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A depressed emotional state — feelings of hopelessness and apathy — could have a direct effect on your physical health, new research indicates.

A study of stroke survivors found a slower rate of recovery among those experiencing apathy, caring little about themselves and the world around them. And a study of healthy middle-aged women found an association between hopelessness and unexpected thickening of the carotid artery, the main blood vessel to the brain.

Both findings are reported in the Aug. 27 issue of Stroke.

The apathy study was triggered by a 2006 paper on Parkinson’s disease in a different journal, said Nancy E. Mayo, a professor of medicine at McGill University in Montreal, and lead author of the apathy study. “It said that if patients were apathetic the best thing was just to leave them alone,” she said. “I was incensed that the author said we just shouldn’t care.”

So Mayo launched a study in which 408 family caregivers of stroke survivors filled out apathy questionnaires every four months, asking whether the survivor “waits for someone to do things that he or she can do for self,” or “just sits and watches” and the like.

It’s an admittedly imperfect method of measurement, Mayo said, “but we used what we had.” Reports indicated that a third of the stroke survivors had minor apathy through the first year, with 3 percent having high levels of apathy. Apathy worsened for 7 percent of the survivors, and eased for 7 percent during the year.

Measurements of physical function showed that “even very minor apathy had just as strong an impact on recovery as major apathy,” Mayo said. Answers about the quality of life of the stroke survivors, such as their engagement in social activities, found lesser improvement among those whose apathy worsened.

It’s not clear what can be done to help in such a situation, Mayo said, in large part because very little research has been done on apathy. “You can’t fix what you can’t measure,” she said. “This is a first attempt to sort things out. Since no one is paying attention, it is not surprising there are no treatments for it.”

Drug therapy is a vague possibility, along with behavioral therapy. “We don’t have anything that has evidence-based data other than being kind and enthusiastic,” Mayo said. “Were looking at clues from addiction research. There needs to be a lot of work.”

The report on the physical effect of hopelessness was an offshoot of a nationwide study of cardiovascular disease in women, said study author Susan A. Everson-Rose, an associate professor of medicine at the University of Minnesota.

She and her colleagues singled out 559 menopausal women with no history of cardiovascular disease to answer a two-item questionnaire about their expectations regarding future goals.

A previous study led by Everson-Rose, using the same questionnaire in Finnish men, found an association between hopelessness and cardiovascular disease outcome, she said, as did another study in women with documented cardiovascular disease.

This new study found a direct relationship between rising hopelessness and thickening of the lining of the carotid artery, a risk factor for stroke. Overall, women measuring higher on the hopelessness scale had .02 millimeters more thickening, equal to the amount caused by one year of aging. Women with the highest hopeless scores had an average .06 millimeters greater thickening than those with the lowest scores.

“This doesn’t necessarily mean that hopelessness had a direct physical effect, since it could be operating through mechanisms we didn’t measure,” Everson-Rose said.

But there is a clinical message, she said: “Physicians should tell patients that emotional states can have a physical effect, and that they should seek appropriate treatment for them. Psychiatric treatment for severe depression and hopelessness is warranted.”

Medical imaging tests nearly double the amount of radiation Americans would otherwise be exposed to, new research shows.

CT scans and nuclear imaging contributed to more than three-quarters of the exposure, and more than 80 percent of the procedures were performed on an outpatient, said Dr. Reza Fazel, senior author of a study appearing in the Aug. 27 issue of the New England Journal of Medicine.

“We don’t want to scare people and have them refuse procedures. The individual risk in any patient is very small. If it’s going to benefit the patient, it’s well worth the risk,” said Fazel, who is an assistant professor of medicine in the division of cardiology at Emory University School of Medicine in Atlanta.

But one expert called for further research on the subject.

“It’s striking that such a large proportion of the non-elderly population is being exposed to at least a moderate amount of radiation,” said Dr. Michael S. Lauer, who wrote an accompanying perspective in the same issue of the journal. “This is an opportunity to stimulate us to do the trials we need to do to figure out the value of all these tests.”

In the meantime, he added, “physicians need to know about the risks and communicate them, and patients need to talk with their doctor and understand why they’re getting the procedure.”

Although there are masses of trials demonstrating the benefit of mammographies, the values of other types of tests, most notably cardiovascular ones, are much less clear.

“We’re actually working in a knowledge vacuum,” said Lauer, who is director of the Divisions of Prevention and Population Sciences and of Cardiovascular Diseases at the U.S. National Heart, Lung, and Blood Institute. “What we know is that the radiation exposure that people are getting now might entail a risk but we don’t know the benefit.”

Up to 2 percent of all cancers in the United States may be due to CT scans, Lauer added.

And Harvard researchers reported in March that cumulative exposure to radiation from CT scans alone can increase the risk for cancer by as much as 12 percent.

According to this latest study, the number of CT scans performed since 1992 has quadrupled. The test used most frequently, and with the highest amount of radiation, is a myocardial perfusion scan to assess blood flow through the heart or trace damaged heart muscle. Use of that scan increased more than 6 percent each year between 1993 and 2001, the researchers found.

The authors looked at records on nearly 1 million adults aged 18 to 64 in five regions across the United States: Arizona, Texas, Wisconsin, South Florida and North Florida. All participants were enrolled in the same insurance plan.

During the study period, which lasted from the beginning of 2005 to the end of 2007, almost 70 percent of the participants had at least one imaging procedure that exposed them to radiation.

“That’s a huge proportion,” Fazel said.

Although the mean cumulative exposure was 2.4 millisieverts (mSv) per year, considered a low dose, the design of the study allowed the researchers to find wide variations.

Cumulative doses tended to be higher in women and in older people.

A “sizable minority” received moderate-, high- and very high-intensity doses, defined as 3-20 mSv per year, 20-50 mSv per year and more than 50 mSv a year, respectively.

By way of comparison, health-care workers and those who work in the nuclear industry are only allowed to be exposed to 20 mSv per year.

“More than 2 percent had very high doses, higher levels than radiation workers,” said study author Dr. Andrew J. Einstein, director of cardiac computed tomography research and an assistant professor of clinical medicine at Columbia University Medical Center and New York-Presbyterian Hospital in New York City.