Psychological stress may play a role in the development of stroke, coronary heart disease, and hypertension, but epidemiological data on these topics have been limited to predominantly Western populations. We sought to examine the relationship of depressive symptoms, anger expression, and anxiety with cardiovascular diseases among Japanese men and women. (1) A 10.3-year prospective study on the relationship between depressive symptoms and the incidence of stroke and coronary heart disease was conducted with 901 men and women aged 40 to 78 years in a rural Japanese community. Depressive symptoms were measured at baseline with the use of the Zung Self-Rating Depression Scale (SDS). During the 10-year follow-up, 69 strokes and 21 coronary heart diseases occurred. Persons with SDS scores in the high tertile had twice the age- and sex-adjusted relative risk of total stroke as those with scores in the low tertile. The excess risk was confined to ischemic stroke. Persons with SDS scores in the high tertile had a 7-fold higher age- and sex-adjusted relative risk of coronary heart disease than did those with scores in the low tertile. Depressive symptoms predict the risk of ischemic stroke and coronary heart disease among Japanese. (2) A 4-year prospective study on the relationship of anger expression and anxiety with hypertension was conducted with 4,970 normotensive men and women aged 30 to 74 years in four rural and urban communities. Anger expression was estimated at baseline using the anger-out and anger-in scores of the Spielberger Anger Expression Scale. Anxiety was measured with the use of the Framingham Tension Scale. Men with anger-in scores in the high tertile had a 1.5-fold higher age-adjusted relative risk of hypertension than did those with scores in the low tertile. For women, the anger-in score was not associated with hypertension. There was no relation between the anger-out or anxiety score and hypertension in either men or women. Suppressed anger predicts the risk of hypertension among Japanese men, but not women.

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The purpose of this study was to investigate the influence of anxiety and depression on the autonomic nervous system. Subjects were patients with depressive disorder (n = 8), panic disorder (n = 10), and normal controls (n = 10). We examine the autonomic function using power spectral analysis of diastolic blood pressure and pulse interval. We used the high frequency power of pulse interval variability as the parameter of the cardiac parasympathetic activity, low frequency power of diastolic blood pressure variability as the parameter of the peripheral vascular sympathetic activity, and mid frequency normalized unit of diastolic blood pressure variability as the parameter of the baroreflex sympathetic activity. In patients with depressive disorder, cardiac parasympathetic activity showed a significant decrease (p < 0.05), and peripheral vascular sympathetic activity also decreased (p < 0.05). On the other hand, in patients with panic disorder, baroreflex sympathetic activity significantly increased (p < 0.05). These findings suggest that anxiety and depression have different influences on the autonomic nervous system.

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The purpose of this study was to investigate the effects of patient-therapist relationship and clinical improvement on patient satisfaction in depressive disorder. The patient-therapist relationships were evaluated using the short form relationship inventory. The clinical improvement of depressive symptom was evaluated using Beck depressive inventory. The patient satisfaction was evaluated using VAS. Subjects were 36 patients with depressive disorder (male, n = 19 ; female, n = 17 ; mean age 32.4 ± 11.3 yr (SD)). All subjects were diagnosed as depressive disorder by Structured clinical interview for DSM-III-R. Significant positive correlation between patient therapist relationship and patient satisfaction was observed at first visit and during treatment. But Multiple regression analysis revealed that the patient-therapist relationship at first visit and the clinical improvement did not predict the patient satisfaction during treatment. Major depression predicted the patient satisfaction during treatment. There were no correlations between demographic variables and the patient satisfaction. Results of this study were discussed from the viewpoint of the rote of patient-therapist relationship in the patient satisfaction research.

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Lately the reports on abuse and domestic violence have been increasing. Many outpatients who visit the departments of Psychosomatic Medicine have symptoms of anxiety and/or depression. Not a few of them who are persistently ill have been abused. The onset and persistence of psychosomatic diseases seem to be partly correlated with history of physical abuse. We examined the relationship between childhood physical abuse and anxiety and/or depression in new 564 outpatients of the Department of Psychosomatic Medicine of Kyushu University Hospital. In this study, we used STAI- I (state anxiety), STAI- II (trait anxiety) and SDS (Zung's Self-rating Depression Scale) on psychological assessment scores. We divided the patients into two groups : the physical abused group and the non-abused group. We compared these psychological scores and a prevalence rate of self-injury behavior and drive between the two groups. Childhood physical abuses were reported by patients with depressive disorders (12.7%), eating disorders (16.3%), pain disorders (10.8%), anxiety disorders (16.7%) and irritable bowel syndrome (12.5%), functional dyspepsia (5.1%). In both the patients with depressive disorders and anxiety disorders, the scores of STAI- I and STAI- II were higher in the abused group than in the non-abused group (p < 0.05). The prevalence of self-injury behavior and drive was higher in those with depressive disorders, with pain disorders and with anxiety disorders of the abused group than in the non-abused group (p < 0.0001). The global psychosomatic studies on abuse including sexual abuse need to be further promoted in Japan.

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Our previous report showed that out of 100 patients who were diagnosed as Panic Disorder with or without agoraphobia, 34 patients fulfilled the criteria of Major Depression (DSM-IV), in whom 22 patients (62.5%) showed Atypical Depression. Clinical characteristics of Anxious Depression in Panic disorder was abstractly described. Clinical portraits of a mother having Anxious Depression in Panic Disorder and her 2 daughters, both of whom had Atypical Depression with agoraphobia and incomplete panic attacks, were reported. These cases suggested a pathogenetical relationship existing between some Panic Disorder with Agoraphobia and Atypical Depression.

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We investigated the influence of family function and bringing-up environment on the onset of psychosomatic and psychosomatic-related diseases in adolescence. The subjects were 195 patients (average age was 21 years) who consulted our psychosomatic department and 415 volunteers students as controls (average age was 20 years). We used logistic regression to analyse their responses to our original questionnaires. Six items were extracted as risk factors of psychosomatic diseases (eating disorders, irritable bowel syndrome, and hyperventilation syndrome et al) and psychosomatic-related diseases (mood disorders, adjustment disorders, and anxiety disorders) by logistic multi-regression analysis. They were "My parents did physical violence to me", "Father often did physical violence to mother", "I did not feel safe in our house", "I was indulged by my parents", "One parent died in my childhood", "I don't remember whether I was loved by parents". The odd's ratio of subjects who answered "yes" to two of these factors was 7.9 compared to the subjects who answered "no" to all these factors. Subjects who were "yes" for more than three factors had an odd's ratio of 21.1. These results suggest that psychologically safe household and good family function are very important for the prevention of psychosomatic and psychosomatic-related diseases.

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