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Darmour CA, Luk JW, LaCroix JM, Perera KU, Goldston DB, Soumoff AA, Weaver JJ, Ghahramanlou-Holloway M. Social Support and Social Stress Among Suicidal Inpatients at Military Treatment Facilities: A Multidimensional Investigation. J Nerv Ment Dis 2024; 212:261-269. [PMID: 38416406 DOI: 10.1097/nmd.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT The associations between social support and stress with internalizing symptoms (depressive symptoms and hopelessness) and hazardous drinking were tested in an inpatient sample of suicidal military personnel. Baseline data from a randomized clinical trial were analyzed. Different sources of support and stressors in the social context of military personnel were differentially linked to internalizing symptoms and hazardous drinking. In the full sample ( n = 192), family and nonfamily support were both inversely associated with internalizing symptoms but not hazardous drinking. Family stress was positively associated with internalizing symptoms. In a subsample of service members who had a history of deployment ( n = 98), postdeployment social support was protective against internalizing symptoms, whereas deployment harassment was associated with increased odds of hazardous drinking. Results underscore the need for assessment of various dimensions of social support and stress to guide case formulation and optimize strategies to support patients' mental well-being and adaptive coping.
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Affiliation(s)
- Charles A Darmour
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Alyssa A Soumoff
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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2
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Ng XR, Tey YXS, Lew KJ, Lee PSS, Lee ES, Sim SZ. Cross-sectional study assessing health outcome priorities of older adults with multimorbidity at a primary care setting in Singapore. BMJ Open 2023; 13:e079990. [PMID: 38081675 PMCID: PMC10729092 DOI: 10.1136/bmjopen-2023-079990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Managing older adults with multimorbidity may be challenging due to the conflicting benefits and harms of multiple treatments. Thus, it is important to identify patients' health outcome priorities to align treatment goals with their health preferences. This study aimed to use the Outcome Prioritisation Tool (OPT) to describe the health outcome priorities of older adults with multimorbidity and determine the factors associated with these priorities. Additionally, it aimed to assess the ease of completing the OPT in Singapore's primary care population. DESIGN Cross-sectional study conducted from January to March 2022. SETTING A public primary care centre in Singapore. PARTICIPANTS 65 years and older with multimorbidity. OUTCOME MEASURES Primary outcome measure was the most important health outcome priorities on the OPT. Secondary outcome measures were factors affecting these priorities and ease of completing the OPT. RESULTS We enrolled 180 participants (mean age: 73.2±6.1 years). Slightly more than half (54.4%) prioritised 'staying alive', while the remainder (45.6%) prioritised 'maintaining independence' (25.6%), 'relieving pain' (10.6%) and 'relieving other symptoms' (9.4%). Participants with six or more chronic conditions were three times (OR 3.03 (95% CI1.09 to 8.42)) more likely to prioritise 'staying alive' compared with participants with three conditions. Most participants (69.4%) agreed that the OPT was easy to complete, and the mean time taken to complete the OPT was 3.8±1.6 minutes. CONCLUSION 'Staying alive' was the most important health outcome priority, especially for older adults with six or more chronic conditions. The OPT was easily completed among older adults with multimorbidity in primary care. Further qualitative studies can be conducted to understand the factors influencing patients' priorities and explore the relevance of the OPT in guiding treatment decisions.
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Affiliation(s)
- Xin Rong Ng
- National Healthcare Group Polyclinics, Singapore
| | | | - Kaiwei Jeremy Lew
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | | | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Sai Zhen Sim
- National Healthcare Group Polyclinics, Singapore
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3
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Wang J, Lin Y, Gao L, Li X, He C, Ran M, Zhao X. Menopause-Related Symptoms and Influencing Factors in Mosuo, Yi, and Han Middle-Aged Women in China. Front Psychol 2022; 13:763596. [PMID: 35756261 PMCID: PMC9226393 DOI: 10.3389/fpsyg.2022.763596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
Although previous studies showed that women’s menopause-related symptoms varied in different ethnic groups and countries, and were affected by specific social and cultural factors, few studies have been conducted to explore menopause-related symptoms and its influencing factors in middle-aged women among ethnic groups in China. This study aimed to explore the characteristics of menopause-related symptoms and its influencing factors among Mosuo, Yi, and Han women in Yongning area of Yunnan province, China. A cross-cultural design by snowball sampling method was used to recruit 208 women aged 40–60 from Yongning Township, Ninglang County, Yunnan province, China. The 11-item Menopause Rating Scale (MRS) was used to assess menopause-related symptoms. Compared with Yi and Han women, Mosuo women were accorded the highest family status. Multiple linear regression analyses showed that ethnicity, age, family support, and family decision-making patterns were associated with the severity of menopause-related symptoms. Yi and Han women had more severe menopause-related symptoms than Mosuo women. Among the three groups, women living in “female-dominated” and “co-deliberated” households had significantly lower scores of menopause-related symptoms than those in “male-dominated” households. This study indicates that menopause-related symptoms vary among middle-aged women in different ethnic groups. A higher level of female status in the family and family support may be protective factors of menopause-related symptoms in middle-aged women.
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Affiliation(s)
- Jinyi Wang
- School of Humanities, Tongji University, Shanghai, China.,Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.,Department of Psychosomatic Medicine, Shanghai East Hospital Affiliated to Tongji University, Shanghai, China
| | - Yezhe Lin
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.,Department of Psychosomatic Medicine, Shanghai East Hospital Affiliated to Tongji University, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | - Limin Gao
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
| | - Xingjun Li
- Department of Rheumatology and Immunology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chunhua He
- The Second People's Hospital of Lijiang, Lijiang, China
| | - Maosheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xudong Zhao
- School of Humanities, Tongji University, Shanghai, China.,Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.,Department of Psychosomatic Medicine, Shanghai East Hospital Affiliated to Tongji University, Shanghai, China.,Tongji University School of Medicine, Shanghai, China
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4
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Chan ZY, Lim CF, Leow JL, Chium FY, Lim SW, Tong CHM, Zhou JJX, Tsi MMY, Tan RYC, Chew LST. Using the technology acceptance model to examine acceptance of telemedicine by cancer patients in an ambulatory care setting. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221104578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Telemedicine has demonstrated benefits for cancer patients including the potential to improve care coordination and patient outcomes. Since June 2020, teleconsultations have been implemented in the National Cancer Centre Singapore. Objectives: This study aims to assess cancer patients acceptance of telemedicine as a complement to traditional in-person care and identify factors affecting their acceptance. Methods: An online self-administered questionnaire was designed using a modified technology acceptance model (TAM) previously validated to predict acceptance of telemedicine by patients and factors affecting acceptance. Descriptive statistics were used to summarise data on demographic factors and TAM construct scores. Univariate and multivariate logistic regression were used to determine how demographics factors and TAM constructs influenced acceptance. Results: Respondents ( n = 278; mean age 59 years) were mostly female (67.6%), Chinese (86.3%) and received parenteral chemotherapy (72.6%). Technology access and confidence were generally moderate to high, while past telemedicine use was low (18%). Overall, more than half (59.7%) expressed acceptance. The odds of acceptance were significantly higher if respondents agreed that their healthcare access would improve by using telemedicine (OR 4.17, 95% CI 1.71–10.16) or they would have the necessary resources for using telemedicine (OR 4.54, 95% CI 2.30–8.97). Conclusion: Acceptance of telemedicine was high amongst respondents. Facilitating conditions such as having necessary resources and perceived improved access were identified as main predictors of high acceptance. Telemedicine services should work to improve these aspects, leverage on advantages and address disadvantages brought up by patients.
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Affiliation(s)
- Zhi Yao Chan
- Department of Pharmacy, National University Hospital, National University Health System, Singapore
| | - Chen Fang Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Jo Lene Leow
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Feng Yong Chium
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Su Wen Lim
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | | | - Jessie Jie Xi Zhou
- Ambulatory Support Services – Telemedicine, National Cancer Centre Singapore, Singapore
| | - Moses Min Yuan Tsi
- Ambulatory Support Services – Telemedicine, National Cancer Centre Singapore, Singapore
| | - Ryan Ying Cong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
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5
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Thompson MF, Luk JW, LaCroix JM, Perera KU, Goldston DB, Weaver JJ, Soumoff A, Ghahramanlou-Holloway M. Understanding the clinical characteristics of lesbian, gay, and bisexual military service members and adult beneficiaries within an inpatient psychiatric sample. Suicide Life Threat Behav 2022; 52:268-279. [PMID: 34889465 DOI: 10.1111/sltb.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited knowledge exists regarding targets for suicide-focused care among high-risk United States (U.S.) civilian and military sexual minorities. PURPOSE This study aimed to understand the demographic and clinical characteristics of a suicidal sexual minority sample, psychiatrically hospitalized in military treatment facilities, to advance future targeted care for this vulnerable subgroup. METHODS Secondary analysis of baseline data from a multisite psychotherapy randomized controlled trial was performed comparing those who self-identified as lesbian, gay, or bisexual (LGB; n = 39) to heterosexual participants (n = 170). RESULTS LGB participants were more likely than heterosexual participants to be younger, female, never married, and enlisted rank. LGB participants reported significantly lower family support, higher perceived burdensomeness, lower acquired capability for suicide, and were twice as likely to report that they could not control their suicidal thoughts. LGB and heterosexual participants reported similar levels of other suicide risk indicators and similar lifetime suicidal ideation and attempt histories. CONCLUSIONS Compared to heterosexual participants, LGB participants reported increased risk indicators for suicide yet similar lifetime suicidal ideation and attempt histories. Suicide prevention programs should address the unique needs of this vulnerable subgroup. Interventions targeting family support, perceived burdensomeness, and controllability of suicidal thoughts may be promising.
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Affiliation(s)
- Matthew F Thompson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | | | - Alyssa Soumoff
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, Maryland, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
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6
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Guo JW, Reblin M, Tay D, Ellington L, Beck AC, Cloyes KG. Patterns of stress and support in social support networks of in-home hospice cancer family caregivers. JOURNAL OF SOCIAL AND PERSONAL RELATIONSHIPS 2021; 38:3121-3141. [PMID: 34898795 PMCID: PMC8664070 DOI: 10.1177/02654075211024743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Family caregivers of home hospice cancer patients often experience burden and distress, which can be mitigated by perceived social support. However, less attention has been paid to the non-family sources of support within social networks, or to how sources of support may also be sources of stress. We describe support and stress in social networks of hospice family caregivers and identify caregiving characteristics associated with classes identified in our data. We collected demographic and psychosocial self-report data from family caregivers providing in-home hospice care for advanced cancer patients (N = 90). Caregivers also reported perceived support and stress from specific family and non-family relationships. We identified three classes with unique patterns of stress and support within caregivers' support networks using a latent class analysis. Classes include: 1) high support, low stress across family and non-family network members ("supportive"; 53% of caregivers); 2) high support, high stress across family and non-family network ("ambivalent maximizers"; 26%); and 3) high support, high stress across family network only ("family-focused ambivalent"; 21%). Caregivers in the ambivalent maximizer class reported more burden than caregivers in the supportive class (p = .024). This is one of the first studies to systematically explore the role of non-family support, as well as how stress and support co-occur within relationships and across networks. As informal support networks of hospice family caregivers are complex and multifaceted, understanding the patterns of support and stress across various network members is essential to offer services to more effectively manage caregiver burden.
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Affiliation(s)
- Jia-Wen Guo
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Maija Reblin
- Moffitt Cancer Centre, Health Outcomes and Behavior, 12902 Magnolia Dr, Tampa, FL, USA 33612
| | - Djin Tay
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Lee Ellington
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
| | - Anna C. Beck
- 1. University of Utah School of Medicine, Medical Oncology, 30 North 1900 East, Salt Lake City, UT, USA 84132; 2. University of Utah Health Huntsman Cancer Institute, Supportive Oncology and Survivorship, 1950 Circle of Hope, Salt Lake City, UT, USA 84112
| | - Kristin G Cloyes
- University of Utah, College of Nursing, 10 South 2000 East, Salt Lake City, UT, USA 84112
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7
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Luk JW, Bond AE, Gabrielli J, LaCroix JM, Perera KU, Lee-Tauler SY, Goldston DB, Soumoff A, Ghahramanlou-Holloway M. A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients. J Psychiatr Res 2021; 142:9-16. [PMID: 34311282 DOI: 10.1016/j.jpsychires.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual). METHODS Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis. RESULTS Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average). CONCLUSION Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.
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Affiliation(s)
- Jeremy W Luk
- National Institute on Alcohol Abuse and Alcoholism, Office of the Clinical Director, Building 10 - CRC, Room 1-5340, Bethesda, MD, 20892, USA
| | - Allison E Bond
- The University of Southern Mississippi, Department of Psychology, 118 College Dr., Hattiesburg, MS, 39406, USA
| | - Joy Gabrielli
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Rm. 3130, Gainesville, FL, 32610-0165, USA
| | - Jessica M LaCroix
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kanchana U Perera
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Su Yeon Lee-Tauler
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - David B Goldston
- Duke University School of Medicine, Box 3527 Med Ctr, Durham, NC, 27710, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Marjan Ghahramanlou-Holloway
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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Olawa BD, Idemudia ES. The extraversion-neuroticism and geriatric depression relations: do social engagements and social supports have roles to play? Heliyon 2020; 6:e05719. [PMID: 33364493 PMCID: PMC7750367 DOI: 10.1016/j.heliyon.2020.e05719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 12/09/2020] [Indexed: 02/02/2023] Open
Abstract
Evidence on the social pathways by which personality traits associate with depressive feeling is lacking. This study assessed the mediating roles of social engagements and social supports on the associations of extraversion and neuroticism with depressive symptoms among 465 older adults (Meanage = 74.18 ± 9.42) recruited from the senatorial districts of Ekiti State, Nigeria. Major assumptions were tested in structural equation modelling frame-work. High extraversion influenced both high engagements in social activities and perceived social supports, and then low depressive symptoms. High neuroticism predicted both low social engagements and social supports, and then increased depressive symptoms. While a full mediation was established between extraversion and depression, a partial one was found between neuroticism and depression. The total effect of neuroticism on depression surpassed that of extraversion. Psychotherapeutic interventions targeting depression from high neuroticism may aim frequent social engagements and seeking family and non-family supports.
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9
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Olawa BD, Idemudia ES. Gender Differences in the Associations Between Forms of Social Engagements and Loneliness in a Sample of Nigerian Older Adults: A Cross-Sectional Survey. PSYCHOLOGICAL STUDIES 2020. [DOI: 10.1007/s12646-020-00579-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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10
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Chokkanathan S. Prevalence of and risk factors for loneliness in rural older adults. Australas J Ageing 2020; 39:e545-e551. [DOI: 10.1111/ajag.12835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/31/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Srinivasan Chokkanathan
- Department of Social Work Faculty of Arts & Social Sciences National University of Singapore Singapore City Singapore
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Schneider FD, Loveland Cook CA, Salas J, Scherrer J, Cleveland IN, Burge SK. Childhood Trauma, Social Networks, and the Mental Health of Adult Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:1492-1514. [PMID: 29294679 DOI: 10.1177/0886260517696855] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this study was to investigate the relationship of childhood trauma to the quality of social networks and health outcomes later in adulthood. Data were obtained from a convenience sample of 254 adults seen in one of 10 primary care clinics in the state of Texas. Standardized measures of adverse childhood experiences (ACEs), stressful and supportive social relationships, medical conditions, anxiety, depression, and health-related quality of life were administered. Using latent class analysis, subjects were assigned to one of four ACE classes: (a) minimal childhood abuse (56%), (b) physical/verbal abuse of both child and mother with household alcohol abuse (13%), (c) verbal and physical abuse of child with household mental illness (12%), and (d) verbal abuse only (19%). Statistically significant differences across the four ACE classes were found for mental health outcomes in adulthood. Although respondents who were physically and verbally abused as children reported compromised mental health, this was particularly true for those who witnessed physical abuse of their mother. A similar relationship between ACE class and physical health was not found. The quality of adult social networks partly accounted for the relationship between ACE classes and mental health outcomes. Respondents exposed to ACEs with more supportive social networks as adults had diminished odds of reporting poor mental health. Conversely, increasing numbers of stressful social relationships contributed to adverse mental health outcomes. Although efforts to prevent childhood trauma remain a critical priority, the treatment of adult survivors needs to expand its focus on both strengthening social networks and decreasing the negative effects of stressful ones.
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Affiliation(s)
| | | | - Joanne Salas
- Saint Louis University School of Medicine, MO, USA
| | | | | | - Sandra K Burge
- The University of Texas Health Science Center at San Antonio, TX, USA
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12
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Ketcher D, Trettevik R, Vadaparampil ST, Heyman RE, Ellington L, Reblin M. Caring for a spouse with advanced cancer: similarities and differences for male and female caregivers. J Behav Med 2019; 43:817-828. [PMID: 31845168 DOI: 10.1007/s10865-019-00128-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/11/2019] [Indexed: 11/28/2022]
Abstract
Most caregiving literature has focused on women, who have traditionally taken on caregiving roles. However, more research is needed to clarify the mixed evidence regarding the impact of gender on caregiver/patient psychological outcomes, especially in an advanced cancer context. In this paper, we examine gender differences in caregiver stress, burden, anxiety, depression, and coping styles, as well as how caregiver gender impacts patient outcomes in the context of advanced cancer. Eighty-eight patients with advanced cancer and their caregivers completed psychosocial surveys. All couples were heterosexual and most caregivers were women (71.6%). Female caregivers reported significantly higher levels of perceived stress, depression, anxiety, and social strain compared with male caregivers, and female patients of male caregivers were more likely to use social support as a coping style compared with male patients of female caregivers. These findings highlight the potential differences between male and female caregivers' needs and psychological health.
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Affiliation(s)
- Dana Ketcher
- Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, USA
| | | | - Susan T Vadaparampil
- Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, USA
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Maija Reblin
- Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, USA.
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13
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Westmaas JL, Fallon E, McDonald BR, Driscoll D, Richardson K, Portier K, Smith T. Investigating relationships among cancer survivors' engagement in an online support community, social support perceptions, well-being, and moderating effects of existing (offline) social support. Support Care Cancer 2019; 28:3791-3799. [PMID: 31828494 DOI: 10.1007/s00520-019-05193-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Socially supportive relationships help cancer survivors cope with their diagnosis and may improve quality of life; however, many survivors report unmet support and information needs. Online communities of survivors may address these needs, but research on their benefits have been equivocal. This cross-sectional, self-report study investigated relationships among cancer survivors' level of engagement in an online survivor community (The American Cancer Society Cancer Survivors Network®; CSN), perceptions of emotional/informational support available from online communities ("online social support"), well-being, and moderating effects of "offline social support." METHODS Participants were 1255 registered users of the CSN who completed surveys between 2013 and 2014. Three types of engagement with the CSN-social/communal, interpersonal communication, and informational/search engagement-were identified through principal components analysis. Regression analyses examined hypotheses. RESULTS More frequent social/communal and interpersonal communication engagement were associated with increased online social support (p < .0001), and the relationship between interpersonal communication engagement and online social support was strongest for survivors reporting lower offline social support (interaction β = - .35, p < .001). Greater online social support was associated with increased well-being, but only among survivors reporting low offline social support (interaction β = - .35, p < .0001). CONCLUSIONS Engagement in online survivor communities may increase support perceptions that promote well-being, but benefits may accrue more to survivors reporting low offline social support. IMPLICATIONS FOR CANCER SURVIVORS Newly diagnosed cancer survivors, particularly those with unmet emotional/informational support needs, should be given the opportunity to communicate with other survivors through online survivor support networks.
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Affiliation(s)
- J Lee Westmaas
- American Cancer Society, 250 Williams St. NW, Atlanta, 30303, Georgia.
| | - Elizabeth Fallon
- American Cancer Society, 250 Williams St. NW, Atlanta, 30303, Georgia
| | | | - Deborah Driscoll
- American Cancer Society, 250 Williams St. NW, Atlanta, 30303, Georgia
| | - Kristi Richardson
- American Cancer Society, 250 Williams St. NW, Atlanta, 30303, Georgia
| | - Kenneth Portier
- American Cancer Society, 250 Williams St. NW, Atlanta, 30303, Georgia
| | - Tenbroeck Smith
- American Cancer Society, 250 Williams St. NW, Atlanta, 30303, Georgia
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Olawa BD, Omolayo BO, Azikiwe JC. Gender influence on loneliness and family and nonfamily support among older adults: The confounding role of widowhood. J Women Aging 2019; 33:268-287. [PMID: 31730398 DOI: 10.1080/08952841.2019.1690370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Based on interviews with 465 community elders in Ekiti-State, Nigeria, this study addressed the questions: (a) Do older men and women differ in self-reported loneliness, family and nonfamily support?; and (b) If so, is this relationship maintained when controlling for widowhood, age, social-engagements, extroversion, and neuroticism? Three independent models were tested using one-way MANOVA and MANCOVA. Compared to males, females reported more loneliness and less family support. However, these outcomes became nonexistent after excluding widowhood. Gender maintained significance after excluding other covariates. The study buttresses the primary importance of widowhood in the gender differences found in later-life loneliness and family supports.
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Affiliation(s)
- Babatola D Olawa
- Department of Psychology, Federal University Oye Ekiti, Oye-Ekiti, Nigeria
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Later-life satisfaction with adult children's achievements: does parents' personality matter? Heliyon 2019; 5:e02406. [PMID: 31535043 PMCID: PMC6744603 DOI: 10.1016/j.heliyon.2019.e02406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/10/2019] [Accepted: 08/29/2019] [Indexed: 02/02/2023] Open
Abstract
The happy personality model proposes that individuals with happy personality traits are more satisfied with the events of their lives than those who are not. Based on this proposition, this study examined whether parents' personality - as measured by the Big Five typology - would predict satisfaction with the achievements of adult children. Participants include 465 community elders from Ekiti State, comprising 294 mothers with mean age 74.18 ± 9.42. Both univariate and multivariate statistics were used in data analyses. Results indicated that mothers' extraversion and conscientiousness respectively predicted satisfaction with children's achievements in relationships and spirituality. Conversely, mothers' neuroticism predicted dissatisfaction in education, occupation, finances and health achievements. Fathers' agreeableness and openness traits respectively predicted satisfaction in education and occupation. These results provide support for the happy personality model by demonstrating that extraversion, agreeableness, and conscientiousness predict satisfaction with life events, while neuroticism predicts dissatisfaction.
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Chokkanathan S, Natarajan A. Perceived Quality of Life following Elder Mistreatment in Rural India. J Gerontol B Psychol Sci Soc Sci 2019; 73:e69-e80. [PMID: 28449084 DOI: 10.1093/geronb/gbx043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/03/2017] [Indexed: 01/07/2023] Open
Abstract
Objectives Using resilience theory, we examined multiple risks (individual, familial, and mistreatment characteristics) and promotive factors (mastery and social support) associated with perceived quality of life following mistreatment and tested two competing models, compensatory and protective models, to explain the role of promotive factors in the mistreatment-wellbeing linkage. Method Face-to-face interviews were conducted by administering standardized instruments to 897 randomly selected older adults in rural Tamil Nadu, India. Information from 187 older adults, who, in the interview had reported mistreatment in the past 1 year formed the analysis. Quality of life following mistreatment was measured using the Satisfaction with Life Scale. Mistreatment was measured by an adapted version of the Conflict Tactics Scale. Results Being single, hailing from a low income family, experiencing high levels of relationship strain, and experiencing more than one type of mistreatment were associated with decreased quality of life. High levels of mastery and social support were associated with high levels of quality of life following mistreatment. There was support for both compensatory and protective-reactive models of resilience. Some of the resources that counteract the negative effects of adversities and mistreatment appear to be effective only at lower levels of mistreatment. Discussion Quality of life following mistreatment was influenced by multiple risk and promotive factors, results that are consistent with resilience theory. Concerted efforts must be undertaken to bolster protective factors and minimize risk factors to enhance quality of life following mistreatment.
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Affiliation(s)
| | - Aravindhan Natarajan
- Department of Criminal Justice, Social Work and Legal Specialties, College of Social Justice and Human Service, Health and Human Services Building, University of Toledo, Ohio
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Duberstein PR, Ward EA, Chaudron LH, He H, Toth SL, Wang W, Van Orden KA, Gamble SA, Talbot NL. Effectiveness of interpersonal psychotherapy-trauma for depressed women with childhood abuse histories. J Consult Clin Psychol 2018; 86:868-878. [PMID: 30265045 DOI: 10.1037/ccp0000335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Women with depression and childhood sexual abuse histories constitute more than 20% of the female patient population in publicly funded community mental health centers (CMHCs). Interventions are needed that address depression and posttraumatic stress disorder (PTSD) symptoms and social health. METHOD We compared Interpersonal Psychotherapy-Trauma (IPT-T), an IPT adaptation for this population and setting, to Clinic Psychotherapy (CP). CP clinicians were free to implement the psychotherapy of choice. Women (n = 162; 54% White, 10.5% Hispanic; 52.2% Medicaid-insured) with a major depressive episode (MDE) and history of sexual abuse before 18 were randomly assigned to IPT-T or CP. Participants were offered 16 free sessions of IPT-T or CP. Outcomes were MDE remission, improved depression (Beck Depression Inventory, Hamilton Depression Rating Scale) and PTSD symptoms (Modified PTSD Symptom Scale), and improved social health (e.g., UCLA Loneliness Scale). Weighted generalized estimating equations were used to examine outcomes at 8 (primary) and 20 (secondary) months postrandomization. RESULTS IPT-T led to greater improvements in PTSD symptoms and many social health indicators, including loneliness and social support, at both 8- and 20-month follow-up. Effect sizes ranged from .18 to .39 at the primary endpoint (8 months). IPT-T and CP yielded comparable improvements in depression symptoms and MDE remission. CONCLUSION Evidence-based psychotherapies like IPT-T are needed in CMHCs, where some of the most vulnerable patients receive treatment. With comparable findings for depression, IPT's superior improvements in social health and PTSD symptoms are cause for optimism. IPT-T should be evaluated in dissemination trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Erin A Ward
- Clinical Research Associate, Center for Community Health, Northwestern University Feinberg School of Medicine
| | - Linda H Chaudron
- Department of Psychiatry, University of Rochester Medical Center
| | - Hue He
- Department of Epidemiology, Tulane University
| | - Sheree L Toth
- Department of Clinical and Social Sciences in Psychology, Mt. Hope Family Center University of Rochester
| | - Wenjuan Wang
- Department of Biostatistics, Brightech International
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Karwacka A, Zamkowska D, Radwan M, Jurewicz J. Exposure to modern, widespread environmental endocrine disrupting chemicals and their effect on the reproductive potential of women: an overview of current epidemiological evidence. HUM FERTIL 2017; 22:2-25. [PMID: 28758506 DOI: 10.1080/14647273.2017.1358828] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Growing evidence indicates that exposure to widespread, environmental contaminants called endocrine disruptors (EDCs) negatively affects animal and human reproductive health and has been linked to several diseases including infertility. This review aims to evaluate the impact of environmental exposure to endocrine disrupting chemicals [phthalates, parabens, triclosan, bisphenol A (BPA), organochlorine (PCBs) and perfluorinated (PFCs) compounds] on the reproductive potential among women, by reviewing most recently published literature. Epidemiological studies focusing on EDCs exposure and reproductive potential among women for the last 16 years were identified by a search of the PUBMED, MEDLINE, EBSCO and TOXNET literature databases. The results of the presented studies show that exposure to EDCs impacts the reproductive potential in women, measured by ovarian reserve and by assisted reproductive technology outcomes. Exposure to environmental endocrine disrupting chemicals decrease: (i) oestradiol levels (BPA); (ii) anti-Müllerian hormone concentrations (PCBs); (iii) antral follicle count (BPA, parabens, phthalates); (iv) oocyte quality (BPA, triclosan, phthalates, PCBs); (v) fertilization rate (PFCs, PCBs); (vi) implantation (BPA, phthalates, PCBs); (vii) embryo quality (triclosan, PCBs, BPA); (viii) rate of clinical pregnancy and live births (parabens, phthalates). The studies were mostly well-designed and used prospective cohorts with the exposure assessment based on the biomarker of exposure. Considering the suggested health effects, more epidemiological data is urgently needed to confirm the presented findings.
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Affiliation(s)
- Anetta Karwacka
- a Department of Gynecology and Reproduction , 'Gameta' Hospital , Rzgow , Poland
| | - Dorota Zamkowska
- b Department of Obstetrics , Medical University of Gdansk , Gdansk , Poland
| | - Michał Radwan
- a Department of Gynecology and Reproduction , 'Gameta' Hospital , Rzgow , Poland
| | - Joanna Jurewicz
- c Department of Environmental Epidemiology , Nofer Institute of Occupational Medicine , Lodz , Poland
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Health, family strains, dependency, and life satisfaction of older adults. Arch Gerontol Geriatr 2017; 71:129-135. [DOI: 10.1016/j.archger.2017.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 01/07/2023]
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Abstract
OBJECTIVES This study sought to examine the pathways through which interpersonal relationship strain and loneliness (stressors) influence elder mistreatment. In addition, the study tested the buffer effects of social support within the stressor-mistreatment relationship. METHOD Face-to-face interviews were conducted with 897 randomly selected older adults in rural Tamil Nadu, India. Mediation and moderation models were tested using the process module. RESULTS Results showed that, in addition to the direct effects, interpersonal problems also influenced mistreatment via loneliness (partially mediating model). In the moderation model, social support buffered the influence of interpersonal strain on mistreatment (unconditional direct effect) and also buffered the influence of interpersonal strain on mistreatment through loneliness (conditional indirect effects). DISCUSSION Intervention on mistreatment should involve elimination of risk factors and strengthening of social resources.
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Pyne JM, Fortney JC, Mouden S, Lu L, Hudson TJ, Mittal D. Cost-effectiveness of on-site versus off-site collaborative care for depression in rural FQHCs. Psychiatr Serv 2015; 66:491-9. [PMID: 25686811 PMCID: PMC5968353 DOI: 10.1176/appi.ps.201400186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Collaborative care for depression in primary care settings is effective and cost-effective. However, there is minimal evidence to support the choice of on-site versus off-site models. This study examined the cost-effectiveness of on-site practice-based collaborative care (PBCC) versus off-site telemedicine-based collaborative care (TBCC) for depression in federally qualified health centers (FQHCs). METHODS In a multisite, randomized, pragmatic comparative cost-effectiveness trial, 19,285 patients were screened for depression, 2,863 (14.8%) screened positive, and 364 were enrolled. Telephone interview data were collected at baseline and at six, 12, and 18 months. Base case analysis used Arkansas FQHC health care costs, and secondary analysis used national cost estimates. Effectiveness measures were depression-free days and quality-adjusted life years (QALYs) derived from depression-free days, the 12-Item Short-Form Survey, and the Quality of Well-Being (QWB) Scale. Nonparametric bootstrap with replacement methods were used to generate an empirical joint distribution of incremental costs and QALYs and acceptability curves. RESULTS The TBCC intervention resulted in more depression-free days and QALYs but at a greater cost than the PBCC intervention. The disease-specific (depression-free day) and generic (QALY) incremental cost-effectiveness ratios (ICERs) were below their respective ICER thresholds for implementation, suggesting that the TBCC intervention was more cost effective than the PBCC intervention. CONCLUSIONS These results support the cost-effectiveness of TBCC in medically underserved primary care settings. Information about whether to insource (make) or outsource (buy) depression care management is important, given the current interest in patient-centered medical homes, value-based purchasing, and bundled payments for depression care.
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Affiliation(s)
- Jeffrey M Pyne
- Dr. Pyne, Ms. Lu, and Dr. Hudson are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (e-mail: ). Dr. Pyne and Dr. Hudson are also with the Department of Psychiatry, Central Arkansas Veterans Healthcare System, North Little Rock, where Dr. Mittal is affiliated. Dr. Fortney is with the Department of Psychiatry and Behavioral Sciences, University of Washington, and with the Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, both in Seattle. Ms. Mouden was with Community Health Centers of Arkansas, Inc., North Little Rock, at the time of this study. A poster of this research was presented at the Academy Health Annual Research Meeting, San Diego, June 8-10, 2014
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Chokkanathan S. Factors associated with elder mistreatment in rural Tamil Nadu, India: a cross-sectional survey. Int J Geriatr Psychiatry 2014; 29:863-9. [PMID: 24436119 DOI: 10.1002/gps.4073] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is limited evidence for the multifactorial aetiology of elder mistreatment. The goal of this study is to investigate the factors associated with the mistreatment of older adults living in rural Tamil Nadu, India. METHOD A cross-sectional household survey was conducted in a sub-district of rural Tamil Nadu by using a standard questionnaire. Face to face interviews were conducted with 902 older adults aged 61 years and older. The relation between the characteristics of older adults, family members and family environments with reported mistreatment was examined by univariate and multivariate logistic regression analyses. RESULTS The multivariate results reveal that elder mistreatment is related to several factors associated with the perpetrator and the family environment. Perpetrator factors include middle age, a tertiary education (protective), alcohol consumption and the mistreatment of other family members. Family environment factors include family stress and low cohesion. Among the factors related to older adults, only physical abuse of family members was associated with exposure to mistreatment. CONCLUSION The characteristics of older adults, family members and family environment are potent predictors of elder mistreatment. Multi-dynamic interventions should target dysfunctional families displaying alcohol use, relationship conflicts, low cohesion and the presence of some form of family violence.
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Affiliation(s)
- Srinivasan Chokkanathan
- Department of Social Work, Faculty of Arts & Social Sciences, National University of Singapore, Singapore, Singapore
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Yang YC, Schorpp K, Harris KM. Social support, social strain and inflammation: evidence from a national longitudinal study of U.S. adults. Soc Sci Med 2014; 107:124-35. [PMID: 24607674 DOI: 10.1016/j.socscimed.2014.02.013] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 12/20/2013] [Accepted: 02/09/2014] [Indexed: 11/18/2022]
Abstract
Social relationships have long been held to have powerful effects on health and survival, but it remains unclear whether such associations differ by function and domain of relationships over time and what biophysiological mechanisms underlie these links. This study addressed these gaps by examining the longitudinal associations of persistent relationship quality across a ten year span with a major indicator of immune function. Specifically, we examined how perceived social support and social strain from relationships with family, friends, and spouse at a prior point in time are associated with subsequent risks of inflammation, as assessed by overall inflammation burden comprised of five markers (C-reactive protein, interleukin-6, fibrinogen, E-selectin, and intracellular adhesion molecule-1) in a national longitudinal study of 647 adults from the Midlife Development in the United States (1995-2009). Results from multivariate regression analysis show that (1) support from family, friends, and spouse modestly protected against risks of inflammation; (2) family, friend, and total social strain substantially increased risks of inflammation; and (3) the negative associations of social strain were stronger than the positive associations of social support with inflammation. The findings highlight the importance of enriched conceptualizations, measures, and longitudinal analyses of both social and biological stress processes to elucidate the complex pathways linking social relationships to health and illness.
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Affiliation(s)
- Yang Claire Yang
- Department of Sociology, University of North Carolina at Chapel Hill, United States; Carolina Population Center, University of North Carolina at Chapel Hill, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, United States.
| | - Kristen Schorpp
- Department of Sociology, University of North Carolina at Chapel Hill, United States; Carolina Population Center, University of North Carolina at Chapel Hill, United States
| | - Kathleen Mullan Harris
- Department of Sociology, University of North Carolina at Chapel Hill, United States; Carolina Population Center, University of North Carolina at Chapel Hill, United States
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Fortney JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, Williams DK, Bynum CA, Mattox R, Rost KM. Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry 2013; 170:414-25. [PMID: 23429924 PMCID: PMC3816374 DOI: 10.1176/appi.ajp.2012.12050696] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Practice-based collaborative care is a complex evidence-based practice that is difficult to implement in smaller primary care practices that lack on-site mental health staff. Telemedicine-based collaborative care virtually co-locates and integrates mental health providers into primary care settings. The objective of this multisite randomized pragmatic comparative effectiveness trial was to compare the outcomes of patients assigned to practice-based and telemedicine-based collaborative care. METHOD From 2007 to 2009, patients at federally qualified health centers serving medically underserved populations were screened for depression, and 364 patients who screened positive were enrolled and followed for 18 months. Those assigned to practice-based collaborative care received evidence-based care from an on-site primary care provider and a nurse care manager. Those assigned to telemedicine-based collaborative care received evidence-based care from an on-site primary care provider and an off-site team: a nurse care manager and a pharmacist by telephone, and a psychologist and a psychiatrist via videoconferencing. The primary clinical outcome measures were treatment response, remission, and change in depression severity. RESULTS Significant group main effects were observed for both response (odds ratio=7.74, 95% CI=3.94-15.20) and remission (odds ratio=12.69, 95% CI=4.81-33.46), and a significant overall group-by-time interaction effect was observed for depression severity on the Hopkins Symptom Checklist, with greater reductions in severity over time for patients in the telemedicine-based group. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence base in the telemedicine-based group. CONCLUSIONS Contracting with an off-site telemedicine-based collaborative care team can yield better outcomes than implementing practice-based collaborative care with locally available staff.
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Affiliation(s)
- John C. Fortney
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Jeffrey M. Pyne
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Sip B. Mouden
- Community Health Centers of Arkansas Inc. North Little Rock, AR, 72114
| | - Dinesh Mittal
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Teresa J. Hudson
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205,South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114,Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR, 27114
| | - Gary W. Schroeder
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | - David K. Williams
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | - Carol A. Bynum
- Center for Distance Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205
| | | | - Kathryn M Rost
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL 33612
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Huntley AL, Johnson R, Purdy S, Valderas JM, Salisbury C. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med 2012; 10:134-41. [PMID: 22412005 PMCID: PMC3315139 DOI: 10.1370/afm.1363] [Citation(s) in RCA: 413] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Many patients consulting in primary care have multiple conditions (multimorbidity). Aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and community populations, and to investigate their validity in relation to anticipated associations with patient characteristics, process measures, and health outcomes. METHODS Studies were identified using searches in MEDLINE and EMBASE from inception to December 2009 and bibliographies. RESULTS Included were 194 articles describing 17 different measures. Commonly used measures included disease counts (n = 98), Chronic Disease Score (CDS)/RxRisk (n = 17), Adjusted Clinical Groups (ACG) System (n = 25), the Charlson index (n = 38), the Cumulative Index Illness Rating Scale (CIRS; n = 10) and the Duke Severity of Illness Checklist (DUSOI; n = 6). Studies that compared measures suggest their predictive validity for the same outcome differs only slightly. Evidence is strongest for the ACG System, Charlson index, or disease counts in relation to care utilization; for the ACG System in relation to costs; for Charlson index in relation to mortality; and for disease counts or Charlson index in relation to quality of life. Simple counts of diseases or medications perform almost as well as complex measures in predicting most outcomes. Combining measures can improve validity. CONCLUSIONS The measures most commonly used in primary care and community settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.
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Affiliation(s)
- Alyson L Huntley
- Academic Unit of Primary Health Care, School of Social and Community Medicine, Bristol University, Bristol, England
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Hersch G, Hutchinson S, Davidson H, Wilson C, Maharaj T, Watson KB. Effect of an Occupation-Based Cultural Heritage Intervention in Long-Term Geriatric Care: A Two-Group Control Study. Am J Occup Ther 2012; 66:224-32. [DOI: 10.5014/ajot.2012.002394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We investigated the effectiveness of an occupation-based cultural heritage intervention to facilitate adaptation to relocation into long-term care (LTC) facilities as measured by quality of life, activity engagement, and social participation.
METHOD. We used a quasi-experimental nonequivalent control group design with pre- and posttests. Residents receiving the cultural intervention were compared with residents in a typical activity group. Eight sessions, two per week for 4 wk, were facilitated by certified occupational therapy assistants.
RESULTS. Twenty-nine participants completed the group sessions. Quality-of-life scores improved significantly over time for both groups. Statistically, a greater percentage of time was spent in discretionary than obligatory time, pretest and posttest, with no significant difference between groups.
CONCLUSION. The study demonstrated effectiveness of a structured, occupation-based social group intervention that improved quality of life, an indicator of adaptation. It also provided a description of activity patterns and social participation of LTC residents.
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Affiliation(s)
- Gayle Hersch
- Gayle Hersch, PhD, OTR, is Professor, School of Occupational Therapy, Texas Woman’s University, 6700 Fannin Street, Houston, TX 77030, and served as Principal Investigator on the grant;
| | - Shirley Hutchinson
- Shirley Hutchinson, DrPH, RN, is Associate Professor, Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, and served as Co-Principal Investigator
| | - Harriett Davidson
- Harriett Davidson, MA, OTR, is Associate Professor, School of Occupational Therapy, Texas Woman’s University, Houston, and served as Co-Principal Investigator
| | - Christine Wilson
- Christine Wilson, OTR, is Former Clinical Rehabilitation Director, Park Plaza Hospital, Houston, and served as Project Coordinator and Recruiter on the grant
| | - Teresa Maharaj
- Teresa Maharaj, MSN, RN, is Assistant Clinical Professor, Nelda C. Stark College of Nursing, Texas Woman’s University, Houston, and served as Data Collector
| | - Kathleen B. Watson
- Kathleen B. Watson, PhD, was Instructor, Baylor College of Medicine, Houston, TX, at the time of the grant and served as Statistician
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Pennarola BW, Rodday AM, Mayer DK, Ratichek SJ, Davies SM, Syrjala KL, Patel S, Bingen K, Kupst MJ, Schwartz L, Guinan EC, Hibbard JH, Parsons SK. Factors associated with parental activation in pediatric hematopoietic stem cell transplant. Med Care Res Rev 2011; 69:194-214. [PMID: 22203645 DOI: 10.1177/1077558711431460] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient activation, the extension of self-efficacy into self-management, is an essential component of effective chronic care. In pediatric populations, caregiver activation is also needed for proper disease management. This study investigates the relationships between parental activation and other characteristics of parent-child dyads (N = 198) presenting for pediatric hematopoietic stem cell transplant. Parental activation concerning their child's health was assessed using the Parent Patient Activation Measure (Parent-PAM), a modified version of the well-validated Patient Activation Measure (PAM). Using hierarchical linear regression and following the Belsky process model for determining parenting behaviors, a multivariate model was created for parental activation on behalf of their child that showed that the parent's age, rating of their own general health, self-activation, and duration of the child's illness were significantly related to Parent-PAM score. Our findings characterize a potentially distinct form of activation in a parent-child cohort preparing for a demanding clinical course.
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Deen TL, Fortney JC, Pyne JM. Relationship Between Satisfaction, Patient-Centered Care, Adherence and Outcomes Among Patients in A Collaborative Care Trial for Depression. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 38:345-55. [DOI: 10.1007/s10488-010-0322-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wohl AR, Galvan FH, Myers HF, Garland W, George S, Witt M, Cadden J, Operskalski E, Jordan W, Carpio F. Social support, stress and social network characteristics among HIV-positive Latino and African American women and men who have sex with men. AIDS Behav 2010; 14:1149-58. [PMID: 20107888 DOI: 10.1007/s10461-010-9666-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Social support and stress have been poorly characterized for persons with HIV, particularly for racial/ethnic minorities. To address this gap, data on general and HIV-specific support and stress and social network characteristics were collected for 399 African American and Latino women and men who have sex with men (MSM) in Los Angeles County. African American (mean = 41; SD = 17) and Latina (mean = 40; SD = 19) women reported the highest general support. Stress was also highest for Latina women (mean = 18; SD = 11) and higher compared to Latino and African American MSM. African American and Latina women reported receiving most of their social support and stress from family members, while African American and Latino MSM received their support and stress from friends and providers. Finally, Latina and African American women disclosed their HIV status to more network members and received more HIV-specific support compared to MSM. Interventions are needed to help Latino and African American MSM enhance their support networks to manage a stigmatized illness.
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Affiliation(s)
- Amy Rock Wohl
- HIV Epidemiology Program, Los Angeles County Department of Public Health, Los Angeles, CA 90005, USA.
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Klauke B, Deckert J, Reif A, Pauli P, Domschke K. Life events in panic disorder-an update on "candidate stressors". Depress Anxiety 2010; 27:716-30. [PMID: 20112245 DOI: 10.1002/da.20667] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Studies on gene-environment interactions in mental disorders are characterized by powerful genetic techniques and well defined "candidate genes," whereas a definition of "candidate stressors," in most cases assessed in the form of life events (LEs), is inconsistent or not even provided. This review addresses this problem, with particular attention to the clinical phenotype of panic disorder (PD), by providing an overview and critical discussion for which life events are known to contribute to the etiology of the disease and how they may be conceptualized. There is converging evidence for a significant impact of cumulative as well as specific life events, such as threat, interpersonal and health-related events in adulthood, and abuse or loss/separation experiences in childhood, respectively, on the pathogenesis of panic disorder with some overlapping effect across the anxiety disorder spectrum as well as on comorbid major depression. Besides genetic vulnerability factors, personality and behavioral characteristics, such as anxiety sensitivity, neuroticism, and cognitive appraisal might moderate the influence of LEs on the development of panic disorder. The present state of knowledge regarding the specification and conceptualization of LEs in PD within a more complex multifactorial model, involving mediating and moderating factors in between genes and the clinical phenotype, is hoped to aid in informing future gene-environment interaction studies in panic disorder.
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Affiliation(s)
- Benedikt Klauke
- Department of Psychiatry and Psychotherapy, University of Muenster, Germany
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Charlson ME, Peterson JC, Syat BL, Briggs WM, Kline R, Dodd M, Murad V, Dionne W. Outcomes of community-based social service interventions in homebound elders. Int J Geriatr Psychiatry 2008; 23:427-32. [PMID: 17918183 DOI: 10.1002/gps.1898] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To document within-client change in function and quality of life over 6 months, and determine whether social service interventions, comorbidity, depressive symptoms, social support and stress are predictors of within-patient change. METHOD Assess homebound elderly referred for social services on depressive symptoms measured by the Geriatric Depression Scale (GDS), comorbidity with the Charlson Index, and stress and support with the Duke instrument. Function was measured by the Functional Autonomy Scale (FAS), measuring Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), mobility, communication and mental function. The SF-36 measured quality of life. RESULTS Among 56 new homebound clients with an average age of 82, 33% had depressive symptoms at baseline (>7 on the GDS). At baseline clients were at or below 25th percentile for five of eight domains of the SF-36, and mental and physical summary scores. Further at baseline, 90% had difficulties with mobility and IADLs; 61% had ADL limitations. At 6-month follow-up overall, 26% had depressive symptoms at follow-up. Greater comorbidity was associated with more depressive symptoms at both baseline and follow-up. By 6 months, 18% had deteriorated on the FAS, while 11% improved. More clients had changes in quality of life; regarding the physical component score, 13% had important deterioration, while 63% improved. Similarly, 33% declined on the mental component while 27% improved. CONCLUSION Among newly homebound elders, those with significant depressive symptoms are more likely to experience deterioration in function and quality of life over 6 months. However, those with more support showed significant improvement in the SF-36 mental component scale at 6 months.
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Affiliation(s)
- Mary E Charlson
- Center for Complementary and Integrative Medicine, Weill Cornell Medical College, New York, NY, USA.
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Hsiao KH, Nixon GM. The effect of treatment of obstructive sleep apnea on quality of life in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2008; 29:133-40. [PMID: 17331700 DOI: 10.1016/j.ridd.2007.01.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 01/24/2007] [Indexed: 05/14/2023]
Abstract
Benefits of treatment for obstructive sleep apnea (OSA) in children with cerebral palsy could differ from those in otherwise healthy children. We examined the effects of OSA treatment by comparing a group of children with cerebral palsy treated with adenotonsillectomy or continuous positive airway pressure (CPAP) by nasal mask with controls who had not received treatment. Parents completed a structured questionnaire assessing change in their child's quality of life (QOL) and OSA symptoms after treatment, or between 6 months ago and the present time for controls. Fifty-one children were eligible, of whom 19 (37%) completed questionnaires: treatment group, n=10 (adenotonsillectomy 7, CPAP 3); and controls, n=9. The treatment group showed an improvement in OSA symptoms compared to controls, especially sleep disturbance (p=0.005), daytime functioning (p=0.03) and caregiver concern (p=0.03). Parental QOL score improved by a mean of 18% in the treatment group (p=0.06 for a difference from controls). Treatment of OSA in children with cerebral palsy leads to significant benefit in some aspects of health and QOL.
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Affiliation(s)
- Kai Hsun Hsiao
- Department of Paediatrics, University of Auckland School of Medicine, Auckland, New Zealand
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Fortney JC, Pyne JM, Edlund MJ, Williams DK, Robinson DE, Mittal D, Henderson KL. A randomized trial of telemedicine-based collaborative care for depression. J Gen Intern Med 2007; 22:1086-93. [PMID: 17492326 PMCID: PMC2305730 DOI: 10.1007/s11606-007-0201-9] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 12/12/2006] [Accepted: 03/19/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists. OBJECTIVE The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists. DESIGN Matched sites were randomized to the intervention or usual care. PARTICIPANTS Small VA Community-based outpatient clinics with no on-site psychiatrists, but access to telepsychiatrists. In 2003-2004, 395 primary care patients with PHQ9 depression severity scores > or = 12 were enrolled, and followed for 12 months. Patients with serious mental illness and current substance dependence were excluded. MEASURES Medication adherence, treatment response, remission, health status, health-related quality of life, and treatment satisfaction. RESULTS The sample comprised mostly elderly, white, males with substantial physical and behavioral health comorbidity. At baseline, subjects had moderate depression severity (Hopkins Symptom Checklist, SCL-20 = 1.8), 3.7 prior depression episodes, and 67% had received prior depression treatment. Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 (odds ratio [OR] = 2.1, p = .04) and 12 months (OR = 2.7, p = .01). Intervention patients were more likely to respond by 6 months (OR = 2.0, p = .02), and remit by 12 months (OR = 2.4, p = .02). Intervention patients reported larger gains in mental health status and health-related quality of life, and reported higher satisfaction. CONCLUSIONS Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies.
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Affiliation(s)
- John C Fortney
- VA Health Services Research and Development, Center for Mental Healthcare and Outcomes Research (152/NLR), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114, USA.
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Abstract
BACKGROUND Evidence-based practices designed for large urban clinics are not necessarily portable into smaller isolated clinics. Implementing practice-based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists. OBJECTIVE The purpose of the Telemedicine Enhanced Antidepressant Management (TEAM) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists. DESIGN Matched sites were randomized to the intervention or usual care. PARTICIPANTS Small VA Community-based outpatient clinics with no on-site psychiatrists, but access to telepsychiatrists. In 2003-2004, 395 primary care patients with PHQ9 depression severity scores > or = 12 were enrolled, and followed for 12 months. Patients with serious mental illness and current substance dependence were excluded. MEASURES Medication adherence, treatment response, remission, health status, health-related quality of life, and treatment satisfaction. RESULTS The sample comprised mostly elderly, white, males with substantial physical and behavioral health comorbidity. At baseline, subjects had moderate depression severity (Hopkins Symptom Checklist, SCL-20 = 1.8), 3.7 prior depression episodes, and 67% had received prior depression treatment. Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 (odds ratio [OR] = 2.1, p = .04) and 12 months (OR = 2.7, p = .01). Intervention patients were more likely to respond by 6 months (OR = 2.0, p = .02), and remit by 12 months (OR = 2.4, p = .02). Intervention patients reported larger gains in mental health status and health-related quality of life, and reported higher satisfaction. CONCLUSIONS Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies.
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Ogedegbe G, Schoenthaler A, Richardson T, Lewis L, Belue R, Espinosa E, Spencer J, Allegrante JP, Charlson ME. An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design. Contemp Clin Trials 2006; 28:169-81. [PMID: 16765100 DOI: 10.1016/j.cct.2006.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 02/27/2006] [Accepted: 04/12/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension disproportionately affects African Americans compared to whites, and it is the single most common explanation for the disparity in mortality between African Americans and whites. Adherence with antihypertensive medications can help reduce risk of negative hypertension-related outcomes. Motivational interviewing is a promising patient-centered approach for improving adherence in patients with chronic diseases. In this paper we describe the rationale and design of an ongoing randomized controlled trial testing the effectiveness of motivational interviewing versus usual care in improving medication adherence among 190 African American uncontrolled hypertensive patients, who receive care in a primary care setting. METHODS The usual care group receives standard medical care, while those in the intervention group receive standard care plus four sessions of motivational interviewing at 3-month intervals for a period of 1 year. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. The primary outcome is adherence to prescribed antihypertensive medication, assessed with the electronic medication events monitoring system (MEMS) and the Morisky self-report adherence questionnaire. Secondary outcomes are within-patient changes in blood pressure, self-efficacy, and intrinsic motivation between baseline and 12 months. We report the baseline sociodemographic and clinical characteristics of the participants. CONCLUSIONS Despite the potential utility of motivational interviewing, little is known about its effectiveness in improving medication adherence among hypertensive patients, especially African Americans. In addition to the baseline data this study has generated, this trial should provide data with which we can assess the effectiveness of this approach as a behavioral intervention.
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Fortney JC, Pyne JM, Edlund MJ, Robinson DE, Mittal D, Henderson KL. Design and implementation of the telemedicine-enhanced antidepressant management study. Gen Hosp Psychiatry 2006; 28:18-26. [PMID: 16377361 DOI: 10.1016/j.genhosppsych.2005.07.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Revised: 07/05/2005] [Accepted: 07/07/2005] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Evidence-based practices designed for large urban clinics are not necessarily transportable into small rural practices. Implementing collaborative care for depression in small rural primary care clinics presents unique challenges because it is typically not feasible to employ on-site mental health specialists. The purpose of the Telemedicine-Enhanced Antidepressant Management (TEAM) study was to evaluate a collaborative care model adapted for small rural clinics using telemedicine technologies. The purpose of this paper is to describe the TEAM study design. METHOD The TEAM study was conducted in small rural Veterans Administration community-based outpatient clinics with interactive video equipment available for mental health, but no on-site psychiatrists/psychologists. The study attempted to enroll all patients whose depression could be appropriately treated in primary care. RESULTS The clinical characteristics of the 395 study participants differed significantly from most previous trials of collaborative care. At baseline, 41% were already receiving primary care depression treatment. Study participants averaged 5.5 chronic physical health illnesses and 56.5% had a comorbid anxiety disorder. Over half (57.2%) reported that pain impaired their functioning extremely or quite a bit. CONCLUSIONS Despite small patient populations in rural clinics, enough patients with depression can be successfully enrolled to evaluate telemedicine-based collaborative care.
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Affiliation(s)
- John C Fortney
- VA Health Services Research and Development, HSR&D, Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, 72114, USA.
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Sleath BL, Williams JW. Hispanic ethnicity, language, and depression: physician-patient communication and patient use of alternative treatments. Int J Psychiatry Med 2005; 34:235-46. [PMID: 15666958 DOI: 10.2190/vqu1-qywt-xw6y-4m14] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the relationship between Hispanic ethnicity and language spoken with physician communication about depression and patient use of alternative treatments for depression. METHOD This is a secondary data analysis from a trial of depression screening conducted in four primary care clinics. Patients with Hispanic or non-Hispanic White ethnic backgrounds and those meeting DSM-III-R criteria for current major depression, minor depression, dysthymia as well as those that screened positive on a depression screening instrument (n = 141) are included in this analysis. We labeled those who screened positive for depression but did not meet DSM-IIIR criteria for a current depressive disorder as "distressed." Clinicians' use of counseling and patient use of alternative treatments were based on patient self-report. RESULTS Forty-two percent (n = 59) of the sample stated that their physician had either told them that they had depression, treated them for depression, or recommended that they seek help for depression. Over 40% of patients spent time talking with their physicians at their current visit about what was making them depressed and 34% received counseling about depression. Hispanic ethnicity and language were not significantly related to physician communication with patients about how to overcome depression. Thirty-six percent of patients reported talking with a minister or other religious person about feelings of depression or sadness. Seventeen percent of patients had used herbal remedies or non-prescription medications and 5% had seen a curandero for feelings of depression or sadness. Hispanic ethnicity and language were not significantly related to patient use of alternative treatments for depression. CONCLUSIONS Hispanic ethnicity and language were not significantly related to physician-patient communication about depression or patient use of alternative treatments for depression. Physicians should make sure to ask patients about all of the types of things they are doing to help overcome their depression.
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Affiliation(s)
- Betsy L Sleath
- University of North Carolina at Chapel Hill, Center for Health Services Research, NC 27599-3386, USA.
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Jee SH, Davis MM. Factors associated with variations in parental social support in primary care pediatric settings. ACTA ACUST UNITED AC 2004; 4:316-22. [PMID: 15264948 DOI: 10.1367/a03-054r2.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine social support (SS) among parents across sociodemographically distinct pediatric outpatient settings. METHODS We conducted a cross-sectional, self-administered, anonymous parent survey in 3 primary care sites in a Midwestern metropolitan area: inner-city health center, urban group practice, and suburban group practice. Participants were parents of children aged 6 weeks to 36 months. The main outcome measure was overall SS as measured by a previously validated 10-item instrument. Multivariate linear regression modeling was used to examine sociodemographic and health factors associated with overall SS scores. RESULTS The study sample included 463 parents. The strongest sources of SS were a significant other or spouse and parent's parent or grandparent. The range for overall SS was 0 to 20, with a mean score of 12.1 (SD, +/-4.2). Parents with overall SS in the lowest quartile (n = 123) comprised 43% of parents at the inner-city health center compared with 23% of parents at the urban practice and 16% of parents at the suburban practice. In a multivariate model, factors associated with lower overall SS were race other than white or black, single or cohabiting marital status, poorer parental health, and parental depressive symptoms. CONCLUSIONS Although parental SS was lowest in the most socioeconomically disadvantaged community in this sample, parents in all 3 communities had widely varying levels of support. Providers may gain insights about parents at increased risk for low SS by asking about parents' own physical and mental health.
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Affiliation(s)
- Sandra H Jee
- Division of General Pediatrics and Institute for Social Research, University of Michigan, Ann Arbor, 48106-1248, USA.
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Abstract
OBJECTIVES The objectives of the study were to identify the characteristics of a problematic doctor-patient relationship from the perspective of primary care patients who are cared for by medical residents and to determine whether patients' perception of the relationship is a function of their demographic, clinical, or social attributes. DESIGN Cross-sectional survey. SETTING An adult primary care practice in an academic medical center. PATIENTS One hundred fifty-one patients whose primary care physicians were senior internal medicine residents. MEASUREMENTS AND MAIN RESULTS Patients completed a questionnaire addressing several aspects of their doctor-patient relationship, the general health perception item on the SF-12, and items on social support from the Duke Social Support and Stress Scale. By design of the study, approximately half of the patients had been identified by their physicians as being in problematic relationships (n = 74) and half as being in satisfying relationships (n = 77). Among patients in relationships described as satisfying by their resident, 10% viewed the relationship as problematic. Of the patients involved in relationships described as problematic by the resident, 23% viewed their relationship as problematic (P = .03). Patients who rated the relationship as problematic were much more likely to also report low social support compared to patients involved in relationships described as satisfying (76% vs 16%; P < .001). Compared to residents involved in relationships described as satisfying by their patients, residents in problematic relationships were more likely to be described as being less accessible and less capable of handling medical complaints (P < . 001). CONCLUSIONS Patients were more likely to describe the doctor-patient relationship as problematic if they felt that the resident was less accessible or less capable of handling medical complaints, or if they had low self-perceived social support.
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Affiliation(s)
- C Boutin-Foster
- Department of Medicine, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Parkerson GR, Gutman RA. Perceived mental health and disablement of primary care and end-stage renal disease patients. Int J Psychiatry Med 2001; 27:33-45. [PMID: 9565712 DOI: 10.2190/pwup-ab1n-2ypl-kdg8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare perceived current mental health and disablement between primary care and end-stage renal disease (ESRD) patients, and to study social support and stress and severity of illness as possible determinants of mental health and disablement. METHOD Observational cross-sectional analysis of 414 primary care patients in a rural community health center and 125 ESRD patients requiring hemodialysis in two community dialysis units. The Duke Health Profile (DUKE) anxiety-depression scale was used to assess mental health; the DUKE disability scale, to indicate disablement; the Duke Social Support and Stress Scale, to measure support and stress; and the Duke Severity of Illness Scale, to rate severity of illness. RESULTS Perceived current mental health in terms of anxiety and depression symptoms was worse for primary care than for ESRD patients, and perceived current disablement was no different for the two groups. Patients' perception of their health status and of stress from family members were more closely associated with their level of anxiety and depression symptoms than were their diagnostic profiles or overall severity of illness. In turn, their level of anxiety and depression symptoms was the principal correlate of their disablement. CONCLUSIONS The demonstration of strong relationships among anxiety and depression symptoms, disablement, and family stress in these two very different patient populations should stimulate further research and motivate clinicians to evaluate all three parameters as part of routine patient care.
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Affiliation(s)
- G R Parkerson
- Duke University Medical Center, Durham, North Carolina, USA
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Cheever KH, Hardin SB. Effects of traumatic events, social support, and self-efficacy on adolescents' self-health assessments. West J Nurs Res 1999; 21:673-84. [PMID: 11512186 DOI: 10.1177/01939459922044117] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the relationship between adolescents' exposure to traumatic events and their self-health assessments, and to examine the protective effects of social support and self-efficacy on this relationship. Survey results (N = 1,427) indicated that experiencing violent and nonviolent negative life events and being exposed to a disaster were inversely associated with adolescents' positive health assessments. As social support and self-efficacy decreased, adolescents' health assessments worsened. Female and Black adolescents had less favorable health assessments than their male and White counterparts. Findings suggest that traumatic events are predictive of adolescents' health assessments and that social support and self-efficacy prevent adolescents' health assessments from declining following traumatic events.
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Affiliation(s)
- K H Cheever
- Allentown College of St. Francis deSales, Center Valley, PA, USA
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Abstract
BACKGROUND Prior investigations have demonstrated a link between quality of life (QOL) deficits and depression. This report elaborates on prior investigations findings by implementation of formal assignment of the diagnosis of depression and a hierarchical approach to assessment of QOL. METHODS A masters or doctoral level mental health clinician used the SCID to confirm a diagnosis of major depression in ninety psychiatric inpatients. Function was assessed with the PSMS (a measure of ADL), the IADL scale, and the "daily living and role functioning" and the "relation to self and others" subscales of the Basis-32. RESULTS Patient age and severity of depression were the most consistent predictors of QOL deficits, although the direction of the age-effect on QOL depended on the specific measure of QOL. Increasing severity of depression was consistently associated with worse QOL, and remained significant after adjusting for age. LIMITATIONS The cross-sectional method of this study limits the inference of causality between depression severity and poor QOL. CONCLUSIONS QOL deficits in acutely depressed hospitalized patients occur at multiple strata in the hierarchy of behavior and are most consistently influenced by age and severity of depression. The effect of age on QOL in depressed inpatients is complex, and age is not uniformly associated with poor QOL.
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Affiliation(s)
- W V McCall
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Wood RL, Worthington AD. Outcome in Community Rehabilitation: Measuring the Social Impact of Disability. Neuropsychol Rehabil 1999. [DOI: 10.1080/096020199389554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Barrett JE, Williams JW, Oxman TE, Katon W, Frank E, Hegel MT, Sullivan M, Schulberg HC. The treatment effectiveness project. A comparison of the effectiveness of paroxetine, problem-solving therapy, and placebo in the treatment of minor depression and dysthymia in primary care patients: background and research plan. Gen Hosp Psychiatry 1999; 21:260-73. [PMID: 10514950 DOI: 10.1016/s0163-8343(99)00023-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This report describes the background, rationale, and research plan for a comparative treatment trial of the effectiveness of paroxetine, problem-solving therapy (PST-PC), and placebo in the treatment of minor depression and dysthymia in primary care patients. Patients were recruited from a variety of primary care practice settings in four separate geographic locations (Hanover, New Hampshire; Pittsburgh, Pennsylvania, San Antonio, Texas; and Seattle, Washington). Patients were randomly assigned to each of the three intervention conditions the medication/placebo conditions were double-blinded. The treatment trial was 11 weeks, with independent assessments of patient clinical status at baseline, 6 weeks, and 11 weeks. There was a follow-up at 25 weeks. Since there are relatively few placebo-controlled trials in primary care settings on patients with these disorders, the background of this project and a description of it are presented at this time, prior to the availability of outcome data, to provide methodological detail and to increase awareness in the research community of this treatment trial, with results to appear subsequently.
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Affiliation(s)
- J E Barrett
- Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755, USA
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Williams JW, Mulrow CD, Kroenke K, Dhanda R, Badgett RG, Omori D, Lee S. Case-finding for depression in primary care: a randomized trial. Am J Med 1999; 106:36-43. [PMID: 10320115 DOI: 10.1016/s0002-9343(98)00371-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Depression is a highly prevalent, morbid, and costly illness that is often unrecognized and inadequately treated. Because depression questionnaires have the potential to improve recognition, we evaluated the accuracy and effects on primary care of two case-finding instruments compared to usual care. SUBJECTS AND METHODS The study was conducted at three university-affiliated and one community-based medical clinics. Consecutive patients were randomly assigned to be asked a single question about mood, to fill out the 20-item Center for Epidemiologic Studies Depression Screen, or to usual care. Within 72 hours, patients were assessed for Diagnostic and Statistical Manual of Mental Disorders Third Revised Edition (DSM-III-R) disorders by an assessor blinded to the screening results. Process of care was assessed using chart audit and administrative databases; patient and physician satisfaction was assessed using Likert scales. At 3 months, depressed patients and a random sample of nondepressed patients were re-assessed for DSM-III-R disorders and symptom counts. RESULTS We approached 1,083 patients, of whom 969 consented to screening and were assigned to the single question (n = 330), 20-item questionnaire (n = 323), or usual care (n = 316). The interview for DSM-III-R diagnosis was completed in 863 (89%) patients; major depression, dysthymia, or minor depression was present in 13%. Both instruments were sensitive, but the 20-item questionnaire was more specific than the single question (75% vs 66%, P = 0.03). The 20-item questionnaire was less likely to be self-administered (54% vs 90%) and took significantly more time to complete (15 vs 248 seconds). Case-finding with the 20-item questionnaire or single question modestly increased depression recognition, 30/77 (39%) compared with 11/38 (29%) in usual care (P = 0.31) but did not affect treatment (45% vs 43%, P = 0.88). Effects on DSM-III-R symptoms were mixed. Recovery from depression was more likely in the case-finding than usual care groups, 32/67 (48%) versus 8/30 (27%, P = 0.03), but the mean improvement in depression symptoms did not differ significantly (1.6 vs 1.5 symptoms, P = 0.21). CONCLUSIONS A simple question about depression has similar performance characteristics as a longer 20-item questionnaire and is more feasible because of its brevity. Case-finding leads to a modest increase in recognition rates, but does not have consistently positive effects on patient outcomes.
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Affiliation(s)
- J W Williams
- San Antonio Veterans Health Services Research Field Program, and Division of General Internal Medicine, University of Texas Health Science Center, USA
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Koenig HG. Differences in psychosocial and health correlates of major and minor depression in medically ill older adults. J Am Geriatr Soc 1997; 45:1487-95. [PMID: 9400559 DOI: 10.1111/j.1532-5415.1997.tb03200.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the differences in correlates of different levels of depression in medically ill hospitalized older adults. DESIGN, SETTING, AND PARTICIPANTS A consecutive series of 542 patients aged 60 or older admitted to the medical inpatient services of Duke Hospital underwent a structured psychiatric evaluation administered by a psychiatrist. MEASUREMENT A wide range of demographic, social, psychiatric, and physical health data were collected, and associations with major and minor depression were assessed. RESULTS Compared with patients without depression, those with major depression were more likely to have a history of prior episodes of depression, higher dysfunctional attitude scores, greater overall severity of medical illness, cognitive impairment, and symptoms of pain or other somatic complaints. Specific medical diagnosis was less important a predictor of major depression than overall severity of medical illness. Compared with patients without depression, those with minor depression were more likely to report non-health-related stressors during the year before hospital admission, have a diagnosis of immune system disorder, and have greater severity of medical illness. When major and minor depression were compared directly, on the other hand, no significant differences were observed except for history of depression, and that relationship was weak and present only when the etiologic approach to diagnosis was used. CONCLUSION During hospital admission, certain psychosocial, psychiatric, and physical health characteristics of older medical patients place them at high risk for different levels of depression. Patients with major and minor depression resemble each other more than they do patients without depression. These findings may help clinicians better understand the causes of different types of depression in this setting and lead to improved diagnosis and treatment.
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Affiliation(s)
- H G Koenig
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA
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47
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Parkerson GR, Michener JL, Yarnall KS, Hammond WE. Duke Case-Mix System (DUMIX) for ambulatory health care. J Clin Epidemiol 1997; 50:1385-94. [PMID: 9449942 DOI: 10.1016/s0895-4356(97)00217-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Duke Case-Mix System (DUMIX), which combines age, gender, patient-reported perceived and physical health status, and provider-reported or auditor-reported severity of illness to classify patients by their risk of high future utilization, explained 17.1% of the variance in future clinic charges and 16.6% of the variance in return visits. When a random half of 413 ambulatory adults were classified into four risk classes by predictive regression coefficients from the other half, there was a stepwise increase in actual future utilization by risk class. The most accurate classification was for Class 4 (highest risk) patients, with a sensitivity of 40.8%, specificity of 82.1%, and likelihood ratio of 2.3. These 23.7% of patients accounted for 44.2% of charges for all patients. When predictive coefficients from this population were used to classify a different group of 206 ambulatory adults, past utilization also increased in stepwise order by case-mix class.
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Affiliation(s)
- G R Parkerson
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA
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48
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Gentili A, Weiner DK, Kuchibhatil M, Edinger JD. Factors that disturb sleep in nursing home residents. AGING (MILAN, ITALY) 1997; 9:207-13. [PMID: 9258380 DOI: 10.1007/bf03340151] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this cross-sectional survey was to examine subjective sleep quality, and identify factors that disturb sleep in cognitively intact nursing home (NH) residents. We interviewed 51 cognitively intact NH residents using a validated instrument, the Pittsburgh Sleep Quality Index (PSQI). Questions regarding the environment, symptoms suggestive of restless leg syndrome, and periodic leg movements were also asked. Three individuals were unable to answer all the questions and, therefore, analyses were performed on 48 subjects. Seventy-three percent of the subjects were identified as "poor" sleepers based upon a total PSQI score > 5. Factors that disturbed the residents' sleep three or more times a week were: nocturia (71%), environment-related noise or light (38%), pain (33%), feeling too hot (6%) and leg cramps (6%). On multiple regression analysis, poor sleep correlated with depressive symptoms and comorbidity, not with age or gender. Poor sleep quality is common among cognitively intact NH residents. In our study, nocturia, environmental factors and pain were the most commonly perceived causes of sleep disturbance. Poor sleep independently correlated with depressive symptoms and comorbidity. These findings should be kept in mind when evaluating sleep complaints in the nursing home.
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Affiliation(s)
- A Gentili
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
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49
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Abstract
Forty-seven mothers and 33 fathers, representing 48 families, participated in a propective longitudinal study of the effects on family members of a child's dying. The purpose of this article is to describe parents' health during the terminal illness of their child and during the first year following their child's death from cancer. The Duke-UNC Health Profile was used to examine parents' health prior to and at three points in thime after the child's death. The bereavedparents' general health was compared to the health of normative sample of adults. The findings indicate that parents' health is not adversely affected by a child's death from cancer.
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Affiliation(s)
- L K Birenbaum
- Walther Cancer Institute and Indiana University School of Nursing, Indianapolis, USA
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50
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Parkerson GR, Broadhead WE, Tse CK. Anxiety and depressive symptom identification using the Duke Health Profile. J Clin Epidemiol 1996; 49:85-93. [PMID: 8598516 DOI: 10.1016/0895-4356(95)00037-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Duke Health Profile (DUKE) subscales were compared for their ability to identify anxiety and depressive symptoms as measured by the State Anxiety Inventory (SAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) in 413 primary care patients. The seven-item Duke Anxiety-Depression Scale (DUKE-AD) was the best symptom identifier, with sensitivities and specificities greater than 70% for high scores on both the SAI and CES-D. Also, baseline DUKE-AD scores predicted five clinical outcomes during an 18-month follow-up period, with receiver operating characteristic (ROC) curve areas ranging from 57.1 to 58.7%. Patients shown by DUKE-AD scores to be at high risk (>30, scale 0-100) for symptoms of anxiety and/or depression were more often women, less well-educated, not working, and with lower socioeconomic status. The severity of illness was higher than that of low-risk patients. Although the providers did not know which patients were at high risk, they made a clinical diagnosis of anxiety or depression more often in high-risk patients.
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Affiliation(s)
- G R Parkerson
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina, USA
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