Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial

Background: The integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists. Methods/design: This is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Alava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS. Discussion: This is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients.

Depressão pós-parto e estado nutricional infantil no segundo mês de vida

INTRODUÇÃO: As chances de adoecer e de mortalidade são maiores, em crianças com estado nutricional (EN) inadequado nos primeiros meses de vida. Fatores de risco para o EN inadequado, incluem os aspectos psicossociais maternos, como a ansiedade, a depressão pós-parto (DPP), a ausência de suporte social. No entanto, são poucos os estudos sobre o papel destes fatores na determinação do EN infantil e seus resultados controversos. OBJETIVO: Investigar a relação entre depressão no pós-parto e o estado nutricional infantil inadequado no segundo mês de vida. MÉTODOS: Trata-se de um estudo seccional com 466 crianças aos dois meses de vida (média= 65 dias; DP=0,5) oriundas de unidades básicas de saúde do município do Rio de Janeiro, realizado entre junho de 2005 e dezembro de 2009. Para compor o desfecho, médias de peso-para-idade foram expressas em escores z e comparadas às informações da nova curva de referência WHO (2006) para menores de cinco anos. Foram classificadas como estado nutricional inadequado, crianças com escore z abaixo de -2, baixo peso-para-idade, e crianças com escore z acima de +2, excesso de peso-para- idade. Informações referentes à DPP foram obtidas por meio da aplicação da versão em português do instrumento EPDS (Edinburgh Postnatal Depression Scale). As análises das associações entre a DPP e os desfechos foram verificadas via modelos de regressão logística multinomial, mediante estimativas de razões de chances (OR) brutas e ajustadas e seus respectivos intervalos de confiança de 95% (IC 95). RESULTADOS: A amostra revelou escores z médios de -0,22 para peso-para-idade, 4,51%(n=21) apresentaram baixo peso-para- idade e 1,72% (n=8) de excesso de peso-para-idade. A prevalência de depressão foi de 27,6%. Nas análises brutas, filhos de mães deprimidas apresentavam 2,45 mais chance (OR=2,45; I.C. 95%=1,01-5,93;p-valor=0,050) de baixo peso-para-idade e 0,38 chance de excesso de peso-para-idade (OR=0,38;I.C. 95%=0,04-3,17;p-valor=0,38), do que os filhos de mães não deprimidas, porém esta associação apresentou nível de significância maior que 5%. Após ajuste pelo peso ao nascer, condições ambientais, posse de utensílios, prematuridade, idade materna e escolaridade materna a associação entre depressão e estado nutricional infantil não apresentou significância estatística (OR=2,39;I.C. 95%=0,74-7,71;p- valor>0,05).CONCLUSÃO: A DPP não foi associada ao estado nutricional infantil.

Avaliação da fadiga em pacientes com artrite reumatoide e sua relação com qualidade de vida, capacidade funcional, sintomas de ansiedade e depressão e atividade de doença

Fadiga é um sintoma subjetivo de difícil definição. Extremamente comum em pacientes com Artrite Reumatoide. O objetivo deste estudo é estudar a fadiga numa amostra de pacientes brasileiros de dois hospitais de grande porte na cidade do Rio de Janeiro e analisar sua correlação com outras variáveis freqüentes da doença como a Qualidade de Vida, Capacidade Funcional, Ansiedade, Depressão e atividade inflamatória da doença.Um protocolo padrão foi prospectivamente aplicado a 371 pacientes como diagnóstico de AR de acordo com os critérios de classificação do American College of Rheumatology de 1987. Achados clínicos, demograficos e laboratoriais foram coletados.Os dados laboratoriais incluíram a velocidade de sedimentação das hemácias e dosagem da proteína C reativa. O número de juntas dolorosas foi obtido atraves do terceiro item do questionário de atividade inflamatória da doença DAS 28. Idade, gênero, índice de massa corporal, tempo de doença, qualidade de vida avaliada pelos domínios físico e mental do questionário Medical Outcomes Study Short-Form 36-item Health Survey (SF-36P e SF-36M), a capacidade funcional avaliada pelo Health Assessment Questionaire - Disability Index (HAQ DI). A ansiedade e a depressão foi mensurada pelo Hospital Anxiety and Depression Scale (HAD a/d). A fadiga foi avaliada pela utilização da subscalaprópria para mensuração das queixas de fadiga do questionário Fatigue Assessment of Chronic Illness Therapy (Facit FS). Foi aplicado o intervalo de confiança de 95% como medida de precisão. O valor médio de fadiga mensurado pelo Facit FS foi 39.88 8.64. O escore da fadiga correlacionou-se com capacidade funcional mensurada pelo HAQ DI (-0.507; p < 0.0000), a ansiedade e depressão mensurada pelo HAD a/d (-0.542 e -0.545; p < 0.0000 respectivamente) e com a qualidade de vida mensuradapor ambos domínios do SF-36, porém predominantemente com o seu domínio físico (SF-36P: 0.584; p < 0.0000 e 0.405; p < 0,05 respectivamente).Não encontramos associação com a velocidade de sedimentação das hemácias (-0.118; p < 0.05), da proteína C reativa (-0.089), da atividade de doença mensurada pelo DAS 28 (-0.250; p < 0.0000) ou com o número de juntas dolorosas (-0.135; p < 0.009). Nesta amostra de pacientes com Artrite reumatoide, sugerimos um novo significado para a fadiga, como um parâmetro independente, não relacionado a atividade inflamatória da doença ou ao número de juntas dolorosas. A fadiga mostrou-se associada principalmente a incapacidade funcional e a sintomas de ansiedade. Estudos adicionais e a adoção de métodos padronizados para seu monitoramento e manejo clínico são necessáriospara melhor compreensão da fadiga. A fadiga mostrou ser uma queixa importante em pelo menos 1/3 dos pacientes de AR da amostra.

Saúde Mental Materna e Retenção de Peso no Pós-parto

O objetivo do presente estudo foi investigar a associação entre a depressão pós-parto e a retenção de peso no pós-parto. Trata-se de um estudo longitudinal, com 563 mulheres no baseline acolhidas em unidades de saúde do município do Rio de Janeiro entre 2005 e 2009, acompanhadas até o 6 mês pós-parto, com dados sobre peso e estatura aos 15 dias pós-parto e peso pré-gestacional. O peso retido após o parto foi calculado a partir da diferença entre o peso aferido nas ondas de seguimento (15 dias, 1, 2, 4 e 6 mês) e o peso pré-gestacional. O estado nutricional pré-gestacional foi classificado de acordo com a OMS. A presença de depressão pós-parto foi avaliada a partir da versão em português da Escala de Depressão Pós-parto de Edimburgo (EPDS) aos 15 dias e no 2 mês após o parto, utilizando-se 11/12 da EPDS como ponto de corte. Considerou-se depressão recorrente quando houve presença de depressão nos dois momentos. Inicialmente analisaram-se características da população. Para as análises estatísticas do efeito do estado nutricional pré-gestacional e do efeito da depressão pós-parto sobre a retenção de peso pós-parto empregou-se o proc mixed do pacote estatístico SAS. Dentre os principais achados, destaca-se que 22,7% (IC 95% 19,3-26,4) das mulheres iniciaram a gravidez com sobrepeso e 10,9% (IC 95% 7,0-15,7) apresentaram depressão recorrente. A retenção média de peso foi de 5,6 kg (IC 95% 5,1-6,1) aos 15 dias pós-parto. Na análise das trajetórias no tempo do peso pós-parto por estado nutricional pré-gestacional ajustadas por idade, escolaridade, número de filhos, aleitamento materno e ganho de peso gestacional, observou-se diminuição da retenção de peso pós-parto para os grupos de baixo peso e sobrepeso pré-gestacional e aumento da retenção de peso pós-parto para o grupo de obesidade pré-gestacional. Na análise das trajetórias no tempo do peso pós-parto por depressão pós-parto verifica-se que o efeito entre o tempo e a retenção de peso pós-parto se modifica para mulheres com depressão pós-parto recorrente nas análises bruta e ajustadas por idade, escolaridade, estado nutricional pré-gestacional, número de filhos, ganho de peso gestacional, aleitamento materno e rede social, nas quais observa-se que as mulheres com depressão pós-parto recorrente perdem menos peso. Os resultados permitem identificar que há no pós-parto perda e ganho de peso, apesar de ser esperada perda de peso almejando o retorno ao peso pré-gestacional. Ressalta-se o impacto da depressão pós-parto observado nesta dinâmica de peso, uma vez que mulheres com depressão pós-parto recorrente apresentaram menor perda de peso. Destaca-se a relevância dos resultados deste estudo para o desenvolvimento da promoção da saúde e da segurança alimentar e nutricional, visando um monitoramento do estado nutricional pós-parto e avaliação da saúde mental materna de forma a contribuir para a prevenção da obesidade feminina e comorbidades

Responses of a coastal phytoplankton community to increased nutrient input from the Changjiang (Yangtze) River

Nutrient input from the Changjiang River (Yangtze River) has been increasing dramatically since the 1960s. At the mouth of the Changjiang River, the nitrate concentration has increased about three-fold in 40 years, from 20.5 mu mol/L in the 1960s to 59.1 mu mol/L in the 1980s and to 80.6 mu mol/L in 1990-2004. Phosphate concentration increased by a factor of 30%, from 0.59 mu mol/L in the 1980s to 0.77 mu mol/L in 1990-2004. The increasing nitrate input has arisen mostly from the mid and lower reaches of the Changjiang River, where the river meets one of the most strongly developed agriculture areas in China. Responses of the coastal phytoplankton community to the increasing nutrient inputs are also seen in the available monitoring data. First, a trend of increasing phytoplankton standing stock from 1984 to 2002 appeared in the Changjiang River estuary and adjacent coastal waters, especially in late spring. Secondly, the proportion of diatoms in the whole phytoplankton community showed a decreasing trend from about 85% in 1984 to about 60% in 2000. Finally, red tides/harmful algal blooms increased dramatically in this area in terms of both number and scale. About 30-80 red tide events were recorded each year from 2000 to 2005 in the East China Sea. The scale of some blooms has been in excess of 10,000 km(2). (c) 2008 Elsevier Ltd. All rights reserved.

中职生的成就动机与行为问题的关系

Achievement motive is human’s social motive. In some sense, one’s all-life achievements are decided by his/her achievement motive. By which we can conclude that achievement motive has close connection with individual emotional experience. People pursuing success experience more positive emotion and less negative one, and have good behavioral adaptability. This study aims at explore the relation between achievement motive and behavior problems in the secondary vocational education schools through questionaries (the achievement motivation scale, UCLA Loneliness Scale，State-Trait Anxiety Inventory，Center for Epidemiologic Studies depression Scale and middle school students'behavior questionnaire). There were 1005 students whose age ranged from 14to21 years completed the questionnaires. The main conclusions of this thesis are as follows: (1) Achievement motive of student in the secondary vocational education schools is significantly lower than that of students in the senior high school. (2) Students in the secondary vocational education schools show more obvious emotion and Externalizing behavior problems than those of the senior high schools. (3) Students’ motivation for pursuing success in the secondary vocational education schools has negative correlation with emotion and Externalizing behavior problem, while the motivation for avoiding failure has positive correlation with the emotion and Externalizing behavior problem. Achievement motivation has negative correlation with emotion and Externalizing behavior problem. (4) Students’ achievement motivation shows obvious gender difference in the secondary vocational education schools. The avoiding failure element shows upward trend with the grades increasing and the difference is obvious. While the students’ achievement motive in the secondary vocational education schools shows significantly downward trend with the grades increasing. Whether holding a post at school has influence on the students’ achievement motivation, and the difference is significant. (5) Students’ Externalizing behavior problem in the secondary vocational education schools shows obvious gender difference. Whether holding a post at school has influence on the students’ Externalizing behavior problem, and depression and loneliness, and the difference is significant. Key words: Students in the Secondary Vocational Education Schools, Achievement Motivation, Behavior Problem, Emotion Problem, Externalizing Behavior Problem (Note: In this study, the behavior problems include not only the externalizing behavior problems, but also emotion problems.)

冠状动脉旁路移植术后抑郁焦虑状态随访和分析

To explore the presence of depression, anxiety and cardiac events after coronary artery bypass grafting (CABG) prospectively and comparably. To analysis influential factors of depression and anxiety ( peri-operation and 1 year after operation ), and the effection on cardiac events in the year after operation. We followed the patients who underwent scheduled consecutive CABG. We interviewed patients to assess depression, anxiety symptoms using self-rating depression scale( SDS) and self-rating anxiety scale（SAS）before operation , before discharge and 1 year after operation. And cardiac events were also identified. All patients were divided into the group with depression and/or anxiety symptoms or the other group without depression and/or anxiety symptoms 3 times according to depression and anxiety symptoms before operation , before discharge and 1 year after operation. 69 patients completed the follow-up.24 patients (34.8%) had depression and/or anxiety symptoms before CABG, 31 patients (44.9%) had depression and/or anxiety symptoms before discharge, and 10 patients (14.5%) had depression and/or anxiety symptoms 1 year after operation. 6 patients(8.7%) had cardiac events, and 5 patients were re-admitted. Arhythmia before and after operation, the quantity of blood vessel grafted, length of stay , depression and anxiety symptoms before operation, cardiac events may lead to depression and anxiety symptoms 1 year after operation. The use of cardiopulmonary bypass grafting (CPB), Arhythmia after operation, the prolonged length of stay are influential factors of cardiac events. Though the incidence of depression and/or anxiety symptoms 1 year after operation is lower than before operation and before discharge, it is high still. Arhythmia before and after operation, the more blood vessels grafted, the prolonged length of stay , depression and anxiety symptoms before operation and cardiac events could be risk factors of depression and anxiety symptoms 1 year after operation. Much attention must be paid to this phenomenon. Heavy patient's condition, complicated surgery are risk factors of cardiac events, and bad emotion before operation and before discharge are independent to cardiac events. Key words： perspective research; depression；anxiety; coronary artery bypass grafting; follow up

维持性血液透析患者认知功能特点研究

Objective: To study the episodic memory, semantic memory, cognitive planning ability and inhibition ability in MHD patients. Method: Neuropsychological research methods such as Action memory of verb-object phrase, Trail Making Test (A and B), Verbal Fluency Test, Go-No/Go test and Stroop Color Naming Task were used to investigate Episodic Memory 、Semantic Memory、Executive Function of 40 MHD and 40 NC. Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale(SDS), Social Support Scale, Life Satisfaction Scale, and biochemical examination were applied and their relationships with cognitive function were analized. The mean age and education level of MHD group and NC group have no significant difference. Result: 1.Action memory of verb-object phrase differed significantly between MHD group and NC group. 2.Two tests of Verbal Fluency differed significantly between MHD group and NC group. 3.Trail Making Test A, Trail Making Test B, the baseline condition of Go-No/Go Test and Stroop Color Naming Test differed significantly between MHD group and NC group. 4.There is no significant difference between MHD group and NC group on the correct rate of No/Go Test and the baseline condition. Both groups showed Stroop Effect in Go-No/Go test, but MHD group performed significantly worse. 5.In Stroop Color Naming Task Test, NC group showed Stroop Effect, significant Repeated Distraction Promotion Effect and significant Negative Priming Effect,while MHD group showed only Stroop Effect and no Repeated Distraction Promotion Effect and no Negative Priming Effect. There is significant difference in Stroop Effect between MHD group and NC group. Conclusion: 1.Comparing with NC group, episodic memory, semantic memory, cognitive planning ability, and inhibition ability of MHD group were impaired significantly. 2.The pathological aging of Executive Function in MHD group showed: executive Function should be a unitary system. 3.Cognitive impairment is negatively correlated with serum creatinine, blood pressure and anxiety score in MHD patients; and is related with hemoglobin, hematocrit, social support and life satisfaction. Keyword: maintenance hemodialysis, episodic memory, semantic memory, cognitive planning, inhibition ability.

中学生抑郁和素质、压力、环境因素的关系及其整合模型研究

As a kind of mood, depression is one of the emotions which people experienced usually. Depressive disorder is one of the common mental diseases. There are about 100 million people in the world be disturbed by depression every year. So it is long history that depression is investigated widely in medicine, psychology, and sociology. There are many theorial problems remain to be solved. Viewed from latest vocuments, the development of depression theory is tending to become more complicated. Most of the prior depression theory focused on relation between one factor and depression. Because depressed individuls have various characteristics and factors that cause depression are different, and each factor can explain only part of depression variance, these prior depression theories are defected. As the knowledge about depression accumulated, the view that depression be caused by multifactor is clearer. There is tendency to integrate these cooperational factor into a model while developing a depression theory. In the present study, depression status of 1625 middle school students from junior 1 to senior 3 are measured using Depression Scale of Middle-school Student which is developed by ourselves. From approach of depressive mood, the present study explored depressive diathesis including attributional style, personality, coping style, and self. The relation among depressive diathesis, stress and depression is analysed. The relation between depression and school life adaptation, depression and cohesion, adaptation in family are also analysed from environmental view. At last, relation among environment, stress, depressive diathesis is examined by using covariance structure modelling. Synthesizing the results from the present study, the following conclusions were drawn: (1) There is grade-characteristics in development of depression in middle school students. Depression degree increased with grade. The main reason may be that the stress middle-school students experience increase and self-acceptance decrease with grade; (2) High depressive diathesis is different from low depressive diathesis. the features of high depressive diathesis are that attributing failure to ability or background, low capacity for status, low sociability, low independence, low self-blame, more illusion. The features of low depressive diathesis are that not attributing failure to ability or background, high capacity for status, high sociability, high independence, high self-acceptance, while facing difficulties, using problem-resolving coping strategy, less self-blame, less illusion. Individuals who have high depressive diathesis showed serious depression, and individuals who have low depressive diathesis showed light depression; (3) Depressive diathesis had accumulative effect on depression. More low depressive diathesis, more light is depression. More high depressive diathesis, more serious is depression; (4) Depressive diathesis can predict present depression and future depression. Predicting present depression is more effective than predicting future depression; (5) Individual who has different depressive diathesis experiences different level of stress. Higher the depressive diathesis individual has, higher stress he will experience. Lower the depressive diathesis individual has, lower stress will he experience; (6) There is correlation between life event pressure and depression. Life event pressure can predict a part of variance of depression. Life event pressure has accumulative effect on depression. More life event and higher life event pressure, more serious depression individual will experience; (7) There exits high correlation between depression and school life adaptation which can predict depression; (8) There is high correlative relation between depression and cohesion, adaptation in family which can predict depression; and (9) Environment have more effect on diathesis than on stress. Diathesis has more effect on depression than stress does. The past depression can predict future depression. This study had enlarged the domain of depressive diathesis such as attributional style, personality, coping style, and self, which are analysed wholly. This study had also enriched the connotation of diathesis=stress theory. Above two aspects are theoretical significance of the study. This study provide a framework of mental health educational curriculum in high school and provide the guideline for prevention and cure of depression. It is the practical significance of this study.

工作社会规范观念的心理学研究与跨文化比较

Data on meaning of working (MOW) were collected from 905 respondents in Beijing area through a stratified sampling procedure of the questionnaire used in the restudy of meaning of working (which is still on going, adapted for using in China). Some parts of the factor structure obtained in this study are similar to what found by the MOW International Research Team (1987). Detailed analysis and cross-cultural comparisons were concentrated on the most similar parts societal norms about working (SNW). T-scores of the obligation norm (ON) and entitlement norm (EN) of Chinese were calculated based on the reaction frequencies of relevant items provided by the MOW International Research Team and shown as follows. The results reveal the obligation orientation characteristic of Chinese respondents. And more, 4 SNW patterns of Chinese respondents were obtained through multivariate cluster analysis and multivariate discrimination analysis and shown as follows. The influences of antecedent variables on SNW and the consequences of SNW were analyzed. Two questions were raised from these analyses: 1) The present measurements of SNW are not able to reflect the nature of the relation and dependency between ON and EN and are not free from social desirability; 2) the relationship between SNW and actual working behaviors need to be tested while the relationship between SNW and several work intentions was confirmed. A forced-choice scale of SNW was designed to overcome the shortcomes of the original scale. This scale includes 30 items. Each item is composed of a ON statement and a EN statement with similar values of social desirability. A repertory grids test was used to exam the constructure validity and to analyze the differences of cognitive structures of the 4 SNW patterns. The results indicated that the new scale had a good discrimination power. An experiment was designed to test the relationship of SNW and the actual work behaviors of the respondents. The respondents' action in completing a task was chosen as working behavior index. 4 hypotheses were tested: 1) higher obligation orientation subjects are more likely to complete tasks no matter overtime; 2) scheduled tasks are more likely to be completed no matter overtime; 3) the obligation norm about working is positively correlated with general obligation norms; and, 4) external motivtors will enhance lower obligation orientation subjects' working motivation more than higher obligation orientation subjects' the results verified hypothesis 1 and 3, but didn't support hypothesis 2 and 4 these findings will have great implication in administrating.

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.

Illness perceptions among carer - survivor dyads are related to psychological distress among Oesophageal cancer survivors

Objective

To examine the extent to which the illness perceptions of Oesophageal cancer survivors and the illness perceptions of their carers explain the survivors' levels of psychological distress (in terms of anxiety and depression symptoms) relative to demographic and biomedical variables and patients' coping strategies.

Method

Everyone registered with the Oesophageal Patients' Association in the UK was mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire, and the Hospital Anxiety and Depression Scale. Patients were asked to pass a modified version of the Illness Perception Questionnaire-Revised to someone they identified as a carer. Complete responses were received from 317 dyads.

Results

Regression models indicated that the variables measured could explain 56% of the variance in anxiety and 54% of the variance in depression. Patients' illness perceptions explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological well-being. Some of the carers' illness perceptions made a significant contribution to the explanation of the patients' levels of psychological distress, and in some instances, carer perceptions were found to moderate the relationship between patients' perceptions and psychological distress.

Conclusion

The findings suggest that cognition-based interventions could potentially be most effective in minimizing emotional distress among survivors of Oesophageal cancer. This study also shows that these interventions could usefully be delivered at the level of the patient–carer dyad.

Psychological distress among family carers of oesophageal cancer survivors the role of illness cognitions and coping

Objective: The research aimed to determine the extent to which illness cognitions and coping explain psychological distress (fear of cancer recurrence, anxiety and depression symptoms) among family carers of survivors of oesophageal cancer.


Methods: Carers of patients registered with the Oesophageal Patients' Association in the UK were mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire, the Concerns about Recurrence Scale and the Hospital Anxiety and Depression Scale.


Results: Complete responses were received from 382 family carers (75% male; mean (SD) age=62 (10.91) years). Regression models indicated that the variables measured could explain between 35 and 49% of the variance in psychological distress among carers. Illness cognitions (particularly perceptions of the cause of, consequences of and personal control over oesophageal cancer and the carer's understanding of the condition) explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological distress.


Conclusion: The results of this study are consistent with previous research demonstrating that illness cognitions are significant correlates of adaptive outcomes, thereby suggesting that cognition-based interventions could potentially be effective in minimizing emotional distress among family carers of oesophageal cancer survivors.

Psychological distress among survivors of esophageal cancer: the role of illness cognitions and coping

Leventhal's common sense model has provided a useful framework for explaining psychological distress in several chronic illnesses. The model indicates that a person's perception of their illness and their coping strategies are the key determinants of their experience of psychological distress. The present research examines whether illness perceptions and coping strategies are related to levels of psychological distress among survivors of esophageal cancer. Everyone registered with the Oesophageal Patients' Association in the UK was mailed a questionnaire booklet, which included the Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire, and the Hospital Anxiety and Depression Scale. Complete responses were received from 484 people. Regression models indicated that the variables measured could explain 51% of the variance in anxiety and 42% of the variance in depression. Perceptions of esophageal cancer explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological distress. The results of this study are consistent with previous research demonstrating that illness perceptions are stronger correlates of adaptive outcomes than coping strategies. The findings suggest that cognition-based interventions could potentially be most effective in minimizing emotional distress among survivors of esophageal cancer.

Illness perception clusters at diagnosis predict psychological distress among women with breast cancer at 6 months post-diagnosis.

OBJECTIVE:

This study aimed to examine the extent to which illness perceptions and coping strategies among women diagnosed with breast cancer explain psychological distress at diagnosis and at 6?months post diagnosis relative to demographic and illness-related variables.

METHODS:

Women were recruited to the study shortly after diagnosis. A total of 90 women completed study materials (Illness Perception Questionnaire-Revised, the Cancer Coping Questionnaire and the Hospital Anxiety and Depression Scale) at time 1. The same questionnaires were sent approximately 6?months later to those who had consented at time 1, and completed questionnaires were returned by 72 women.

RESULTS:

Cluster analysis was used to identify groups of respondents who reported a similar profile of illness perception scores. Regression analysis demonstrated that one of these clusters was more likely to experience psychological distress than the other both at diagnosis and at 6?months post diagnosis. Illness perception cluster membership and positive focus type coping were the most important and consistent predictors of lower psychological distress at diagnosis and at 6?months post diagnosis.

CONCLUSIONS:

Illness perceptions remained relatively stable over the study period, and therefore we are unable to clarify whether changes in illness cognitions are associated with a corresponding change in psychological symptoms. Future research should evaluate the impact on psychological distress of interventions specifically designed to modify illness cognitions among women with breast cancer.