Positive functioning as an outcome in its own right.
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3926 to 3950 of 6,178Spirituality, religiosity, and spiritual pain among caregivers of patients with advanced cancer.
Background: Caregivers of patients with advanced cancer often face physical, social, and emotional distress as well as spiritual pain. Limited research has focused on the spiritual aspects of caregivers' suffering in the palliative care setting.
Methods: We interviewed 43 caregivers of patients with advanced cancer in our palliative care outpatient clinic. We determined demographic characteristics, religious affiliation, and relationship to the patient. Levels of spirituality, religiosity, and spiritual pain were self-reported using numeric rating scales (0 = lowest; 10 = highest). The participants completed various validated questionnaires to assess sleep disturbances, psychosocial distress, coping skills, and quality of life (QOL).
Results: The median age was 52 years (range, 21-83); 29 (67%) were women, 34 (78%) were white, 7 (17%) were African American, and 2 (5%) were Hispanic; 39 (…
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Relationship of sense of coherence to stressful events, coping strategies, health status, and quality of life in women with breast cancer.
Objective: To test the hypothesis that Antonovsky's concept of sense of coherence (SOC) predicts stressful events, coping strategies, health status, and quality of life (QoL) in a cohort of postmenopausal women (n = 131) with newly diagnosed primary or recurrent breast cancer.
Methods: Regression analyses of longitudinal data at baseline through 6 months following breast cancer diagnosis examined the relationships between SOC (13-item version), daily assessment of coping with stressful events, health status, and QoL (EORTC QLQ-30).
Results: The findings support Antonovsky's concept of SOC. Women with strong SOC reported fewer stressful events and more days without stressful events. They used more coping strategies and more frequently used distraction, situation redefinition, direct action, and relaxation, but seldom religion, to cope with stressful events, and reported better health stat…
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Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life.
Objectives: Despite the fact that food and diet are central issues, that concern patients with irritable bowel syndrome (IBS), the current understanding about the association between the intake of certain foods/food groups and the gastrointestinal (GI) symptom pattern, psychological symptoms, and quality of life is poor. The aim of this study was to determine which food groups and specific food items IBS patients report causing GI symptoms, and to investigate the association with GI and psychological symptoms and quality of life.
Methods: We included 197 IBS patients (mean age 35 (18-72) years; 142 female subjects) who completed a food questionnaire in which they specified symptoms from 56 different food items or food groups relevant to food intolerance/allergy. The patients also completed questionnaires to assess depression and general anxiety (Hospital Anxiety and Depression), GI-speci…
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Mindfulness meditation, well-being, and heart rate variability: a preliminary investigation into the impact of intensive Vipassana meditation.
Mindfulness meditation has beneficial effects on brain and body, yet the impact of Vipassana, a type of mindfulness meditation, on heart rate variability (HRV) - a psychophysiological marker of mental and physical health - is unknown. We hypothesised increases in measures of well-being and HRV, and decreases in ill-being after training in Vipassana compared to before (time effects), during the meditation task compared to resting baseline (task effects), and a time by task interaction with more pronounced differences between tasks after Vipassana training. HRV (5-minute resting baseline vs. 5-minute meditation) was collected from 36 participants before and after they completed a 10-day intensive Vipassana retreat. Changes in three frequency-domain measures of HRV were analysed using 2 (Time; pre- vs. post-Vipassana)× 2 (Task; resting baseline vs. meditation) within subjects ANOVA. These m…
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Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study.
While symptoms of deficient emotional self-regulation (DESR) such as low frustration tolerance, temper outbursts, emotional impulsivity, and mood lability are commonly associated with attention deficit hyperactivity disorder (ADHD), little is known about their nature. The main aim of this post hoc study was to examine the correlates of DESR in a large sample of adults with and without ADHD. Subjects were 206 adults with ADHD and 123 adults without ADHD from a family study of ADHD. Emotional impulsivity was operationalized using items from the Barkley Current Behavior Scale. Subjects were comprehensively assessed for psychiatric comorbidity using structured diagnostic interview methodology. We used the Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (QLES-Q-SF) and Social Adjustment Scale-Self-report (SAS-SR) to assess quality of life and psychosocial functioning. DE…
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Koreth J, Pidala J, Perez WS, Deeg HJ, Garcia-Manero G, Malcovati L, Cazzola M, Park S, Itzykson R, Ades L, Fenaux P, Jadersten M, Hellstrom-Lindberg E, Gale RP, Beach CL, Lee SJ, Horowitz MM, Greenberg PL, Tallman MS, DiPersio JF, Bunjes D, Weisdorf DJ, Cutler C (2013)MEDLINE-indexed journal, not yet read by usJournal of clinical oncology : official journal of the American Society of Clinical Oncology208 citations Role of reduced-intensity conditioning allogeneic hematopoietic stem-cell transplantation in older patients with de novo myelodysplastic syndromes: an international collaborative decision analysis.
Purpose: Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders that are more common in patients aged ≥ 60 years and are incurable with conventional therapies. Reduced-intensity conditioning (RIC) allogeneic hematopoietic stem-cell transplantation is potentially curative but has additional mortality risk. We evaluated RIC transplantation versus nontransplantation therapies in older patients with MDS stratified by International Prognostic Scoring System (IPSS) risk.
Patients and methods: A Markov decision model with quality-of-life utility estimates for different MDS and transplantation states was assessed. Outcomes were life expectancy (LE) and quality-adjusted life expectancy (QALE). A total of 514 patients with de novo MDS aged 60 to 70 years were evaluated. Chronic myelomonocytic leukemia, isolated 5q- syndrome, unclassifiable, and therapy-related MDS were excluded. Transp…
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Association between anxiety, health-related quality of life and functional impairment in primary care patients with chronic pain.
Objective: Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain.
Methods: Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive-compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariat…
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Neuropsychological and socio-occupational functioning in young psychiatric outpatients: a longitudinal investigation.
Background: Clinical symptoms and neuropsychological deficits are longitudinally associated with functional outcome in chronic psychiatric cohorts. The current study extended these findings to young and early-course psychiatric outpatients, with the aim of identifying cognitive markers that predict later socio-occupational functioning.
Methods: At baseline, 183 young psychiatric outpatients were assessed. Ninety-three returned for follow-up (M = 21.6 years old; SD = 4.5) with an average re-assessment interval of 21.6 months (SD = 7.0), and primary diagnoses of major depressive disorder (n = 34), bipolar disorder (n = 29), or psychosis (n = 30). The primary outcome measure was cross-validated with various other functional measures and structural equation modelling was used to map out the interrelationships between predictors and later functional outcome.
Results: Good socio-occupational f…
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The nature of well-being: the roles of hedonic and eudaimonic processes and trait emotional intelligence.
The present study reconceptualized the role of hedonic (pleasure) and eudaimonic (engagement) functions as well-being processes and distinguished them from well-being outcomes. Well-being outcomes encompass life satisfaction, positive affect, psychological well-being, social well-being, subjective physical health, and absence of depression, anxiety, and stress. It was hypothesized that trait emotional intelligence (EI) would mediate the relationship between well-being processes and well-being outcomes. Participants (N = 370, mean age = 27.35 years, SD = 10.01) completed measures of hedonic and eudaimonic well-being processes, trait EI, and well-being outcome indices. Path analysis using structural equation modeling showed that trait EI fully mediated the relationship between hedonic and eudaimonic processes and well-being outcomes. Results demonstrated that engagement in meaningful activ…
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The psychosocial impact of stigma in people with head and neck or lung cancer.
Background: Lung and head and neck cancers are widely believed to produce psychologically destructive stigma because they are linked to avoidable risk-producing behaviors and are highly visible, but little research has tested these ideas. We examined cancer-related stigma, its determinants, and its psychosocial impact in lung (n = 107) and head and neck cancer survivors (n = 99) ≤ 3 years post-diagnosis. We investigated cancer site, self-blame, disfigurement, and sex as determinants, benefit finding as a moderator, and illness intrusiveness as a mediator of the relation between stigma and its psychosocial impact.
Methods: Prospective participants received questionnaire packages 2 weeks before scheduled follow-up appointments. They self-administered widely used measures of subjective well-being, distress, stigma, self-blame, disfigurement, illness intrusiveness, and post-traumatic growth.…
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Facebook friends with (health) benefits? Exploring social network site use and perceptions of social support, stress, and well-being.
There is clear evidence that interpersonal social support impacts stress levels and, in turn, degree of physical illness and psychological well-being. This study examines whether mediated social networks serve the same palliative function. A survey of 401 undergraduate Facebook users revealed that, as predicted, number of Facebook friends associated with stronger perceptions of social support, which in turn associated with reduced stress, and in turn less physical illness and greater well-being. This effect was minimized when interpersonal network size was taken into consideration. However, for those who have experienced many objective life stressors, the number of Facebook friends emerged as the stronger predictor of perceived social support. The "more-friends-the-better" heuristic is proposed as the most likely explanation for these findings.
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[Psycho-emotional impact of a child's disability on parents].
Care for a child with a disability is a stressful experience for parents. It triggers a range of emotions and feelings that require a set of behaviors and attitudes to manage daily life. To face this situation, parents use coping strategies. The purpose of this study was to assess the psychological reactions (depression and anxiety) of parents and the impact of a child's disability on their quality of life (QOL), and to determine their coping strategies. A survey of 50 parents of handicapped children, treated in the neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in September 2010. The Beck Depression Inventory (BDI), the State Trait Anxiety Inventory (STAI), the SF-36, and the Brief COPE were used to assess, respectively, depression, anxiety, QOL, and coping strategies in parents. Among the group of parents studied, the anxiety and depression rates were, res…
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Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis.
Objective: Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders, which may indicate that the focus of research in individuals at high risk (HR) for psychosis needs updating. In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers.
Method: Between February 2010 and September 2012 60 help-seeking HR individuals, aged 16-35, were recruited from CAMEO Early Intervention in Psychosis Service, Cambridgeshire, UK. Forty-five age- and gender-matched healthy volunteers were randomly recruited from the same geographical area. Sociodemographic, psychiatric morbidity, functioning and quality of life measures were compared between both groups.
Results: HR individuals suffered a wide range of D…
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Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer.
Background: Cancer places a financial and economic burden on individuals, but relatively little is known about the consequences. We investigated associations between cancer-related financial stress and strain and psychological well-being.
Methods: Individuals >6 months post-diagnosis with breast, prostate and lung cancer, identified from the National Cancer Registry Ireland, completed a postal questionnaire. Financial stress was assessed by the impact of the cancer diagnosis on household ability to make ends meet, financial strain by feelings about household financial situation since the cancer diagnosis and psychological well-being (depression, anxiety and distress) by the Depression Anxiety Stress Scales-21. Logistic regression was used to identify associations between financial stress and strain and depression, anxiety and distress of (a) any severity and (b) severe or worse.
Results:…
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Self-esteem mediates the relationship between volunteering and depression for African American caregivers.
Research on the influence of volunteering on mental health outcomes has not placed enough focus on African American female caregivers who are at risk for adverse outcomes such as depression. This study addresses this gap by examining the mechanism through which volunteering might influence depressive symptoms using data collected from 521 African American female caregivers of older adults. Regression results indicate that although volunteering is inversely associated with depressive symptoms, self-esteem mediates this relationship. Findings suggest inclusion in volunteering for African American female caregivers may be relevant to promotion of their mental well-being.
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Long-term experiences after oesophagectomy/gastrectomy for cancer--a focus group study.
Background: After surgery for oesophageal or gastric cancer, patients suffer from a variety of problems that affect their physical and mental health. Most previous studies on quality of life after this type of surgery are based on quantitative methods, and no studies to date have focused on the patient's subjective experiences of their quality of life from a long-term perspective.
Objective: To illuminate patients' experiences of their quality of life, and how they handle their new life situation, from a long-term perspective, after oesophagectomy or gastrectomy for cancer.
Method: This study was carried out in accordance with a descriptive explorative design focusing on the patients' quality of life after surgery for oesophageal/gastric cancer. Data collection was carried out using semi-structured focus group interviews. A total of 17 participants divided into 4 focus groups were includ…
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Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the maximizing independence at home study.
Objectives: To determine the prevalence and correlates of unmet needs in a sample of community-residing persons with dementia (PWD) and their informal caregivers.
Design: Analysis of cross-sectional, baseline participant characteristics before randomization in a care coordination intervention trial.
Setting: Baltimore, Maryland.
Participants: Community-residing PWD (n=254) and their informal caregivers (n=246).
Measurements: In-home assessments of dementia-related needs based on the Johns Hopkins Dementia Care Needs Assessment. Bivariate and multivariate regression analyses were conducted to identify demographic, socioeconomic, clinical, functional, and quality-of-life correlates of unmet needs.
Results: The mean number of unmet needs was 7.7±4.8 in PWD and 4.6±2.3 in caregivers, with almost all PWD (99%) and caregivers (97%) having one or more unmet needs. Unmet needs in PWD were signif…
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The CLOSER survey: impact of postmenopausal vaginal discomfort on relationships between women and their partners in Northern and Southern Europe.
Objectives: CLOSER investigated how postmenopausal vaginal atrophy ('vaginal discomfort') affects relationships between women and their partners.
Study design: CLOSER involved postmenopausal women (55-65 years) with vaginal discomfort, and male partners of women with the condition.
Main outcome measures: Structured questionnaire collecting information on impact of vaginal discomfort and local oestrogen treatment on intimacy and relationships, and symptoms and impact of menopause.
Results: 1600 women and 1600 men from Northern Europe and 1000 women and 1000 men from Southern Europe were included. Worry that vaginal discomfort would never go away was expressed by 28% and 38% of women in Northern and Southern Europe, respectively (p<0.05), while 21% and 27% worried that vaginal discomfort would ruin their future sex life (p<0.05). Half of women who avoided intimacy worried about painful sex…
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Health-Related Quality of Life (HRQoL) in alopecia areata patients-a secondary analysis of the National Alopecia Areata Registry Data.
Alopecia areata (AA) is a nonscarring and recurrent disease characterized by hair loss that may significantly affect patient health-related quality of life (HRQoL). Given the lack of reliable and accurate reporting of HRQoL status in patients with AA, we analyzed data from 532 AA patients from the National Alopecia Areata Registry whose registry record included HRQoL assessments using three validated instruments: Skindex-16, brief version of the Fear of Negative Evaluation Scale, and Dermatology Life Quality Index. The mean HRQoL scores were compared with previously reported HRQoL levels from healthy controls and patients with other skin diseases. Two-step cluster analysis of Skindex-16 scales divided patients into two groups: 481 (57%) with good HRQoL and 361 (43%) with poor HRQoL. Multivariate logistic regression modeling revealed a set of risk factors for poor HRQoL: age <50 years (od…
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Depression and anxiety following myocardial infarction and their inverse associations with future health behaviors and quality of life.
Background: Post-myocardial infarction (MI) depression and anxiety were found to predict prognosis and quality of life.
Purpose: The purpose of this study was to test a behavioral pathway from post-MI depression/anxiety to future quality of life.
Methods: This is a longitudinal cohort study. Five hundred forty patients (≤65 years old) filled out questionnaires after a first MI, including socio-demographics, pre-MI health status and behaviors, MI severity, social support, sense of coherence, depression, and anxiety. Reports of health behaviors were obtained 5 years and of quality of life 10 years later.
Results: A structural equations model confirmed that depression and anxiety were directly related to poorer quality of life 10 years later. These relationships were partly mediated by a positive association between anxiety and health behaviors at 5 years and a negative one between depressi…
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Quality of life and marital adjustment in remitted psychiatric illness: an exploratory study in a rural setting.
People with mental disorders experience impaired quality of life (QOL). In India, spouses form the most important caregiver for the patient and therefore impact the patients' QOL. However, relatively little is known about marital adjustment, which can definitely influence QOL of patients with mental illness. This study intended to explore marital adjustment and QOL among remitted patients with schizophrenia (SC), depression, and bipolar disorders (BPADs) and to study differences, if any, between the groups. Using a cross-sectional design, consecutive patients (N = 150) with an ICD-10-Diagnostic Criteria for Research diagnosis of SC, depression (recurrent depressive disorder [RDD]), or BPAD, who were currently in remission, were taken up for the study and administered the WHOQOL-BREF for assessing QOL and the Marital Adjustment Inventory for assessing marital adjustment, separately for th…
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Oral health-related quality of life of older people from three South American cities.
Objective: To describe subjective oral health status and its association with overall health conditions and socioeconomic factors in the elderly (60 years and older) living in the capital cities with the oldest average populations in South America.
Background: Oral diseases are a public health problem, frequently neglected in older adults. In recent years, the subjective assessment of psychological and social consequences of the problems related to oral health has been valued. One of the instruments used to estimate the Oral Health-Quality of Life is the Geriatric Oral Health Assessment (GOHAI).
Material and methods: Representative samples from SABE study (1999-2000) of Santiago (n = 1301), Buenos Aires (n = 1043), and Montevideo (n = 1450) aged 60 and over community-dwelling people. We assessed OH-QoL (GOHAI), self-reported missing teeth, denture use, and self-rated-health, among other …
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The impact of chemotherapy-related nausea on patients' nutritional status, psychological distress and quality of life.
Purpose: Nausea is a troublesome and distressing symptom for patients receiving chemotherapy. While vomiting is well controlled with current antiemetics, nausea is a more difficult symptom to manage. The aim of this study was to assess the impact of nausea on nutritional status, quality of life and psychological distress.
Methods: This was a prospective observational study over two cycles of chemotherapy. Patients completed the Multinational Association of Supportive Care in Cancer Antiemesis Tool, a measure of nutritional status (Patient-Generated Subjective Global Assessment), the Functional Assessment of Cancer Therapy-General (FACT-G) quality of life scale and the Hospital Anxiety and Depression Scale at the end of each chemotherapy cycle (around day 10 post-chemotherapy).
Results: The sample consisted of 104 patients, primarily female, receiving anthracycline-based chemotherapy. Whi…
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Internalized stigma and quality of life among persons with severe mental illness: the mediating roles of self-esteem and hope.
Research has revealed the negative consequences of internalized stigma among people with serious mental illness (SMI), including reductions in self-esteem and hope. The purpose of the present study was to investigate the relation between internalized stigma and subjective quality of life (QoL) by examining the mediating role of self-esteem and hope. Measures of internalized stigma, self-esteem, QoL, and hope were administrated to 179 people who had a SMI. Linear regression analysis and structural equation modeling (SEM) were used to analyze the cross-sectional data. Self-esteem mediated the relation between internalized stigma and hope. In addition, hope partially mediated the relationship between self-esteem and QoL. The findings suggest that the effect of internalized stigma upon hope and QoL may be closely related to levels of self-esteem. This may point to the need for the developmen…
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Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians.
To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced c…
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