THE ROLE OF SENSE OF CONTROL AND SOCIAL SUPPORT IN MEDIATING THE IMPACT OF PSYCHOLOGICAL DISTRESS - A TEST OF THE HYPOTHESIS OF FUNCTIONAL SUBSTITUTION

The purpose of this paper is to examine the manner in which beliefs relating to sense of control and perceived social support mediate the impact of objective circumstances on psychological distress. In particular it focuses on the nature of the interaction between such variables. The results provide no evidence favouring the displacement hypothesis whereby the benefits of social support involve costs in terms of independence. Consistent support, however, is found for the functional substitution hypothesis. The conclusion is unaffected by the introduction of distinctions relating to types of support and types of power.

Predictors of psychological functioning in mothers and fathers of infants born with severe congenital heart disease

This study examined mental health and coping styles in both mothers and fathers of infants born with a severe congenital heart defect. Factors associated with mental health outcomes were elucidated. Parents of 70 infants, recently born with a severe congenital heart defect, completed questionnaires which examined psychological functioning and coping strategies. Disease, surgical and psychosocial factors were examined for their significance in predicting psychological functioning. Findings indicated elevated levels of clinically significant psychological distress in mothers, compared to fathers, and differences between parents in coping styles. Regression analyses suggested that the extent of distress in both parents was not primarily predicted by illness or demographic factors. Rather, certain coping styles, knowledge, subjective worry and family functioning emerged as significant predictive variables. Implications for early intervention are discussed.

A school based study of psychological disturbance in children following the Omagh bomb

Objective
To assess the extent and nature of psychiatric morbidity among children (aged 8 to 13 years) 15 months after a car bomb explosion in the town of Omagh, Northern Ireland.

Method
A survey was conducted of 1945 school children attending 13 schools in the Omagh district. Questionnaires included demographic details, measures of exposure, the Horowitz Impact of Events Scale, the Birleson Self-Rating Depression Scale, and the Spence Children’s Anxiety Scale.

Results
Children directly exposed to the bomb reported higher levels of probable PTSD (70%), and psychological distress than those not exposed. Direct exposure was more closely associated with an increase in PTSD symptoms than in general psychiatric distress. Significant predictors of increased IES scores included being male, witnessing people injured and reporting a perceived life threat but when co-morbid anxiety and depression are included as potential predictors anxiety remains the only significant predictor of PTSD scores.

Conclusions
School-based studies are a potentially valuable means of screening and assessing for PTSD in children after large-scale tragedies. Assessment should consider type of exposure, perceived life threat and other co-morbid anxiety as risk factors for PTSD.

A qualitative study of psychological, social and behavioral barriers to appropriate food portion size control

Background: Given the worldwide prevalence of overweight and obesity, there is a clear need for meaningful practical healthy eating advice - not only in relation to food choice, but also on appropriate food portion sizes. As the majority of portion size research to date has been overwhelmingly quantitative in design, there is a clear need to qualitatively explore consumers’ views in order to fully understand how food portion size decisions are made. Using qualitative methodology this present study aimed to explore consumers’ views about factors influencing their portion size selection and consumption and to identify barriers to appropriate portion size control.

Methods: Ten focus groups with four to nine participants in each were formed with a total of 66 persons (aged 19–64 years) living on the island of Ireland. The semi-structured discussions elicited participants’ perceptions of suggested serving size guidance and explored the influence of personal, social and environmental factors on their food portion size consumption. Audiotapes of the discussions were professionally transcribed verbatim, loaded into NVivo 9, and analysed using an inductive thematic analysis procedure.
Results: The rich descriptive data derived from participants highlight that unhealthy portion size behaviors emanate from various psychological, social and behavioral factors. These bypass reflective and deliberative control, and converge to constitute significant barriers to healthy portion size control. Seven significant barriers to healthy portion size control were apparent: (1) lack of clarity and irrelevance of suggested serving size guidance; (2) guiltless eating; (3) lack of self-control over food cues; (4) distracted eating; (5) social pressures; (6) emotional eating rewards;
and (7) quantification habits ingrained from childhood.

Conclusions: Portion size control strategies should empower consumers to overcome these effects so that the consumption of appropriate food portion sizes becomes automatic and habitual.
Keywords: Food portion size, Barriers, Obesity, Consumers, Qualitative study. © 2013 Spence et al.; licensee BioMed Central Ltd

The potential role of fruit and vegetables in aspects of psychological well-being: a review of the literature and future directions

The objective of the present paper was to review the literature investigating the potential relationship between fruit and vegetables (FV) and psychological well-being. The rising prevalence of mental ill health is causing considerable societal burden. Inexpensive and effective strategies are therefore required to improve the psychological well-being of the population, and to reduce the negative impact of mental health problems. A growing body of literature suggests that dietary intake may have the potential to influence psychological well-being. For example, studies have suggested that particular dietary constituents, including vitamins and minerals, might be beneficial to psychological health. However, in order to better reflect normal dietary intake, health-based research has increasingly begun to focus on whole foods and dietary patterns, rather than individual nutrients. One food group that has received increasing attention with regard to psychological health is FV. This is probably a result of the strong evidence base, which exists in relation to their protective association with a number of chronic diseases, as well as the fact that they are a rich source of some of the nutrients which have been linked to psychological health. While some promising findings exist with regards to FV intake and psychological well-being, overall, results are inconsistent. Possible reasons for this, such as methodological issues related to study design and the measurement of psychological well-being and FV intake, are discussed within this review. Based on the predominantly observational nature of existing literature, the present paper concludes that future well-designed randomised controlled trials are required to investigate the relationship further.

A Comparison of Support Needs Between Rural and Urban Family Caregivers Providing Palliative Care

The present study examined the support needs for urban and rural family caregivers of a palliative family member using a cross-sectional telephone survey in northeastern Ontario, Canada (n = 140; 70 urban, 70 rural). Support needs identified as most important by both the groups were informational. Rural caregivers reported greater unmet needs in tangible support (P =.01). No differences were observed between the groups for emotional or informational support needs (P =.25 and P =.35, respectively). Rural and urban caregivers perceived care for care recipients as accessible (mean accessibility score 1.9, standard deviation [SD] = 0.09 and 1.7, SD = 0.7, respectively, P =.20); the majority indicated that when needed, services were easily and quickly obtained. Although there are similarities in the formal care experiences, rural caregivers experience greater unmet needs in receiving support for instrumental activities. © The Author(s) 2013.

Family-based associations in measures of psychological distress and quality of life in a cardiac screening clinic for inheritable cardiac diseases: a cross-sectional study

BACKGROUND: Family-based cardiac screening programmes for persons at risk for genetic cardiac diseases are now recommended. However, the psychological wellbeing and health related quality of life (QoL) of such screened patients is poorly understood, especially in younger patients. We sought to examine wellbeing and QoL in a representative group of adults aged 16 and over in a dedicated family cardiac screening clinic.

METHODS: Prospective survey of consecutive consenting patients attending a cardiac screening clinic, over a 12 month period. Data were collected using two health measurement tools: the Short Form 12 (version 2) and the Hospital Anxiety and Depression Scale (HADS), along with baseline demographic and screening visit-related data. The HADS and SF-12v.2 outcomes were compared by age group. Associations with a higher HADS score were examined using logistic regression, with multi-level modelling used to account for the family-based structure of the data.

RESULTS: There was a study response rate of 86.6%, with n=334 patients providing valid HADS data (valid response rate 79.5%), and data on n=316 retained for analysis. One-fifth of patients were aged under 25 (n=61). Younger patients were less likely than older to describe significant depression on their HADS scale (p<0.0001), although there were overall no difference between the prevalence of a significant HADS score between the younger and older age groups (18.0% vs 20.0%, p=0.73). Significant positive associates of a higher HADS score were having lower educational attainment, being single or separated, and being closely related to the family proband. Between-family variance in anxiety and depression scores was greater than within-family variance.

CONCLUSIONS: High levels of anxiety were seen amongst patients attending a family-based cardiac screening clinic.Younger patients also had high rates of clinically significant anxiety. Higher levels of anxiety and depression tends to run in families, and this has implications for family screening and intervention programmes.

A saúde mental dos sem abrigo: comunidades de inserção

Pretendemos com este estudo caracterizar os sem abrigo, as suas redes e relações sociais, bem como os modelos de intervenção, de forma a que se possa ter um maior conhecimento acerca desta problemática. Para a consecução destes propósitos, foram delineados os seguintes objectivos: caracterizar a população sem abrigo em termos de variáveis sócio-demográficas; identificar a sua rede social de apoio; caracterizar as dimensões sociais associadas à vinculação adulta nos sem abrigo; caracterizar a incidência de psicopatologia nesta população; analisar o seu bem estar psicológico; caracterizar os acontecimentos de vida stressantes que contribuem para a emergência desta problemática. Para atingir estes objectivos foram realizados dois estudos, um de carácter quantitativo e um segundo de carácter qualitativo. Participaram 225 indivíduos (105 sem abrigo e 120 pessoas carenciadas) garantindo a homogeneidade nas variáveis sexo e idade. A média de idades da amostra total (n= 225) é de 38 anos, sendo que a maioria dos sujeitos desta investigação pertence ao sexo masculino (78,5%). O grupo dos sem abrigo foi recolhido em duas comunidades de inserção, na zona centro do país, sendo importante destacar que todos nesta fase têm apoio residencial, satisfação das necessidades básicas, acompanhamento social e psicológico, bem como, projectos de inserção em curso. O protocolo de recolha de informação inclui dados pessoais, a versão portuguesa da (ASQ)-Questionário de Estilos de Vinculação nos Sem Abrigo (QEVSA), da escala de ocorrência de acontecimentos de vida stressantes relacionados com o surgimento do primeiro episódio de sem abrigo (EAVSSA), do Questionário de Morbilidade Psiquiátrica em Adultos (QMPA), do Medical Outcomes Study’s social support scale (MOS-SSS-P), a escala de medida de manifestação de bem-estar psicológico (EMMBEP), o programa de intervenção da CINO e uma entrevista estruturada utilizada no estudo qualitativo. Os principais resultados são: a) o perfil de sem abrigo encontrado é maioritariamente homem, em média com 39 anos, solteiro ou divorciado, com 1 filho, 2.º ciclo de escolaridade, desempregado e português; b) maioria viveu na rua mais de um ano, está na instituição há menos de meio ano, não teve nos últimos seis meses consumo de substâncias (álcool e drogas), frequenta consultas (saúde mental e toxicodependência), toma medicação (terapêutica de substituição e neurolépticos), afirma não ter comportamentos de risco, e na maioria têm patologia infecciosa (HIV ou hepatite c), tendo cerca de 40% estado detidos; c) a problemática dos sem abrigo é um fenómeno multicausal apontando como principais factores o conflito familiar, o desemprego e problemas de saúde; d) em termos de vinculação população sem abrigo parece corresponder a indivíduos com vinculação insegura, denotando uma falta de confiança generalizada; e) em termos de bem estar psicológico a média foi significativamente superior no grupo de pessoas carenciadas, quando comparado com o grupo dos sem abrigo; f) no que toca à saúde mental constatamos que 80% dos sem abrigo e 42.5% das pessoas carenciadas são portadores de transtorno mental; g) no que concerne ao apoio social os sem abrigo referem menor suporte social (apoio emocional, afectivo, instrumental e menor interacção social positiva) que as pessoas carenciadas; h) os sem abrigo têm menos familiares e amigos íntimos; i) os resultados do estudo qualitativo indicam que o programa de intervenção da CINO, parece contribuir para a emergência de uma rede social estável, activa, acessível e integrada que se constitui como um sistema salutogénico para o indivíduo, diminuindo o uso dos serviços. Parece ainda eficaz aos olhos dos próprios e destacam como factor fundamental a sua participação activa no mesmo, a importância de rotinas organizadoras, de espaços de terapia de grupo e a existência de equipa multidisciplinar. Destacam ainda como positivo o facto de existir um primeiro período de regime fechado como estratégia de prevenção de recaída, um programa faseado de aquisição de responsabilidades e autonomia, acesso a emprego no exterior da comunidade e o follow-up pós autonomização. Como implicação deste trabalho salienta-se a produção de conhecimentos acerca da realidade dos sem abrigo na região centro do país e de estratégias de intervenção.