A Multiple Indicators Multiple Causes (MIMIC) model of Behavioural and Psychological Symptoms in Dementia (BPSD)

Introduction: Although there is evidence for distinct behavioural sub-phenotypes in Alzheimer's disease (AD), their inter-relationships and the effect of clinical variables on their expression have been little investigated.

The psychological effects of organizational restructuring on nurses

This paper reports a comparison of nurses affected by the restructuring associated with healthcare organization mergers (1998-2000) in the United Kingdom and those of non-affected nurses in the UK.

Psychological and social profile of family caregivers upon commencement of palliative care provision

Context
Palliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized.

Objectives
We sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services.

Methods
A self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire.

Results
Three hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief.

Conclusion
This study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers.

Systemic Family Therapy for Families who have Experienced Trauma: A Randomised Controlled Trial

This paper describes a randomised controlled trial (RCT) investigation of the added value of systemic family therapy (SFT) over individually focused cognitive behavioural therapy (CBT) for families in which one or more members has suffered trauma and been referred to a community-based psychotherapy centre. The results illustrate how an apparently robust design can be confounded by high attrition rates, low average number of therapeutic sessions and poor protocol adherence. The paper highlights a number of general and specific lessons regarding the resources and processes involved that can act as a model for those planning to undertake studies of this type and scope. A key message is that the challenges of conducting RCTs in ‘real world’ settings should not be underestimated. The wider implications in relation to the place of RCTs within the creation of the evidence base for complex psycho-social interventions is discussed and the current movement towards a phased mixed-methods approach, including the appropriate use of RCTs, which some might argue is a return to the original vision of evidence-based practice (EBP), is affirmed.

Psychological adjustment to Type 2 Diabetes and relationship quality

Aims To examine the associations between psychological adjustment to Type 2 diabetes and the reported quality and type of relationships with partners. Methods All participants (n = 88) completed a number of questionnaires, including twomeasures of relationship quality: the Dyadic Adjustment Scale and the PersonalAssessment of Intimacy inRelationships Scale, theDiabetesQuality of Life Scale and the ATT-19 (which assesses personal integration of diabetes). Additionally, HbA1c levels were obtained from medical notes. Results Measures of relationship quality significantly contributed to the explanation of two outcomes: personal integration of diabetes and satisfaction with the burden of self-management behaviours. More specifically, the findings demonstrate that a specific aspect of relationship quality—intimacy in recreational activities—is positively associated with the outcomesmentioned above. Conclusions People with Type 2 diabetes who are not taking insulin, who share engagement in physical activities with their partner are more likely to be psychologically well-adjusted to their diagnosis of diabetes.

Do changes in illness perceptions predict changes in psychological distress among oesophageal cancer survivors?

This study aimed to examine whether changes in the illness perceptions of oesophageal cancer survivors explain changes in their levels of psychological distress relative to demographic and biomedical variables and coping strategies. Oesophageal cancer survivors completed the Illness Perception Questionnaire — Revised, the Cancer Coping Questionnaire and the Hospital Anxiety and Depression Scale at two points in time, 12 months apart. Cluster analysis was used to identify groups of respondents who reported a similar profile of change in their illness perception scores over time. Findings suggested that enhancing control cognitions and encouraging a positive focus coping strategy may be important in improving psychological health.