorbidity in cardiovascular patients, we aimed to assess the impact of a brief expectation-focused psychological intervention on depression dynamics in aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI).

    Methods:

    From 82 TAVI patients showing a Hospital Anxiety and Depression Scale (HADS-D) score ≥8 points for depression, 74 patients underwent 1:1 randomization, with 38 assigned to the control (CON; treatment as usual) and 36 to the intervention (INT; psychological short-term intervention) group. The psychological intervention consisted of 2 individual sessions before and 2 booster sessions after TAVI. Per protocol, the HADS-D score for depression at 6 months was defined as the primary outcome and compared with baseline between the CON and the INT group by using analysis of covariance (ANCOVA).

    Results:

    Regarding the primary outcome measure, there was a mean HADS-D depression score of 10.76 (SD: 2.77) at baseline and 9.44 (SD: 4.56) at 6 months after TAVI in the CON group and of 9.86 (SD: 2.0) at baseline and 7.5 (SD: 3.15) at 6 months after TAVI in the INT group. ANCOVA did not show a significant effect of the psychological short-term interventions versus control (estimate=−1.67; 95% CI=−3.64 to −0.29) on depression dynamics 6 months after TAVI, adjusted for baseline HADS-D.

    Conclusions:

    An effect of a psychological intervention on depression dynamics could not be shown. However, there was an improvement in depression at 6 months after TAVI, which is probably due to a decline in heart failure symptoms.

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    Association of Emotional States With Heart Rate Variability in Patients With Suspected Ischemic Heart Disease: Relevant to Cardiac Symptoms During Daily Life

    October 2026: 88(8):689-698

    Objective:

    Autonomic nervous system dysregulation has been linked to cardiovascular disease risk. Both long-term and short-term emotional distress have also been associated with adverse cardiovascular outcomes. However, the relationship between acute emotional states and autonomic regulation in patients with ischemic heart disease remains unclear. This study examines the association between in-the-moment emotional states with short-term heart rate variability (HRV) indices of autonomic activity and their contribution to cardiac symptoms during daily life activities.

    Methods:

    Patients referred for diagnostic myocardial perfusion imaging (MPI) for inducibility of myocardial ischemia underwent 24-hour ecological momentary assessments (EMA) of emotional states and cardiac symptoms using electronic diaries through their mobile phones. Ambulatory ECG-based HRV indices (repeated 10-min epochs and 24 h) were matched with the EMA assessments. Associations were analyzed using General Estimation Equation models.

    Results:

    A total of 175 EMA assessments were obtained in 26 patients [mean age = 66.5 (9.3) y, 7 (26.9%) women]. Negative emotional states were associated with HRV indices (lower SD of normal-to-normal intervals and low-frequency power) and higher heart rate. Negative emotional states were associated with anginal complaints [B = 0.167 (95% CI = 0.067; 0.268), p < .001] and shortness of breath [B = 0.136 (95% CI = 0.071; 0.202), p < .001]. Lower HRV indices were also associated with these cardiac symptoms. Ischemia during MPI was negatively correlated with 24-hour low-frequency HRV, but not with negative emotions or cardiac symptoms during daily life.

    Conclusions:

    Negative emotions are related to potentially adverse changes in autonomic regulation, contributing to cardiac symptoms. These results highlight the value of in-the-moment emotional states for understanding autonomic dysregulation and cardiovascular symptoms.

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    Racial Group Differences in NREM Sleep Physiology Contribute to Memory Vulnerability

    October 2026: 88(8):677-688

    Objective:

    Racial sleep disparities may lead to long-term cognitive health consequences, with a specific impact on memory formation and maintenance. Few studies have examined the physiological sleep features, including nonrapid eye movement (NREM) stage 2 and 3 sleep and the corresponding electroencephalographic activity indicative of these stages (ie, delta oscillations 0.5 to 4 Hz), that are sensitive to racial stress and result in memory vulnerability, which is the goal of this investigation.

    Methods:

    We assessed self-report and polysomnographic indices of sleep, psychosocial outcomes, and memory performance in a sample of young, Black (n=63) and White (n=77) adults living in the United States.

    Results:

    Black participants self-reported more experiences of discrimination, lower incomes, perceived social status, and educational attainment, as well as worse subjective sleep quality. Racial group membership was associated with differential presleep memory profiles for both neutral and negatively valenced word pairs; however, memory disparities were attenuated after accounting for sociodemographic and psychosocial factors. Overnight sleep architectural differences emerged, with Black participants spending more time in stage 2 sleep, less time in stage 3 sleep, and having reduced NREM delta power when compared with White participants. NREM delta activity was a significant mediator of racial group membership and postsleep memory performance, especially for negative valenced word pairs.

    Conclusion:

    These findings suggest that known racial sleep disparities likely lead to daily, measurable deficits in memory for Black Americans and that NREM delta activity may be a uniquely sensitive biopsychosocial factor that can support cognitive resilience for those experiencing racialized contexts.

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    Associations of Depressive Symptoms With COVID-19 Hospitalization or Death: The C4R Study

    October 2026: 88(8):666-676

    Objective:

    To investigate the relationship between depressive symptoms and risk for COVID-19 hospitalization and death in a US general population-based sample.

    Methods:

    We studied participants enrolled in observational NIH-funded cohorts from 1971 to 2010 with ongoing follow-up through 2023. Prepandemic Centers for Epidemiologic Studies Depression (CES-D) 10-item scale scores ≥10 defined elevated depressive symptoms. Questionnaires, medical records, and death certificates classified incidents of COVID-19 as severe (hospitalized/fatal) or nonsevere from April 2020 through February 2023.

    Results:

    Of 33,565 participants, 633 (1.9%) had incident severe COVID-19 over a mean (SD) follow-up of 453 (207) days. Elevated prepandemic depressive symptoms were present in 4922 (16.3%) of participants. Elevated prepandemic depressive symptoms increased the hazard of severe COVID-19 in fully adjusted (aHR=1.27; 95% CI=1.03-1.57) models. In sex-stratified models (p-interaction=.03), elevated depressive symptoms increased the hazard in women (aHR=1.49; 95% CI=1.17-1.90) but not in men (aHR=0.96; 95% CI=0.67-1.39).

    Conclusions:

    Prepandemic depressive symptoms were associated with increased risk of severe COVID-19 among women in a large US general population-based study of adults, and associations in men were neither confirmed nor ruled out. These results support current CDC recommendations that depression be considered an underlying medical condition associated with a higher risk for severe COVID-19 and suggest that increased clinical focus on risk mitigation for COVID-19 and other acute respiratory infections among patients with depressive symptoms is warranted.

Latest Articles

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    Attachment Anxiety, Mitochondrial Respiration, and Future Depressive Symptoms in Dementia Spousal Caregivers

    Biopsychosocial Science and Medicine. September 28, 2026

    Objective:

    This study aimed to assess whether the negative relationship between mitochondrial respiration in peripheral blood mononuclear cells (PBMCs) and future depressive symptoms in dementia spousal caregivers is strongest for caregivers high on attachment insecurity.

    Methods:

    A sample of 166 dementia spousal caregivers provided self-report data on demographics and health information at baseline, and depressive symptoms at baseline and 7 months later. We also determined mitochondrial respiration in PBMCs at baseline only. We conducted multiple linear regressions, adjusting for demographic and health-related covariates and baseline depressive symptoms.

    Results:

    The interaction between mitochondrial spare respiratory capacity and attachment anxiety predicted future depressive symptoms (b=−1.11, P=.016). Spare respiratory capacity only predicted future depressive symptoms at mean and high levels of attachment anxiety.

    Conclusions:

    Altered mitochondrial respiration may contribute to depressive symptom expression for dementia spousal caregivers who display high levels of attachment anxiety.

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    Early Life Adversity and Cardiovascular Responses to Stress During Tobacco Ad Libitum Use and Withdrawal

    Biopsychosocial Science and Medicine. September 22, 2026

    Objective:

    Early life adversity (ELA) is associated with substance use initiation and maintenance, including tobacco use. However, its influence on cardiovascular responses to psychological stress among tobacco smokers remains unclear. This study explored this association among ad libitum and abstinent smokers.

    Methods:

    Smokers were randomly assigned to an ad libitum (n=49) or 24-h withdrawal (n=69) group, and non-smokers (n=45) participated in the study. They completed two separate but identical sessions. Each session included speech preparation, speech delivery, and a mental arithmetic task. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were repeatedly measured during each session. Linear mixed-effects models were applied to analyze the relationship between ELA and cardiovascular responses across sessions and phases.

    Results:

    In the linear mixed-effects model for SBP, the overall group × ELA interaction was significant (P=0.006). The effect of having ≥1 ELA event on SBP changes in the withdrawal group was significantly greater than that in non-smokers (fixed effect = 3.89; 95% CI = 1.41 to 6.36; P=0.002). Similar findings were also observed for DBP and HR.

    Conclusions:

    Results suggest that individuals with ELA exposure show heightened cardiovascular reactivity to acute stress during nicotine withdrawal, compared with those without ELA. They highlight the potential role of ELA in shaping stress-related physiological vulnerability during tobacco cessation efforts.

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    Protocol for a Digital Health Intervention to Improve Behavioral Rhythms and Social Connectedness for Reducing Suicide Risk Among Older Bereaved Marital Partners

    Biopsychosocial Science and Medicine. September 22, 2026

    Background:

    The death of a spouse in late life is associated with a sense of social disconnection, lack of engagement in pleasant activities, and disruptions in daily routines. Bereaved spouses are more likely to die by suicide than non-bereaved spouses yet there are no behavioral interventions designed to reduce suicide risk in this population. We describe the rationale and methodology of the NIMH-funded RISE Study (Rhythms after loss for Improving Suicide risk in bereaved Elders), a single arm clinical trial examining risk and resilience to late-life suicide following spousal bereavement by investigating the extent to which social connectedness and circadian rhythms influence suicide risk.

    Methods:

    We will enroll 169 recently bereaved (≤12 mo post-death) adults aged 60 years and older who currently have at least subthreshold symptoms of depression or have a history of depression and/or suicide attempt. All participants will complete repeated assessments over 12 months of multiple dimensions of social connectedness, clinical assessments of depression and suicidal ideation, and actigraphic assessments of 24-hour rest/activity rhythms. Participants also complete a 3-month behavioral probe, designed to directly target and increase social activity and more regular sleep-wake cycles in older bereaved adults.

    Discussion:

    RISE findings will inform the development of scalable technology-based suicide prevention programs by determining the extent to which social connectedness and behavioral rhythms are modifiable and if doing so reduces depression severity and suicide risk in older bereaved adults.

    Clinical Trials Identifier:

    NCT06191484

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