Psychosocial Morbidity and its Correlates in Cancer Patients of the Mediterranean Area: Findings from the Southern European Psycho-Oncology Study

BACKGROUND: A few and partial data are available on psychosocial morbidity among cancer patients in Mediterranean countries. As a part of a more general investigation (Southern European Psycho-Oncology Study-SEPOS), the rate of psychosocial morbidity and its correlation with clinical and cultural variables were examined in cancer patients in Italy, Portugal and Spain. METHODS: A convenience sample of cancer outpatients with good performance status and no cognitive impairment were approached. The Hospital Anxiety-Depression scale (HAD-S), the Mini-Mental Adjustment to Cancer scale (Mini-MAC), and the Cancer Worries Inventory (CWI) were used to measure psychological morbidity, coping strategies and concerns about illness. RESULTS: Of 277 patients, 34% had pathological scores ("borderline cases" plus "true cases") on HAD-S Anxiety and 24.9% on HAD-S Depression. Total psychiatric "caseness" was 28.5% and 16.6%, according to different HAD cut-offs (14 and 19, respectively). Significant relationships of HAD-S Anxiety, HAD-S Depression, HAD-S Total score, with Mini-MAC Hopeless and Anxious Preoccupation, and CWI score were found. No differences emerged between countries on psychosocial morbidity, while some differences emerged between the countries on coping mechanisms. Furthermore, Fatalism, Avoidance and marginally Hopeless were higher compared to studies carried out in English-speaking countries. LIMITATIONS: The relatively small sample size and the good performance status prevent us to generalize data on patients with different cancer sites and advanced phase of illness. CONCLUSIONS: One-third of the patients presented anxiety and depressive morbidity, with significant differences in characteristics of coping in Mediterranean countries in comparison with English-speaking countries.

Do Spirituality and Faith Make a Difference? Report from the Southern European Psycho-Oncology Study Group

OBJECTIVE: In the last decade, some attention has been given to spirituality and faith and their role in cancer patients' coping. Few data are available about spirituality among cancer patients in Southern European countries, which have a big tradition of spirituality, namely, the Catholic religion. As part of a more general investigation (Southern European Psycho-Oncology Study--SEPOS), the aim of this study was to examine the effect of spirituality in molding psychosocial implications in Southern European cancer patients. METHOD: A convenience sample of 323 outpatients with a diagnosis of cancer between 6 to 18 months, a good performance status (Karnofsky Performance Status > 80), and no cognitive deficits or central nervous system (CNS) involvement by disease were approached in university and affiliated cancer centers in Italy, Spain, Portugal, and Switzerland (Italian speaking area). Each patient was evaluated for spirituality (Visual Analog Scale 0-10), psychological morbidity (Hospital Anxiety and Depression Scale--HADS), coping strategies (Mini-Mental Adjustment to Cancer--Mini-MAC) and concerns about illness (Cancer Worries Inventory--CWI). RESULTS. The majority of patients (79.3%) referred to being supported by their spirituality/faith throughout their illness. Significant differences were found between the spirituality and non-spirituality groups (p ≤ 0.01) in terms of education, coping styles, and psychological morbidity. Spirituality was significantly correlated with fighting spirit (r = -0.27), fatalism (r = 0.50), and avoidance (r = 0.23) coping styles and negatively correlated with education (r = -0.25), depression (r = -0.22) and HAD total (r = -0.17). SIGNIFICANCE OF RESULTS: Spirituality is frequent among Southern European cancer patients with lower education and seems to play some protective role towards psychological morbidity, specifically depression. Further studies should examine this trend in Southern European cancer patients.

Aplicação da Children's Depression Inventory Numa População Clínica de Adolescentes: Estudo Exploratório

Introdução: A Children’s Depression Inventory (CDI; Kovacs, 1992) é usada para avaliar a existência de sintomatologia depressiva na infância e adolescência e tem sido amplamente aplicada em populações não clínicas, em Portugal, desde a sua validação (Marujo, 1994). Porém, os dados referentes a populações clínicas são escassos. Objectivo: Pretende-se estabelecer correlações clínicas numa amostra de adolescentes seguidos em consulta de Pedopsiquiatria fazendo uma contribuição para a validação da CDI em Portugal, com vista a permitir o alargamento da sua aplicação a populações clínicas. Métodos: A CDI -27 itens foi auto-preenchida na 1ª entrevista de atendimento por 35 adolescentes (F=23; M=12) com necessidade de rastreio de depressão, utentes da Consulta de Ambulatório da Clínica da Juventude entre Janeiro/2010 e Julho/2011. Foram excluídos os casos com processo clínico incompleto. Na estatística usou-se o IBM SPSS 19. Resultados: Os dados correspondem a 7,9% da população de origem (N=443). A idade média foi de 14,5 anos (Mín. =13; Máx. =16). A escolaridade média foi de 8,54 anos (Mín. =5; Máx. =11). A estrutura familiar e motivos de pedido de consulta corresponderam aos estudos anteriores efectuados na Clínica. O cutt-off do nível clínico é 15 e 68,5% da amostra estava acima deste valor. O humor negativo (26%) e sentimento de ineficácia (23%) foram as subescalas mais elevadas; 40% dos jovens pontuou para mais do que uma subescala. Os diagnósticos obtidos foram Perturbações do Humor (43%), Perturbações de Adaptação (17%), Perturbações Disruptivas do Comportamento (14%), Perturbações de Ansiedade (9%), Problemas com Grupo de Apoio Primário (3%), Perturbações de Personalidade (3%), e outros (9%). O qui-quadrado não foi significativo para um cut-off de 15 (considerados Perturbações do Humor e Outros diagnósticos). Conclusões: A CDI e os resultados das subescalas são úteis para uma abordagem focalizada e permitem a priorização de casos. Porém, os resultados obtidos comprometem o uso da CDI na detecção de Perturbações do Humor. Os autores sugerem a realização de mais investigações com o objectivo de alargar e melhorar a avaliação do uso clínico da CDI.

The Role of Psychological Adjustment in the Decision-Making Process for Voluntary Termination of Pregnancy

BACKGROUND: This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. METHODS: In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. RESULTS: The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. CONCLUSION: Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.