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Greszta E, Siemińska MJ. Patient-perceived changes in the system of values after cancer diagnosis. J Clin Psychol Med Settings 2011; 18:55-64. [PMID: 21373853 PMCID: PMC3058334 DOI: 10.1007/s10880-011-9221-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A cross-sectional study investigated changes in patients’ value systems following a diagnosis of cancer. Fifty patients at 1 to 6 months following cancer diagnosis, were asked to compare their current values with their recollection of past values. Using the Rokeach Value Survey we obtained statistically significant results showing that twenty-seven out of thirty-six values changed their importance from the patients’ perspective: 16 values significantly increased, while 11 values significantly decreased in importance. Changes with respect to nine values were insignificant. We indentified clusters of values increasing in importance the most: Religious morality (Salvation, Forgiving, Helpful, Clean), Personal orientation (Self-Respect, True Friendship, Happiness), Self-constriction (Self-Controlled, Obedient, Honest), Family security (Family Security, Responsible), and Delayed gratification (Wisdom, Inner Harmony). We also observed that the following value clusters decreased in importance: Immediate gratification (An Exciting Life, Pleasure, A Comfortable Life); Self-expansion (Capable, Ambitious, Broadminded), Competence (A Sense of Accomplishment, Imaginative, Intellectual). The remaining values belonged to clusters that as a group changed slightly or not at all. Practical implications of the study are discussed.
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Affiliation(s)
- Elżbieta Greszta
- Helena Chodkowska University of Management and Law, Warsaw, Poland.
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2
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Blomberg BB, Alvarez JP, Diaz A, Romero MG, Lechner S, Carver CS, Holly H, Antoni MH. Psychosocial adaptation and cellular immunity in breast cancer patients in the weeks after surgery: An exploratory study. J Psychosom Res 2009; 67:369-76. [PMID: 19837199 PMCID: PMC2764537 DOI: 10.1016/j.jpsychores.2009.05.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 03/25/2009] [Accepted: 05/27/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND The period just after surgery for breast cancer requires psychosocial adaptation and is associated with elevated distress. Distress states have been associated with decreased cellular immune functioning in this population, which could have negative effects on physical recovery. However, little is known about relations between psychological status [negative and positive mood states and overall quality of life (QOL)] and cellular signaling cytokines that could account for these associations in women undergoing treatment for breast cancer. METHODS The present study examined associations between psychological adaptation indicators (mood, QOL) and T-helper cell type 1 (Th1) cytokine production from stimulated peripheral mononuclear cells in women who had recently undergone surgery for early-stage breast cancer but had not yet begun adjuvant therapy. These associations were evaluated while controlling for relevant disease/treatment, sociodemographic, and health behavior covariates. RESULTS Lower anxiety related to greater production of the Th1 cytokine interleukin-2 (IL-2), while greater positive mood (affection) related to greater production of the Th1 cytokines IL-12 and interferon-gamma (IFN-gamma). Better QOL related to greater production of the Th1 cytokine, tumor necrosis factor-alpha (TNF-alpha). CONCLUSION Individual differences in psychosocial adaptation in women with breast cancer during the period after surgery relate to biological parameters that may be relevant for health and well-being as they move through treatment.
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Affiliation(s)
- Bonnie B. Blomberg
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, P.O. Box 016960 (R-138), Miami, FL 33101, USA, Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan P. Alvarez
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, P.O. Box 016960 (R-138), Miami, FL 33101, USA
| | - Alain Diaz
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, P.O. Box 016960 (R-138), Miami, FL 33101, USA
| | - Maria G. Romero
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, P.O. Box 016960 (R-138), Miami, FL 33101, USA
| | - Suzanne Lechner
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124, USA
| | - Charles S. Carver
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124, USA
| | - Heather Holly
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124, USA
| | - Michael H. Antoni
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124, USA, Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA,Correspondence: Corresponding Author: Michael H. Antoni, Ph.D., Department of Psychology, University of Miami, 5665 Ponce DeLeon Blvd, RM 413, Coral Gables, FL. 33124
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Shoma AM, Mohamed MH, Nouman N, Amin M, Ibrahim IM, Tobar SS, Gaffar HE, Aboelez WF, Ali SE, William SG. Body image disturbance and surgical decision making in egyptian post menopausal breast cancer patients. World J Surg Oncol 2009; 7:66. [PMID: 19678927 PMCID: PMC2739851 DOI: 10.1186/1477-7819-7-66] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 08/13/2009] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In most developing countries, as in Egypt; postmenopausal breast cancer cases are offered a radical form of surgery relying on their unawareness of the subsequent body image disturbance. This study aimed at evaluating the effect of breast cancer surgical choice; Breast Conservative Therapy (BCT) versus Modified Radical Mastectomy (MRM); on body image perception among Egyptian postmenopausal cases. METHODS One hundred postmenopausal women with breast cancer were divided into 2 groups, one group underwent BCT and the other underwent MRM. Pre- and post-operative assessments of body image distress were done using four scales; Breast Impact of Treatment Scale (BITS), Impact of Event Scale (IES), Situational Discomfort Scale (SDS), and Body Satisfaction Scale (BSS). RESULTS Preoperative assessment showed no statistical significant difference regarding cognitive, affective, behavioral and evaluative components of body image between both studied groups. While in postoperative assessment, women in MRM group showed higher levels of body image distress among cognitive, affective and behavioral aspects. CONCLUSION Body image is an important factor for postmenopausal women with breast cancer in developing countries where that concept is widely ignored. We should not deprive those cases from their right of less mutilating option of treatment as BCT.
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Affiliation(s)
| | | | | | - Mahmoud Amin
- Surgery Department, Mansoura University Hospital, Egypt
| | | | - Salwa S Tobar
- Psychiatric Department, Mansoura University Hospital, Egypt
| | - Hanan E Gaffar
- Psychiatric Department, Mansoura University Hospital, Egypt
| | | | - Salwa E Ali
- Medical Surgical Department, Alexandria Faculty of Nursing, Egypt
| | - Soheir G William
- Medical Surgical Department, Alexandria Faculty of Nursing, Egypt
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Chapter 5.5 Stress hormones and anxiety disorders. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1569-7339(07)00021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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5
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Nicholson RM, Leinster S, Sassoon EM. A comparison of the cosmetic and psychological outcome of breast reconstruction, breast conserving surgery and mastectomy without reconstruction. Breast 2007; 16:396-410. [PMID: 17368026 DOI: 10.1016/j.breast.2007.01.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 01/03/2007] [Accepted: 01/24/2007] [Indexed: 11/19/2022] Open
Abstract
METHOD The cosmetic and psychological outcomes of patients who underwent reconstructive surgery, conservative surgery or simple mastectomy for breast cancer between 1995 and 2002 were compared. RESULTS There was a significant correlation between good psychological adjustment and good cosmetic outcome scores (p=0.01-0.05). There was no difference in cosmetic outcome between different reconstruction methods. Reconstruction patients rated their cosmetic outcome better than conservative surgery patients, and conservative surgery patients better than mastectomy patients. There were no differences in psychological outcome between patient groups. CONCLUSION Good perception of cosmetic outcome is associated with good psychological adjustment. There is no cosmetic advantage of one type of reconstruction over another. Reconstruction patients have a better body image compared with other treatment groups but there are no other psychological advantages of one type of treatment over another.
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Urcuyo KR, Boyers AE, Carver CS, Antoni MH. Finding benefit in breast cancer: Relations with personality, coping, and concurrent well-being. Psychol Health 2005. [DOI: 10.1080/08870440512331317634] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Figueiredo MI, Cullen J, Hwang YT, Rowland JH, Mandelblatt JS. Breast Cancer Treatment in Older Women: Does Getting What You Want Improve Your Long-Term Body Image and Mental Health? J Clin Oncol 2004; 22:4002-9. [PMID: 15459224 DOI: 10.1200/jco.2004.07.030] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Little is known about the impact of surgical treatment on body image and health outcomes in older breast cancer patients. The purpose of this article is to evaluate whether concordance between treatment received and treatment preferences predicts posttreatment body image and whether body image, in turn, affects mental health in older women with breast cancer 2 years after treatment. Patients and Methods A longitudinal cohort of 563 women who were 67 years old or older and who had stages I and II breast cancer were surveyed by telephone at 3, 12, and 24 months after surgery. All women were clinically eligible for breast conservation. Body image was measured using questions adapted from the Cancer Rehabilitation Evaluation System–Short Form, and mental health was evaluated using a Medical Outcomes Study subscale. Results Body image was an important factor in treatment decisions for 31% of women. Women who received breast conservation had better body image 2 years after treatment than women who had mastectomies (P < .0001). Women who preferred breast conservation but received mastectomy had the poorest body image. Using generalized estimating equations, we found that body image, in turn, predicted 2-year mental health. Conclusion Body image is important for many older women, and receiving treatment consistent with preferences about appearance was important in long-term mental health outcomes. Health professionals should elicit preferences about appearance from women and provide treatment choices in concordance with these preferences. Enhancing shared decision making has the potential to improve mental health in older breast cancer survivors.
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Affiliation(s)
- Melissa I Figueiredo
- Department of Oncology, Cancer Control Program, Lombardi Cancer Center, Georgetown University Medical Center, 2233 Wisconsin Ave, Ste 317, Washington, DC 20007, USA
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Auerbach SM. Should patients have control over their own health care?: empirical evidence and research issues. Ann Behav Med 2001; 22:246-59. [PMID: 11126470 DOI: 10.1007/bf02895120] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Available research indicates that purported patient insufficiencies in ability to process information and make rational and reliable decisions have likely been overestimated. Furthermore, data indicate that nonscientific factors often play a role in physician decision-making and that physicians may not value different health outcomes in the same way as patients. Though the data on patient cognitive functioning are limited because of heavy reliance on patient responses in hypothetical versus actual decision-making situations, these findings lend credence to arguments that patients should have increased control over their own health care. Research on the effects of interventions designed to enhance patient control indicates that: (a) patients generally respond positively to increased information, but few studies have evaluated the effects of information as a precursor to decision-making; (b) the few studies using simple behavioral control interventions have shown generally positive effects on a range of patient outcomes; and (c) studies of decisional control (with breast cancer patients) have had experimental confounds which prohibit conclusions regarding effectiveness. Areas in greatest need of research include: (a) further exploration of the utility of noninvasive behavioral control interventions in different settings; (b) measuring the impact of control manipulations on patient perception of control as well as patient control-related behaviors; (c) matching patient differences in desire for control to experimental conditions and to physician differences in receptiveness to patient control; and (d) clinical trials in which patients facing critical decisions in trade-off situations are actually given a choice.
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Affiliation(s)
- S M Auerbach
- Department of Psychology, Box 842018, Virginia Commonwealth University, Richmond, VA 23284-2018, USA
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Antoni MH, Lehman JM, Kilbourn KM, Boyers AE, Culver JL, Alferi SM, Yount SE, McGregor BA, Arena PL, Harris SD, Price AA, Carver CS. Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychol 2001; 20:20-32. [PMID: 11199062 DOI: 10.1037/0278-6133.20.1.20] [Citation(s) in RCA: 596] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors tested effects of a 10-week group cognitive-behavioral stress management intervention among 100 women newly treated for Stage 0-II breast cancer. The intervention reduced prevalence of moderate depression (which remained relatively stable in the control condition) but did not affect other measures of emotional distress. The intervention also increased participants' reports that having breast cancer had made positive contributions to their lives, and it increased generalized optimism. Both remained significantly elevated at a 3-month follow-up of the intervention. Further analysis revealed that the intervention had its greatest impact on these 2 variables among women who were lowest in optimism at baseline. Discussion centers on the importance of examining positive responses to traumatic events--growth, appreciation of life, shift in priorities, and positive affect-as well as negative responses.
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Affiliation(s)
- M H Antoni
- Department of Psychology, University of Miami, Coral Gables, Florida 33124-2070, USA.
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de Leeuw JR, de Graeff A, Ros WJ, Blijham GH, Hordijk GJ, Winnubst JA. Prediction of depressive symptomatology after treatment of head and neck cancer: the influence of pre-treatment physical and depressive symptoms, coping, and social support. Head Neck 2000; 22:799-807. [PMID: 11084641 DOI: 10.1002/1097-0347(200012)22:8<799::aid-hed9>3.0.co;2-e] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Head and neck cancer and its treatment can have important psychosocial implications, and many patients become depressed. The aim of this prospective study is to examine whether pretreatment variables can be used to predict depression 6 and 12 months later. METHODS Head and neck cancer patients (155) treated with surgery and/or radiotherapy completed a questionnaire including items on social support, coping, depressive symptoms, physical functioning, and physical symptoms before and after treatment. RESULTS By using 5 variables (physical symptoms, depressive symptoms, emotional support, extent of the social network, and avoidance coping), it was possible to predict those patients who would have symptoms at 6 (81%) and 12 months (67%) after treatment. Inclusion of actual physical symptoms reported at follow-up increased these percentages to 89% and 82%. CONCLUSIONS It is concluded that screening for psychosocial variables and physical symptoms before treatment can be used to determine which patients are at risk of developing depressive symptoms after treatment.
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Affiliation(s)
- J R de Leeuw
- Research Group Psychology of Health and Illness, Faculty of Medicine, University Medical Center, P.O. Box 80036, 3508 TA, Utrecht, The Netherlands
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11
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Hanson Frost M, Suman VJ, Rummans TA, Dose AM, Taylor M, Novotny P, Johnson R, Evans RE. Physical, psychological and social well-being of women with breast cancer: the influence of disease phase. Psychooncology 2000; 9:221-31. [PMID: 10871718 DOI: 10.1002/1099-1611(200005/06)9:3<221::aid-pon456>3.0.co;2-t] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While research exists on the well-being of women during a specific phase of breast cancer, little research exists in which researchers utilized the same instruments to examine differences in women's well-being, based on the phase of their breast cancer. Using a trajectory framework, the purpose of this study is to examine the differences in the physical and social well-being of women during the following breast cancer states: newly diagnosed, adjuvant therapy, stable disease and recurrent disease. The convenience sample consisted of 35 women newly diagnosed with breast cancer, 52 women with breast cancer undergoing adjuvant therapy, 84 women whose breast cancer was considered stable and 64 women with recurrent breast cancer. Participants completed a packet of questionnaires which contained a demographic questionnaire, Short Form-36 (SF-36) Health Survey, a researcher designed (RD) questionnaire, Cancer Rehabilitation Evaluation System-Short Form (CARES-SF) and the Brief Symptom Inventory (BSI). Descriptive statistics, analysis of variance, and general linear F-tests were used to analyze the data. Differences were found across phases of disease on various subscales, including those representing perceived health states, overall impact, medical interactions, physical function, role function, fatigue, pain, social function and satisfaction with health. No significant differences were found between groups on the BSI subscales with the exception of somatization, global psychosocial measures, sexual and marital relation subscales. While individuals with recurrent disease often experienced more difficulties with their well-being than women in the other groups, women newly diagnosed and in the adjuvant group experienced more difficulties in select areas of well-being when compared with women in the stable group. Health care professionals need to recognize differences between groups to better meet the needs of patients with a breast cancer diagnosis.
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Affiliation(s)
- M Hanson Frost
- Division of Medical Oncology, Mayo Foundation, Rochester, MN, USA.
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12
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Charavel M, Brémond A, Courtial I. Psychosocial profile of women seeking breast reconstruction. Eur J Obstet Gynecol Reprod Biol 1997; 74:31-5. [PMID: 9243198 DOI: 10.1016/s0301-2115(96)02675-9] [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: 02/04/2023]
Abstract
As opposed to studies focused on the role of reconstruction in the rehabilitation of cancer patients, the aim of this study is to define what kind of women undergo post-mastectomy reconstruction. The social, cultural and psychological variables influencing women in this choice were assessed using a questionnaire administered to 45 women who had breast reconstruction and 51 who did not. An univariate analysis shows significant differences between the two groups regarding age, education, socioeconomic status, leisure activities, sexual intercourse, information about breast reconstruction and fear of recurrence. These results show that social status is a deciding factor in a woman's access to information about reconstruction. If every women undergoing mastectomy is to be given the opportunity of plastic surgery, we think that information must be adapted to psychosocial profile.
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Affiliation(s)
- M Charavel
- Hopital E. Herriot, Fédération Femme Mère Nouveau-Né, Lyon, France
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Street RL, Voigt B. Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Making 1997; 17:298-306. [PMID: 9219190 DOI: 10.1177/0272989x9701700306] [Citation(s) in RCA: 208] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This investigation of patients with early breast cancer examined relationships among patient involvement in deciding treatment (i.e., whether to undergo breast removal or breast conservation), perceptions of control over treatment decisions, and subsequent health-related quality of life. It was predicted 1) that patients who more actively participated in consultations to decide treatment would perceive more decision control than would more passive patients and 2) that patients who perceived greater decision control would report better health-related quality of life following treatment than would patients perceiving less decision control. Sixty patients with stage I or II breast cancer allowed their consultations with surgeons to be audiorecorded. Following these visits, patients reported on their involvement in the consultation, optimism for the future, knowledge about treatment, and two aspects of perceived decision control, the perception of having a choice for treatment and the extent to which the doctor or patient was responsible for the decision. Six and 12 months postoperatively, 51 patients (85%) returned a follow-up survey assessing perceived decision control and health-related quality of life. The first prediction received some support. The patients who had more actively participated in their consultations, particularly in terms of offering opinions, assumed more responsibility for treatment decisions during the year following surgery than did less expressive patients. Also, the patients who reported more involvement in their consultations later believed they had had more of a choice for treatment. The second hypothesis was partially supported. Six and 12 months following treatment, the patients who believed they were more responsible for treatment decisions and believed they had more choice of treatment reported higher levels of quality of life than did the patients who perceived themselves to have less decision control. However, perceived control at the time of treatment did not predict later quality of life. Theoretical and clinical implications are discussed.
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Affiliation(s)
- R L Street
- Department of Speech Communication, Texas A&M University, College Station 77843-4234, USA.
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Spielvogel AM, Dickstein LJ, Robinson GE. A Psychiatric Residency Curriculum About Gender and Women's Issues. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 1995; 19:187-201. [PMID: 24435609 DOI: 10.1007/bf03341545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Over the last 30 years, major advances have been made in our understanding of how bio-logical factors and sociocultural influences contribute to gender differences, gender identity formation, and gendered role behavior. Sensitivity to the psychological effects of changing family structure and workforce composition, the contribution of reproductive events, and the high rates of exposure to trauma in women is essential for optimal psychiatric assessment and treatment planning. This knowledge has not been systematically integrated into residency training. The authors present an outline for a curriculum in gender and women's issues, including educational objectives, learning experiences through which residents could meet these objectives, and recommended readings. The authors also discuss potential obstacles and suggest helpful strategies for implementing the proposed curriculum.
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Affiliation(s)
- A M Spielvogel
- Department of Psychiatry, University of California, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA, 94110, USA
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Affiliation(s)
- D R Powell
- New York Medical College, Metropolitan Hospital Center, New York 10029, USA
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Brown GW, Harris TO, Eales MJ. Aetiology of anxiety and depressive disorders in an inner-city population. 2. Comorbidity and adversity. Psychol Med 1993; 23:155-165. [PMID: 8475203 DOI: 10.1017/s0033291700038940] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An earlier paper documented that adverse experiences in childhood and adolescence considerably raise risk of both depressive and anxiety conditions (with the exception of mild agoraphobia and simple phobia) in adult life. This paper deals with the same inner-city women with children at home. Consideration of adverse experiences throughout adulthood as a whole (excluding the period just before onset) particularly involving major prior losses suggests that rather different aetiological processes may be involved. Depression appears to be often linked to experiences of major loss in adulthood as a whole and to be particularly susceptible to shortcomings in the quality of ongoing social support. For anxiety only early adverse experiences appeared to be critical. (However, the onset of both conditions is often provoked by a severely threatening event in the most recent period--particularly 'loss' in depression, and 'danger' in anxiety.) Finally the critical role of early experience for both anxiety and depression explains to a considerable extent why they so often occur together; and social factors not studied in the present enquiry may account for some of the remaining unexplained comorbidity.
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Affiliation(s)
- G W Brown
- Department of Social Policy and Social Science, Royal Holloway and Bedford New College, London
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Hogbin B, Jenkins VA, Parkin AJ. Remembering ‘bad news’ consultations: An evaluation of tape-recorded consultations. Psychooncology 1992. [DOI: 10.1002/pon.2960010304] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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