Describes the frustrating search for a link between specific negative emotions and health and why the search often fails. Integrates epidemiology and psychology.

1. Why do we keep stalking bears, when
we only find scat in the woods?
Hans Ormel’s contribution to
psychosomatic scatology
James C. Coyne, PhD
Professor Emeritus, University of Pennsylvania
Professor, University of Groningen, University Medical
Center Groningen (UMCG), The Netherlands

2. “Discovery” -> Disappointment -> Decline.
Recurring cycles of premature,
exaggerated, and simply false
“discoveries” concerning
negative emotion and health.
Hans Ormel’s work can be
used to set a higher threshold
for future declarations of
“discoveries.”

4. John Snow and the Broad
Street Pump Handle

5. For over half a century, researchers in
psychosomatic medicine have stalked an
elusive trophy bear, a modifiable connection
between negative emotion and morbidity and
mortality.
Claims of finding one have attract
considerable attention again and again, only
to lead to embarrassing disconfirmations.

6. Depressive symptoms linked to
Death, dementia, coronary artery disease, cancer,
asthma, diabetes, Parkinson’s disease, COPD,
headaches, insomnia, acne, health problems after
pregnancy, lower back pain, anorgasmia,
premature ejaculation, impotence, hypertension,
HIV viral load, poor glycemic control, constipation,
diarrhea, nausea, chronic pelvic pain,
incontinence, …and flatulence.

9. Just as many
oncologists now view
pain as a symptom to
be treated, they should
also consider
depression a symptom
to be treated to improve
quality of—and possibly
extend—life.

10. The National Heart Lung and Blood Institute
ENRICH-D trial was an expensive attempt to
show we could save cardiac patients from re-
infarction and death by improving the outcome
of their depression.
Clinical depression was the identified bear.

11. But in hindsight, ENRICH-D does not seem to have been
on the trail of a bear. Maybe was just making too much
of scat in the woods.
Bear Scat

12. ENRICH-D presumed clinical depression
was the long sought bear-modifiable risk
factor.
Target may only have been scat on the
trail—uniformative risk marker.
Shooting scat does not reduce mortality.

15. Coyne JC, van Sonderen E:
The Hospital Anxiety and
Depression Scale (HADS) is
dead, but like Elvis, there will
still be citings. Journal of
Psychosomatic Research.
73:77-78.

16. Meehl (1990) applied “crud factor” to
the broader tendency of self-reported
negative factors to be correlated in
ways that cannot readily be
unambiguously differentiated.

17. Ketterer MW, Denollet J, Goldberg AD,
McCullough PA, John S, Farha AJ, et
al. The big mush: psychometric
measures are confounded and non-
independent in their association with
age at initial diagnosis of Ischaemic
Coronary Heart Disease. J Cardiovasc
Risk 2002; 9(1): 41-48.

18. Lesperance and Frasure-Smith
Denollet et al. added a new term – the distressed
personality (Type D) – to a field congested with related
concepts including type A personality, anger and hostility,
psychological stress, vital exhaustion, major depression,
depressive symptoms, and social isolation. Each of these
concepts enjoyed a period of prime time exposure following
publication of one or more epidemiological reports linking it
to mortality in patients with CHD and then declined in
popularity.…

19. John Ioannidis
Most “discoveries” in biomedical literature are
premature, exaggerated, or simply false.
Apparent discoveries are created and
perpetuated by a combination of confirmatory
bias, flexible rules of design, data analysis and
reporting, and significance chasing.
Beware of unexpected large findings from
small samples.

20. The psychological sciences may be particularly
susceptible because many of the psychological
variables and outcomes measured and analyzed
are often convoluted, complex, and highly
correlated.
There is large flexibility in definitions, uses of cut-
offs, modeling, and statistical handling of the data,
hence large room for exploratory analyses.

21. John Ioannidis (2012)
Obliged replication: Proponents of dominant
view are so strong in controlling the publication
venues that they can largely select and mold
the results, wording, and interpretation of
studies eventually published.

23. John MacLeod and George Davey
Smith
Challenge of distinguishing causal influence of negative
affect from other negative environmental and physical
health variables.
 High likelihood of noncausal relationships generated by
confounding between self-reported negative affect and
physical health outcomes.
 Residual confounding often impossible to rule out.
 Plausible biological mechanism can almost always be
cited, so not a good way of excluding spurious findings.

24. Hans Ormel -- Neuroticism: a non-
informative marker of vulnerability
Broad set of items describing anxiety,
insecurity, irritability, anger, hostility, worry,
depression, frustration, self-consciousness,
emotionality, sensitivity to criticism, stress
reactivity, and impulsiveness.

25. Hans Ormel -- Neuroticism: a non-
informative marker of vulnerability
Prospective studies of associations of
neuroticism with mental health outcomes are
basically futile, and largely tautological since
scores on any characteristic with substantial
within-subject stability will predict, by definition,
that characteristic and related variables at later
points in time.

26. Hans Ormel
What about hard biomedical outcomes…like
death?
Need to rule out antecedent and concurrent
associations with known risk factors.
Persons with physical conditions register their
malaise on measures of negative emotion.

27. “Negative emotion predicts
survival”
Another unexpected large effect from small
study?
Flexible rules of collecting, analyzing
interpreting data?
Spurious association convincingly ruled out?
Only that negative emotion?
Risk factor or uninformative risk indicator?

28. What’s wrong with continuing to stalk
the bear?
 Continued embarrassment, decreased
credibility
 Squandering of research and clinical
resources
 Denigrating of genuine accomplishments of
behavioral medicine in terms of reducing
behavioral risk factors
 AvaIIable distorted by obliged replication
 Bad message to junior scientists