title: Association of vital exhaustion and depressive symptoms with changes in fibrin D-dimer to acute psychosocial stress.
abstract: OBJECTIVE
  Vital exhaustion and depression are psychosocial risk factors of coronary artery disease. A hypercoagulable state in response to acute psychosocial stress contributes to atherothrombotic events. We aimed to investigate the hypothesis that vital exhaustion and depression correlate with stress-induced changes in the hypercoagulability marker D-dimer.
  
  
  METHODS
  Thirty-eight healthy and nonsmoking school teachers (mean age 50+/-8 years, 55% women) completed the nine-item Maastricht Vital Exhaustion Questionnaire and the seven-item depression subscale of the Hospital Anxiety and Depression Scale. Within 1 week, subjects twice underwent the Trier Social Stress Test (i.e., preparation phase, mock job interview, and mental arithmetic that totaled 13 min). Plasma D-dimer levels were determined at five time points during the protocol.
  
  
  RESULTS
  Vital exhaustion (P=.022; eta(2)=.080) and depressive symptoms (P=.011; eta(2)=.090) were associated with stress-induced changes in D-dimer levels over time controlling for sex and age. Elevated levels of vital exhaustion (r=-.46, P=.005) and of depression (r=-.51, P=.002) correlated with reduced D-dimer increase from pre-stress to immediately post-stress. Also, elevated vital exhaustion (r=.34, P=.044) and depression (r=.41, P=.013) were associated with increase (i.e., attenuated recovery) of D-dimer levels between 20 and 45 min post-stress. Controlling for stress hormone and blood pressure reactivity did not substantially alter these results.
  
  
  CONCLUSIONS
  The findings suggest an attenuated immediate D-dimer stress response and delayed recovery of D-dimer levels post-stress with elevated vital exhaustion and depressive symptoms. In particular, the prolonged hypercoagulability after stress cessation might contribute to the atherothrombotic risk previously observed with vital exhaustion and depression, even at subclinical levels.
authors.affiliation: Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Silja
authors.initials: S
authors.lastname: Bellingrath
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Kudielka
mesh_terms: D000208:Acute Disease; D000933:Antifibrinolytic Agents / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D003863:Depression / Q000097:blood* / Q000453:epidemiology / Q000523:psychology; D005221:Fatigue / Q000097:blood* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000097:blood* / Q000453:epidemiology / Q000523:psychology; D013997:Time Factors
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D