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Risk factors for psychological morbidity and the protective role of coping self-efficacy in young women with breast cancer early in diagnosis: a national multicentre cohort study. Breast Cancer Res Treat 2022; 194:91-102. [DOI: 10.1007/s10549-022-06576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/17/2022] [Indexed: 11/02/2022]
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2
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Guedes VA, Lange RT, Lippa SM, Lai C, Greer K, Mithani S, Devoto C, A Edwards K, Wagner CL, Martin CA, Driscoll AE, Wright MM, Gillow KC, Baschenis SM, Brickell TA, French LM, Gill JM. Extracellular vesicle neurofilament light is elevated within the first 12-months following traumatic brain injury in a U.S military population. Sci Rep 2022; 12:4002. [PMID: 35256615 PMCID: PMC8901614 DOI: 10.1038/s41598-022-05772-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/14/2021] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) can be associated with long-term neurobehavioral symptoms. Here, we examined levels of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in extracellular vesicles isolated from blood, and their relationship with TBI severity and neurobehavioral symptom reporting. Participants were 218 service members and veterans who sustained uncomplicated mild TBIs (mTBI, n = 107); complicated mild, moderate, or severe TBIs (smcTBI, n = 66); or Injured controls (IC, orthopedic injury without TBI, n = 45). Within one year after injury, but not after, NfL was higher in the smcTBI group than mTBI (p = 0.001, d = 0.66) and IC (p = 0.001, d = 0.35) groups, which remained after controlling for demographics and injury characteristics. NfL also discriminated the smcTBI group from IC (AUC:77.5%, p < 0.001) and mTBI (AUC:76.1%, p < 0.001) groups. No other group differences were observed for NfL or GFAP at either timepoint. NfL correlated with post-concussion symptoms (rs = - 0.38, p = 0.04) in the mTBI group, and with PTSD symptoms in mTBI (rs = - 0.43, p = 0.021) and smcTBI groups (rs = - 0.40, p = 0.024) within one year after injury, which was not confirmed in regression models. Our results suggest the potential of NfL, a protein previously linked to axonal damage, as a diagnostic biomarker that distinguishes TBI severity within the first year after injury.
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Affiliation(s)
- Vivian A Guedes
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Rael T Lange
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- University of British Columbia, Vancouver, BC, Canada
| | - Sara M Lippa
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Chen Lai
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Kisha Greer
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Sara Mithani
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Christina Devoto
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Katie A Edwards
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Chelsea L Wagner
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Carina A Martin
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA
| | - Angela E Driscoll
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Megan M Wright
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Kelly C Gillow
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Samantha M Baschenis
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
| | - Tracey A Brickell
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- General Dynamics Information Technology, Falls Church, VA, USA
- University of British Columbia, Vancouver, BC, Canada
| | - Louis M French
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jessica M Gill
- National Institutes of Health, National Institute of Nursing Research, Bethesda, MD, 20814, USA.
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Korkut S. Research on the frequency of post-traumatic stress disorder in healthcare workers during the COVID-19 pandemic. Ir J Med Sci 2021; 191:2257-2262. [PMID: 34854016 PMCID: PMC8635317 DOI: 10.1007/s11845-021-02871-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022]
Abstract
Background It is highly probable that the COVID-19 outbreak, one of the most severe pandemics to which humanity has been exposed, will promote post-traumatic stress disorder (PTSD). PTSD is a serious mental illness that decreases quality of life and functionality of healthcare workers (HCWs) during the COVID-19 pandemic. Aims This study aims to research the frequency of PTSD in HCWs who are working in a central pandemic hospital, during the COVID-19 outbreak. Methods In total, 300 HCWs were included in the study. Diagnosis of PTSD was made according to DSM-5 diagnostic criteria, and the severity of PTSD symptoms was evaluated using the PTSD Checklist – Civilian Version Scale. Results In total, 21.6% (n = 65) of the HCWs were diagnosed with PTSD, 18.3% of them were female (n = 55) and 3.3% were male (n = 10) participants. The mean PCL-C score of participants diagnosed with PTSD was found to be 60.38 ± 4.81. No statistically significant difference was found between profession groups diagnosed with PTSD. Conclusions HCWs who are working directly with COVID-19 patients have significantly higher levels of PTSD. PTSD can lead to severe negative consequences such as lower quality of life and loss of workforce and productivity, if it is not diagnosed and treated early. Therefore, it should become a routine to continuously monitor and establish early targeted mental health interventions.
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Affiliation(s)
- Süleyman Korkut
- University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
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Panisch LS, Currin-McCulloch J, Covington E. Dissociation among individuals receiving cancer care: a scoping review. J Psychosoc Oncol 2021; 40:541-560. [PMID: 34190678 DOI: 10.1080/07347332.2021.1930324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PROBLEM IDENTIFICATION Dissociation is a common presentation of trauma, distinguishable from classic post-traumatic stress disorder (PTSD) symptoms. While pre-cancer and cancer-related traumatic experiences are prevalent among cancer-affected individuals, the specific impact of traumatic dissociation is unclear. LITERATURE SEARCH This scoping review includes a search of English articles published between 1980 and 2019 referencing dissociation in the context of cancer-affected adults. DATA EVALUATION/SYNTHESIS Articles assessed how dissociation was addressed in relation to pre-cancer and cancer-related trauma exposure and treatment. Out of 1,265 articles, 71 met inclusion criteria, and 15 underwent a full review. Two studies addressed dissociation related to pre-cancer trauma, nine in regard to cancer-related trauma only, and four in relation to both trauma types. No studies included experimental designs or described interventions. CONCLUSIONS Despite high rates of trauma exposure among cancer-affected adults, limited studies specifically address the impact of dissociation. Further inquiry on this topic is needed, especially on treatment implications.
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Affiliation(s)
- Lisa S Panisch
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, USA
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5
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An Improved Stress-Scale Specifically Designed to Measure Stress of Women with Newly Diagnosed Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052346. [PMID: 33673627 PMCID: PMC7967728 DOI: 10.3390/ijerph18052346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 01/22/2023]
Abstract
Most breast cancer patients are middle-aged women actively involved in establishing a family, developing a career, or raising children. With the exception of the Newly Diagnosed Breast Cancer Stress Scale (NDBCSS), few stress scales have been designed for women with breast cancer. This study checked the dimensionality of the NDBCSS by confirmatory factor analysis (CFA) and the results showed a poor fit, indicating an urgent need for improvement. Exploratory factor analysis (EFA) using the varimax rotation method was performed to improve the model, the revised NDBCSS (NDBCSS-R), which showed a good Kaiser-Meyer-Olkin value, Bartlett’s test of sphericity, and internal consistency reliability. The NDBCSS-R showed improved indices compared with NDBCSS, including: chi-square fit statistics/degree of freedom (CMIN/DF), goodness-of-fit index (GFI), adjusted goodness of fit index (AGFI), normed fix index (NFI), relative fit index (RFI), incremental fix index (IFI), Tucker–Lewis index (TLI), comparative fix index (CFI), root mean square error of approximation (RMSEA), root mean square residual (RMR), parsimonious goodness-fit-index (PGFI), and parsimonious normed fit index (PNFI). In conclusion, the improved NDBCSS-R can provide health professionals with an early understanding of the stress levels of women with breast cancer so that they can provide immediate medical intervention to prevent vicious cycles in a timely manner.
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Larson AG, Morris KJ, Juckett MB, Coe CL, Broman AT, Costanzo ES. Mindfulness, Experiential Avoidance, and Recovery From Hematopoietic Stem Cell Transplantation. Ann Behav Med 2020; 53:886-895. [PMID: 30624541 DOI: 10.1093/abm/kay097] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mood disturbance, pain, and fatigue are prevalent and distressing concerns for patients with hematologic cancer recovering from hematopoietic stem cell transplantation (HSCT). The way in which individuals approach difficult thoughts and emotions may affect symptoms and functioning. Specifically, mindfulness has been associated with more optimal psychological and physical functioning, whereas experiential avoidance has been associated with poorer outcomes. PURPOSE The primary objective was to determine whether mindfulness and experiential avoidance measured prior to HSCT were associated with recovery of psychological and physical functioning following HSCT. We also evaluated dimensions of mindfulness to determine which were most robustly associated with outcomes. METHODS Participants completed measures of mindfulness and experiential avoidance prior to HSCT. Depression and anxiety symptoms and pain and fatigue interference with daily activities were assessed prior to HSCT and 1, 3, and 6 months post-HSCT. RESULTS Participants who reported better ability to describe their internal experiences and who were better able to act with awareness experienced less depression, anxiety, and fatigue interference following HSCT. Participants who were nonjudgmental and nonreactive toward thoughts and emotions experienced less depression and anxiety following HSCT, but these traits were not associated with pain or fatigue interference. Being a good observer of internal experiences was not associated with outcomes, nor was experiential avoidance. CONCLUSIONS Results suggest that most facets of mindfulness may optimize psychological functioning following HSCT, and the ability to describe one's internal experience and to focus on the present moment may have a beneficial influence on physical functioning.
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Affiliation(s)
- Anna G Larson
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Keayra J Morris
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Mark B Juckett
- University of Wisconsin Paul P. Carbone Cancer Center, Madison, WI.,Department of Hematology and Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | | | - Aimee T Broman
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI.,University of Wisconsin Paul P. Carbone Cancer Center, Madison, WI
| | - Erin S Costanzo
- University of Wisconsin Paul P. Carbone Cancer Center, Madison, WI.,Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Qi R, Chen W, Liu S, Thompson PM, Zhang LJ, Xia F, Cheng F, Hong A, Surento W, Luo S, Sun ZY, Zhou CS, Li L, Jiang X, Lu GM. Psychological morbidities and fatigue in patients with confirmed COVID-19 during disease outbreak: prevalence and associated biopsychosocial risk factors. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.05.08.20031666. [PMID: 32511502 PMCID: PMC7273270 DOI: 10.1101/2020.05.08.20031666] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective The coronavirus disease 2019 (COVID-19) - a novel and highly infectious pneumonia - has now spread across China and beyond for over four months. However, its psychological impact on patients is unclear. We aim to examine the prevalence and associated risk factors for psychological morbidities and fatigue in patients with confirmed COVID-19 infection. Methods Amidst the disease outbreak, 41 out of 105 COVID-19 patients in a local designated hospital in China were successfully assessed using a constellation of psychometric questionnaires to determine their psychological morbidities and fatigue. Several potential biopsychosocial risk factors (including pre-existing disabilities, CT severity score of pneumonia, social support, coping strategies) were assessed through multivariable logistic regression analyses to clarify their association with mental health in patients. Results 43.9% of 41 patients presented with impaired general mental health, 12.2% had post-traumatic stress disorder (PTSD) symptoms, 26.8% had anxiety and/or depression symptoms, and 53.6% had fatigue. We did not find any association between pneumonia severity and psychological morbidities or fatigue in COVID-19 patients. However, high perceived stigmatization was associated with an increased risk of impaired general mental health and high perceived social support was associated with decreased risk. Besides, negative coping inclination was associated with an increased risk of PTSD symptoms; high perceived social support was associated with a decreased risk of anxiety and/or depression symptoms. Conclusions Psychological morbidities and chronic fatigue are common among COVID-19 patients. Negative coping inclination and being stigmatized are primary risk factors while perceived social support is the main protective factor.
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Affiliation(s)
- Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
- Department of Radiology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, 210002, China
| | - Wei Chen
- Department of Radiology, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, 210002, China
- Department of Radiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Xueyuanxi Road, No 109, Wenzhou, Zhejiang, 325027, China
| | - Saiduo Liu
- Departments of Infectious Disease, Wenzhou Central Hospital, 32 West Jiangbin Road, Wenzhou, Zhejiang, 325000, China
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Fei Xia
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Fang Cheng
- Departments of Infectious Disease, Wenzhou Central Hospital, 32 West Jiangbin Road, Wenzhou, Zhejiang, 325000, China
| | - Ailing Hong
- Departments of Infectious Disease, Wenzhou Central Hospital, 32 West Jiangbin Road, Wenzhou, Zhejiang, 325000, China
| | - Wesley Surento
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Song Luo
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zhi Yuan Sun
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, China National Clinical Research Center for Mental Health Disorders, National Technology Institute of Psychiatry, 139 Middle Renmin Road, Changsha, Hunan 410011, China
| | - Xiangao Jiang
- Departments of Infectious Disease, Wenzhou Central Hospital, 32 West Jiangbin Road, Wenzhou, Zhejiang, 325000, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
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8
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Sager ZS, Wachen JS, Naik AD, Moye J. Post-Traumatic Stress Disorder Symptoms from Multiple Stressors Predict Chronic Pain in Cancer Survivors. J Palliat Med 2020; 23:1191-1197. [PMID: 32228350 DOI: 10.1089/jpm.2019.0458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the association between chronic pain and post-traumatic stress disorder (PTSD), little is known about the longitudinal course of pain and PTSD during cancer treatment. Objectives: We examined the prevalence of PTSD and chronic pain at three time periods in veterans with a diagnosis of cancer, and the relationship between the experience of pain and PTSD. Methods: Participants (N = 123) with oral-digestive cancers were recruited from the Veterans Healthcare System (age M = 65.31 and SD = 9.13; 98.4% male) and completed face to face interviews at 6, 12, and 18 months post-diagnosis. Measures included the Post-traumatic Stress Disorder Checklist-Stressor-Specific version (PCL-S), Primary care PTSD (PC-PTSD), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Impact Scale. Results: About one-third (26.8%) of the sample had chronic pain, defined as elevated pain at two time periods. About one-fifth (20.3%) endorsed symptoms of combat-related PTSD at 6 months, and 22.8% endorsed symptoms of cancer-related PTSD, exceeding a clinical cutoff for older adults (12 months = 21.1%, 18 months = 23.1%). Changes over time were observed for cancer-related PTSD symptom clusters of hyperarousal (F = 3.85 and p = 0.023) and emotional numbing (F = 4.06 and p = 0.018) with a statistically significant quadratic function increasing at 18 months. In logistic regression, individuals with both combat and cancer-related PTSD symptoms at six months had 8.49 times higher odds of experiencing chronic pain (χ2 = 25.91 and p < 0.001; R2 = 0.28). Conclusions: Persisting pain may be a concern in veterans with cancer. Individuals who have experienced traumatic events with persisting PTSD symptoms may be at elevated risk for chronic pain. Veterans with PTSD symptoms from both cancer and combat are at the highest risk to experience chronic pain.
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Affiliation(s)
- Zachary S Sager
- VA New England GRECC and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Wachen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Aanand D Naik
- Health Services Research and Development, Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer Moye
- VA New England GRECC and Harvard Medical School, Boston, Massachusetts, USA
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9
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Papazoglou K, Blumberg DM, Chiongbian VB, Tuttle BM, Kamkar K, Chopko B, Milliard B, Aukhojee P, Koskelainen M. The Role of Moral Injury in PTSD Among Law Enforcement Officers: A Brief Report. Front Psychol 2020; 11:310. [PMID: 32194477 PMCID: PMC7064734 DOI: 10.3389/fpsyg.2020.00310] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/10/2020] [Indexed: 02/05/2023] Open
Abstract
Exposure to critical incidents and hence potentially traumatic events is endemic in law enforcement. The study of law enforcement officers’ experience of moral injury and their exposure to potentially morally injurious incidents, and research on moral injury’s relationship with different forms of traumatization (e.g. compassion fatigue, post-traumatic stress disorder) are in their infancy. The present study aims to build on prior research and explores the role of moral injury in predicting post-traumatic stress disorder (PTSD) and its clusters thereof. To this end, a sample of law enforcement officers (N = 370) from the National Police of Finland was recruited to participate in the current study. Results showed that moral injury significantly predicted PTSD as well as its diagnostic clusters (i.e., avoidance, hyperarousal, re-experiencing). The aforementioned role of moral injury to significantly predict PTSD and its clusters were unequivocal even when compassion fatigue was incorporated into the path model. Clinical, research, and law enforcement practice implications are discussed.
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Affiliation(s)
| | - Daniel M Blumberg
- California School of Professional Psychology, Alliant International University, San Diego, CA, United States
| | | | | | - Katy Kamkar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Brian Chopko
- Department of Sociology, Kent State University, North Canton, OH, United States
| | | | - Prashant Aukhojee
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Mari Koskelainen
- National Bureau of Investigation, Intelligence Division, Threat Assessment Team, Vantaa, Finland
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10
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Fuzesi S, Becetti K, Klassen AF, Gemignani ML, Pusic AL. Expectations of breast-conserving therapy: a qualitative study. J Patient Rep Outcomes 2019; 3:73. [PMID: 31883052 PMCID: PMC6934637 DOI: 10.1186/s41687-019-0167-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background Early-stage breast cancer is often treated with breast-conserving therapy (BCT), including lumpectomy with radiation therapy. Patients’ expectations of BCT remain largely unknown. Expectations affect perceptions of treatment-related experiences and health-related quality of life (HR-QOL) outcomes. Our primary aim was to describe expectations of BCT among patients with early breast cancer through qualitative methods. Our secondary aim was to inform preoperative patient education and improve the patient experience through knowledge. Methods We used a grounded-theory approach to investigate a convenience sample of 22 women with stage I and II breast cancer who were treated with BCT at a single hospital in New York City between May and August 2016. Semi-structured interviews were conducted in person and by telephone. Open-ended questions covered participants’ expectations of treatment experiences and outcomes. Data was analyzed in a line-by-line approach to identify emergent themes related to patient expectations. Interviews continued until no new themes emerged. Results Analysis of data identified the following themes related to patient expectations of BCT: experience of cancer care, recovery, appearance, and HR-QOL. Despite preoperative informed consent and teaching, participants expressed few expectations preoperatively, owing to a lack of knowledge about the process of care. Lack of expectations preoperatively was compensated with available care and resources postoperatively. Conclusions Patients in our sample had a surprisingly limited understanding of what to expect during treatment with BCT. Despite available information and preoperative teaching, patients have a clear knowledge gap regarding BCT. These findings suggest patients often undergo cancer treatment with trust rather than complete understanding of the process. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.
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Affiliation(s)
- Sarah Fuzesi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. .,Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA.
| | - Karima Becetti
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | - Mary L Gemignani
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Andrea L Pusic
- Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, 02115, USA
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11
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Voiß P, Höxtermann MD, Dobos G, Cramer H. Mind-body medicine use by women diagnosed with breast cancer: results of a nationally representative survey. Support Care Cancer 2019; 28:1077-1082. [PMID: 31187251 DOI: 10.1007/s00520-019-04914-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/31/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Worldwide breast cancer is the most commonly diagnosed cancer in women and often associated with a profound physiological stress reaction. Mind-body medicine modalities have been proven effective in reducing stress symptoms. This article will cover the prevalence of MBM use in women with and without breast cancer in the US population and detect predictors of MBM use in women diagnosed with breast cancer. METHODS The 2017 National Health Interview Survey (NHIS) was used to study the prevalence of breast cancer and the use of mind-body medicine (MBM) among individuals with breast cancer in the US population. Using chi-squared tests and backward stepwise multiple logistic regression analyses, predictors of MBM use in women with breast cancer in the past 12 months were identified. RESULTS The prevalence of breast cancer in women was 3.1%. Among women diagnosed with breast cancer, 25.2% had used MBM in the past 12 months. Spiritual meditation (14.3%), followed by yoga (9.6%), and mindfulness meditation (4.3%) were the most commonly used MBM approaches for women with breast cancer diagnosis. Only higher education independently predicted the use of MBM among them. CONCLUSIONS In this nationally representative sample of the USA, the most common used MBM approach was spiritual meditation, while this approach is much less researched than the evidence based approaches of yoga and mindfulness meditation. Especially stressed individuals worldwide could benefit from MBM the literature suggests. Particularly in the acute survivorship stage, influencing the initial stress reaction could be beneficial.
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Affiliation(s)
- Petra Voiß
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | - Melanie Désirée Höxtermann
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.
| | - Gustav Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany
| | - Holger Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Am Deimelsberg 34a, 45276, Essen, Germany.,Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
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12
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Regier NG, Naik AD, Mulligan EA, Nasreddine ZS, Driver JA, Sada YHF, Moye J. Cancer-related cognitive impairment and associated factors in a sample of older male oral-digestive cancer survivors. Psychooncology 2019; 28:1551-1558. [PMID: 31134710 DOI: 10.1002/pon.5131] [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: 02/21/2019] [Revised: 05/08/2019] [Accepted: 05/21/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This study examines the demographic and clinical variables associated with cancer-related cognitive impairment (CRCI) in a sample of older, male, oral-digestive cancer survivors at VA Medical Centers in Boston and Houston. METHODS A two-time point, longitudinal design was used, with cognitive assessment conducted at 6 and 18 months post-diagnosis. Using ANCOVA, the cognitive functioning of 88 older adults with head and neck, esophageal, gastric, or colorectal cancers was compared with that of 88 healthy controls. Paired t-tests examined cognitive change over time in the cancer group. Hierarchical linear regression examined variables potentially associated with cognitive impairment at 18 months. RESULTS Forty-eight percent of cancer patients exhibited cognitive impairment 6 months post-cancer diagnosis, and 40% at 18 months. Cancer survivors were impaired relative to controls on measures of sustained attention, memory, and verbal fluency at 18 months, controlling for age. Older age, low hemoglobin, and cancer-related PTSD were associated with worse cognition at 18 months. CONCLUSIONS CRCI is more frequent in older adults than reported in studies of younger adults and may be more frequent in men. Potential areas of intervention for CRCI include psychotherapy for cancer-related PTSD, treatment of anemia, and awareness of particularly vulnerable cognitive domains such as sustained attention, memory, and verbal fluency.
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Affiliation(s)
- Natalie G Regier
- Johns Hopkins School of Nursing, Baltimore, Maryland.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland
| | - Aanand D Naik
- VA Boston Healthcare System, Boston, Massachusetts.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Elizabeth A Mulligan
- VA Boston Healthcare System, Boston, Massachusetts.,San Francisco VA Healthcare System, San Francisco, California
| | - Ziad S Nasreddine
- Service de Neurologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jane A Driver
- VA Boston Healthcare System, Boston, Massachusetts.,Hematologic Malignancies Program, Dana Farber Cancer Institute, Boston, Massachusetts.,Brigham and Women's Hospital, Center for Older Adult Health, Boston, Massachusetts
| | - Yvonne H-F Sada
- Michael E. DeBakey VA Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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13
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A Review of Health Survey Research for People with Refugee Background Resettled from Africa: Research Gaps and Methodological Issues. J Racial Ethn Health Disparities 2018; 6:160-181. [PMID: 30014446 DOI: 10.1007/s40615-018-0511-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/20/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
We reviewed 27 studies on adults with a refugee background resettled from Africa published between 1999 and 2017 to appraise their methodological issues for survey research. Out of 27 studies, eleven used a single sampling method (referral = 1, convenience = 10), and 16 relied on multiple sampling methods, many of which were combinations of referral and convenience. The two most salient recruitment strategies found were building trusted relationships with the community (n = 15), and using recruiters who were culturally and linguistically matched to the refugee communities of interest (n = 14). Fifteen studies used existing data collection instruments, while in 13 studies, researchers developed their own data collection instruments. In-person or phone interviews using bilingual interviewers (n = 21) were the most frequently used mode of data collection, followed by a self-administered survey (n = 7). Our review presents methodological gaps in current refugee health studies, such as limited use of probability sampling approach due to system barriers, lack of information in community engagement and recruitment processes, and insufficient considerations of unique culture and experiences of refugee communities when developing or adapting the instruments. Efforts can be made to guide and facilitate appropriate reporting and development of more scientifically robust survey methodologies for refugee health studies, as well as to improve registration system infrastructure that may help identify these hidden populations more effectively.
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14
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Kagee A, Bantjes J, Saal W. Prevalence of Traumatic Events and Symptoms of PTSD Among South Africans Receiving an HIV Test. AIDS Behav 2017; 21:3219-3227. [PMID: 28224321 DOI: 10.1007/s10461-017-1730-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We studied posttraumatic stress disorder (PTSD) among a community sample of 500 persons seeking an HIV test. The majority of participants (62.2%) indicated that they had experienced at least one index event that qualified for PTSD, even though a small proportion (5%) actually met the diagnostic criteria for the disorder. Of those who reported an index event, 25 (8.04%) met the diagnostic criteria for PTSD while 286 (91.96%) did not. On average about one-third of participants who did not meet the criteria for PTSD endorsed PTSD symptoms whereas more than three quarters of those who met the full criteria did so. No demographic factors were associated with PTSD caseness, except number of traumatic events. These results are discussed in the context of the need to address traumatic events and PTSD among persons who undergo HIV testing.
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15
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Husson O, Zebrack B, Block R, Embry L, Aguilar C, Hayes-Lattin B, Cole S. Posttraumatic growth and well-being among adolescents and young adults (AYAs) with cancer: a longitudinal study. Support Care Cancer 2017; 25:2881-2890. [PMID: 28424888 PMCID: PMC5527055 DOI: 10.1007/s00520-017-3707-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/10/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examines posttraumatic growth (PTG) among adolescents and young adults (AYAs) with cancer, as well as its correlates and trajectories over time. The study also explores the buffering role of PTG on the associations between posttraumatic stress (PTS), health-related quality of life (HRQoL), and psychological distress. METHODS A multicenter, longitudinal, prospective study was conducted among AYA cancer patients aged 14-39 years. One hundred sixty-nine patients completed a self-report measure of PTG (PTGI) and PTS (PDS) 6, 12, and 24 months after baseline (within the first 4 months of diagnosis). At 24-month follow-up, HRQoL (SF-36) and psychological distress (BSI-18) were also assessed. RESULTS Among participants, 14% showed increasing PTG, 45% remained at a stable high PTG level, 14% showed decreasing PTG, and 27% remained at a stable low PTG level. AYAs who remained high on PTG were more often younger, female, and received chemotherapy. PTG level at 6-month follow-up was predictive of mental HRQoL (β = 0.19; p = 0.026) and psychological distress (β = -0.14; p = 0.043) at 24-month follow-up when corrected for PTS and sociodemographic and clinical covariates. No relationship between PTG and physical HRQoL was found. The interactive effects of PTS and PTG on outcomes were not significant, indicating that buffering did not take place. CONCLUSION This study indicates that PTG is dynamic and predicts mental well-being outcomes but does not buffer the effects of PTS. Psychosocial interventions should focus on promoting PTG and reducing PTS in order to promote the adjustment of AYAs diagnosed with cancer.
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Affiliation(s)
- O Husson
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - B Zebrack
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - R Block
- MNR Analytics, Portland, OR, USA
| | - L Embry
- Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - C Aguilar
- Pediatric Hematology/Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - B Hayes-Lattin
- Oregon Health and Sciences University, Portland, OR, USA
| | - S Cole
- HopeLab Foundation, Redwood City, CA, USA
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16
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Gabriel S, Read JP, Young AF, Bachrach RL, Troisi JD. Social Surrogate use in those Exposed to Trauma: I Get by with a Little Help from my (Fictional) Friends. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2017; 36:41-63. [PMID: 29861540 PMCID: PMC5983032 DOI: 10.1521/jscp.2017.36.1.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Traumatic events bring an increased need for social connection but paradoxically can make relationships more difficult. The current research examines the unique role social surrogates such as favorite TV shows, books, and celebrities may play in fulfilling the social needs of people who have experienced trauma. Across two studies we predicted and found that experiencing traumatic events is associated with higher interest in using social surrogates. Furthermore, individuals who have experienced trauma without developing PTSD are able to effectively use social surrogates to combat social isolation. However, perhaps because PTSD symptoms often are associated with impaired social functioning, those with PTSD actually feel worse after social surrogate use. Implications for trauma, PTSD, social surrogates, and social self research are discussed.
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Affiliation(s)
- Shira Gabriel
- University at Buffalo, The State University of New York
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17
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Liu L, Yang YL, Wang ZY, Wu H, Wang Y, Wang L. Prevalence and Positive Correlates of Posttraumatic Stress Disorder Symptoms among Chinese Patients with Hematological Malignancies: A Cross-Sectional Study. PLoS One 2015; 10:e0145103. [PMID: 26669841 PMCID: PMC4679613 DOI: 10.1371/journal.pone.0145103] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/28/2015] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Positive psychological constructs have been given increasing attention in research on the coping resources of cancer-related distresses. However, little research is available on posttraumatic stress disorder (PTSD) in patients with hematological malignancies. The purposes of this study were to assess the prevalence of PTSD symptoms and to explore the associations of perceived social support (PSS), hope, optimism and resilience with PTSD symptoms among Chinese patients with hematological malignancies. METHODS A cross-sectional study was conducted during the period from July 2013 through April 2014. A total of 225 inpatients with hematological malignancies, which were eligible for the study, completed the Post-traumatic Stress Checklist-Civilian Version, Multidimensional Scale of Perceived Social Support, Adult Hope Scale, Life Orientation Scale-Revised, and Resilience Scale. Hierarchical regression analysis was performed to explore the correlates of PTSD symptoms. RESULTS Overall, the prevalence of PTSD symptoms was 10.7%. Initially, PSS was negatively associated with PTSD symptoms (β = -0.248, P < 0.01). However, when positive psychological variables were added, optimism was negatively associated with PTSD symptoms (β = -0.452, P < 0.01), and gender had a significant effect on PTSD symptoms. Women were more vulnerable to these symptoms than men (β = 0.123, P < 0.05). When the analysis was performed separately by gender, only optimism showed a significantly negative association with PTSD symptoms in both men (β = -0.389, P < 0.01) and women (β = -0.493, P < 0.01). CONCLUSIONS Some patients with hematological malignancies suffer from PTSD symptoms. The positive effects of PSS and optimism on PTSD symptoms suggest that an integrated approach to psychosocial intervention from both external and internal perspectives could have practical significance. Gender difference should be considered in developing potential interventions in reducing cancer-related PTSD symptoms.
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Affiliation(s)
- Li Liu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yi-Long Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Zi-Yue Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Hui Wu
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yang Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
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18
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Magruder K, Yeager D, Goldberg J, Forsberg C, Litz B, Vaccarino V, Friedman M, Gleason T, Huang G, Smith N. Diagnostic performance of the PTSD checklist and the Vietnam Era Twin Registry PTSD scale. Epidemiol Psychiatr Sci 2015; 24:415-22. [PMID: 24905737 PMCID: PMC5881392 DOI: 10.1017/s2045796014000365] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/14/2014] [Accepted: 04/16/2014] [Indexed: 11/06/2022] Open
Abstract
AIMS Self-report questionnaires are frequently used in clinical and epidemiologic studies to assess post-traumatic stress disorder (PTSD). A number of studies have evaluated these scales relative to clinician administered structured interviews; however, there has been no formal evaluation of their performance relative to non-clinician administered epidemiologic assessments such as the Composite International Diagnostic Interview (CIDI). We examined the diagnostic performance of two self-report PTSD scales, the PTSD checklist (PCL) and the Vietnam Era Twin Registry (VET-R) PTSD scale, compared to the CIDI. METHODS Data were derived from a large epidemiologic follow-up study of PTSD in 5141 Vietnam Era Veterans. Measures included the PCL, VET-R PTSD scale and CIDI. For both the PCL and VET-R PTSD scale, ROC curves, areas under the curve (AUC), sensitivity, specificity, % correctly classified, likelihood ratios, predictive values and quality estimates were generated based on the CIDI PTSD diagnosis. RESULTS For the PCL and VET-R PTSD scale the AUCs were 89.0 and 87.7%, respectively. Optimal PCL cutpoints varied from the 31-33 range (when considering sensitivity and specificity) to the 36-56 range (when considering quality estimates). Similar variations were found for the VET-R PTSD, ranging from 31 (when considering sensitivity and specificity) to the 37-42 range (when considering quality estimates). CONCLUSIONS The PCL and VET-R PTSD scale performed similarly using a CIDI PTSD diagnosis as the criterion. There was a range of acceptable cutpoints, depending on the metric used, but most metrics suggested a lower PCL cutpoint than in previous studies in Veteran populations.
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Affiliation(s)
- K. Magruder
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - D. Yeager
- Mental Health Service, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - J. Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - C. Forsberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - B. Litz
- Massachusetts Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - V. Vaccarino
- Departments of Epidemiology and Medicine, Emory University, Atlanta, Georgia, USA
| | - M. Friedman
- Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, White River Junction, Vermont, USA
- Departments of Psychiatry and Pharmacology & Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - T. Gleason
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - G. Huang
- Cooperative Studies Program, Clinical Science Research and Development, VA Office of Research and Development, Washington, DC, USA
| | - N. Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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19
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Autonomic dysfunction in early breast cancer: Incidence, clinical importance, and underlying mechanisms. Am Heart J 2015; 170:231-41. [PMID: 26299219 DOI: 10.1016/j.ahj.2015.05.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/25/2015] [Indexed: 12/14/2022]
Abstract
Autonomic dysfunction represents a loss of normal autonomic control of the cardiovascular system associated with both sympathetic nervous system overdrive and reduced efficacy of the parasympathetic nervous system. Autonomic dysfunction is a strong predictor of future coronary heart disease, vascular disease, and sudden cardiac death. In the current review, we will discuss the clinical importance of autonomic dysfunction as a cardiovascular risk marker among breast cancer patients. We will review the effects of antineoplastic therapy on autonomic function, as well as discuss secondary exposures, such as psychological stress, sleep disturbances, weight gain/metabolic derangements, and loss of cardiorespiratory fitness, which may negatively impact autonomic function in breast cancer patients. Lastly, we review potential strategies to improve autonomic function in this population. The perspective can help guide new therapeutic interventions to promote longevity and cardiovascular health among breast cancer survivors.
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20
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Norlund F, Olsson EMG, Burell G, Wallin E, Held C. Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial. Trials 2015; 16:154. [PMID: 25873137 PMCID: PMC4404081 DOI: 10.1186/s13063-015-0689-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/26/2015] [Indexed: 12/20/2022] Open
Abstract
Background Major depression and depressive symptoms are common in patients with a recent myocardial infarction (MI), and depression is associated with adverse cardiovascular outcomes. Anxiety post-MI is less studied, but occurs commonly in patients with heart disease, and is also considered a risk factor for recurrence of cardiac events. Cognitive behavior therapy (CBT) is an established therapy for depression and anxiety disorders. To the best of our knowledge, there have not been any studies to determine if internet-based CBT (iCBT) can reduce the symptoms of depression and anxiety in patients with a recent MI. The main aim of the U-CARE Heart trial is to evaluate an iCBT intervention for patients with a recent MI. Methods/design This is a randomized, controlled, prospective study with a multicenter design. A total of 500 participants will be randomized at a 1:1 ratio, around two months after an acute MI, to either iCBT or to a control group. Both groups will receive an optimal standard of care according to guidelines. The intervention consists of a self-help program delivered via the internet with individual online support from a psychologist. Treatment duration is 14 weeks. The primary outcome is change in patients’ self-rated anxiety and depression symptoms from baseline to end of treatment. An internal pilot study was conducted indicating sufficient levels of study acceptability and engagement in treatment. Discussion The present study is designed to evaluate an iCBT intervention targeting symptoms of depression and anxiety in a post-MI population. If effective, iCBT has several advantages, and will potentially be implemented as an easily accessible treatment option added to modern standard of care. Trial registration This trial was registered with Clinicaltrials.gov (identifier: NCT01504191) on 19 December 2011.
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Affiliation(s)
- Fredrika Norlund
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Erik M G Olsson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Gunilla Burell
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Emma Wallin
- Department of Psychology, Uppsala University, Box 562 S-75122, Uppsala, Sweden.
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center Uppsala University, Dag Hammarskjölds väg 14B, S-752 37, Uppsala, Sweden.
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21
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Stammel N, Abbing EM, Heeke C, Knaevelsrud C. Applicability of the ICD-11 proposal for PTSD: a comparison of prevalence and comorbidity rates with the DSM-IV PTSD classification in two post-conflict samples. Eur J Psychotraumatol 2015; 6:27070. [PMID: 25989951 PMCID: PMC4438098 DOI: 10.3402/ejpt.v6.27070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The World Health Organization recently proposed significant changes to the posttraumatic stress disorder (PTSD) diagnostic criteria in the 11th edition of the International Classification of Diseases (ICD-11). OBJECTIVE The present study investigated the impact of these changes in two different post-conflict samples. METHOD Prevalence and rates of concurrent depression and anxiety, socio-demographic characteristics, and indicators of clinical severity according to ICD-11 in 1,075 Cambodian and 453 Colombian civilians exposed to civil war and genocide were compared to those according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS Results indicated significantly lower prevalence rates under the ICD-11 proposal (8.1% Cambodian sample and 44.4% Colombian sample) compared to the DSM-IV (11.2% Cambodian sample and 55.0% Colombian sample). Participants meeting a PTSD diagnosis only under the ICD-11 proposal had significantly lower rates of concurrent depression and a lower concurrent total score (depression and anxiety) compared to participants meeting only DSM-IV diagnostic criteria. There were no significant differences in socio-demographic characteristics and indicators of clinical severity between these two groups. CONCLUSIONS The lower prevalence of PTSD according to the ICD-11 proposal in our samples of persons exposed to a high number of traumatic events may counter criticism of previous PTSD classifications to overuse the PTSD diagnosis in populations exposed to extreme stressors. Also another goal, to better distinguish PTSD from comorbid disorders could be supported with our data.
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Affiliation(s)
- Nadine Stammel
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,Center for Torture Victims, Berlin, Germany;
| | - Eva M Abbing
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,Center for Torture Victims, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,Center for Torture Victims, Berlin, Germany
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Read JP, Griffin MJ, Wardell JD, Ouimette P. Coping, PTSD symptoms, and alcohol involvement in trauma-exposed college students in the first three years of college. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2014; 28:1052-64. [PMID: 25528048 PMCID: PMC4285146 DOI: 10.1037/a0038348] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of the present study was to examine prospective, bidirectional associations among posttraumatic stress disorder (PTSD) symptoms, coping style, and alcohol involvement (use, consequences) in a sample of trauma-exposed students just entering college. We also sought to test the mechanistic role that coping may play in associations between PTSD symptoms and problem alcohol involvement over time. Participants (N = 734) completed measures of trauma exposure, PTSD symptoms, coping, and alcohol use and consequences in September of their first college year and again each September for the next 2 years. We observed reciprocal associations between PTSD and negative coping strategies. In our examination of a mediated pathway through coping, we found an indirect association from alcohol consequences and PTSD symptoms via negative coping, suggesting that alcohol consequences may exacerbate posttraumatic stress over time by promoting negative coping strategies. Trauma characteristics such as type (interpersonal vs. noninterpersonal) and trauma reexposure did not moderate these pathways. Models were also invariant across gender. Findings from the present study point to risk that is conferred by both PTSD and alcohol consequences for using negative coping approaches, and through this, for posttraumatic stress. Interventions designed to decrease negative coping may help to offset this risk, leading to more positive outcomes for those students who enter college with trauma exposure.
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Affiliation(s)
- Jennifer P Read
- Department of Psychology, University at Buffalo, State University of New York
| | - Melissa J Griffin
- Department of Psychology, University at Buffalo, State University of New York
| | - Jeffrey D Wardell
- Department of Psychology, University at Buffalo, State University of New York
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23
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Posluszny DM, Dougall AL, Johnson JT, Argiris A, Ferris RL, Baum A, Bovbjerg DH, Dew MA. Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners. Head Neck 2014; 37:1282-9. [PMID: 24817018 DOI: 10.1002/hed.23760] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 01/31/2014] [Accepted: 05/07/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Head and neck cancer is a life-threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant. METHODS Newly diagnosed patients and partners (number of dyads = 42) completed questionnaires to assess symptoms of PTSD, anxiety, and depression, as well as demographic, medical, and attitudinal variables. RESULTS Partners had higher average levels of PTSD symptoms than patients (p = .023). More partners (28.6%) met criteria for estimated PTSD caseness than did patients (11.9%). There were no significant differences in levels of other anxiety or depression symptoms. Perceived threat of disease appeared to be a stronger correlate of PTSD symptom levels than medical variables in patients and partners. CONCLUSION A diagnosis of head and neck cancer elicits significant levels of PTSD symptoms in patients, and even higher levels among partners. Identified correlates of distress, including perceived threat of disease, are potential intervention targets.
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Affiliation(s)
- Donna M Posluszny
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | | | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Athanassios Argiris
- Division of Hematology/Oncology, Department of Medicine, University of Texas Health Center at San Antonio, Texas
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Head and Neck Cancer Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew Baum
- Department of Psychology, University of Texas at Arlington, Texas
| | - Dana H Bovbjerg
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Departments of Psychiatry, Psychology, Behavioral, and Community Health Sciences, and Clinical and Translational Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Amanda Dew
- Biobehavioral Medicine in Oncology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
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24
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Read JP, Wardell JD, Colder CR. Reciprocal associations between PTSD symptoms and alcohol involvement in college: a three-year trait-state-error analysis. JOURNAL OF ABNORMAL PSYCHOLOGY 2014; 122:984-97. [PMID: 24364601 DOI: 10.1037/a0034918] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bidirectional associations between posttraumatic stress disorder (PTSD) symptoms and alcohol involvement have been theorized, but have not been tested empirically. In this study, we examined these relations at the transition into and over the first 3 years of college by using an analytic approach (Trait-State-Error Modeling [TSE]; Kenny & Zautra, 1995) that allowed us to examine prospective, reciprocal associations among these constructs while accounting for intraindividual stability. Young adults (N = 486) were recruited at matriculation into college and assessed by Web survey in September of the first college year (T1) and 11 additional time points over 3 years. Findings showed evidence of prospective associations from alcohol involvement (both use and problems) to PTSD symptoms over the 3-year assessment period. We also observed prospective relations from PTSD symptoms to alcohol involvement over time. Patterns of covariation in trait vulnerability for alcohol involvement and PTSD symptoms differed from crossed-lagged associations among state-like variance in these constructs. Results suggest that PTSD symptoms and alcohol involvement each predict the other over the course of college. Findings also highlight the importance of considering both time-varying and stable sources of variation in these associations.
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Self-regulatory fatigue in hematologic malignancies: impact on quality of life, coping, and adherence to medical recommendations. Int J Behav Med 2014; 20:13-21. [PMID: 21928059 DOI: 10.1007/s12529-011-9194-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is an intensive cancer therapy entailing numerous physical, emotional, cognitive, and practical challenges. Patients' ability to adjust and cope with such challenges may depend on their ability to exert control over cognitive, emotional, and behavioral processes, that is, ability to self-regulate. Self-regulatory capacity is a limited resource that can be depleted or fatigued (i.e., "self-regulatory fatigue"), particularly in the context of stressful life events such as cancer diagnosis and treatment. PURPOSE This is one of the first studies to examine self-regulatory fatigue in a cancer population. The current study aimed to (1) extract items for a specific scale of self-regulatory capacity and (2) examine the impact of such capacity on adaptation in patients with hematologic malignancies preparing for HSCT. METHODS Factor analysis of four existing scales gauging psychological adjustment and well-being in 314 patients preparing for HSCT (63% male and 89% Caucasian) identified 23 items (α = 0.85) related to self-regulatory control or fatigue. This measure was then examined using existing clinical data obtained from 178 patients (57% male and 91% Caucasian) undergoing treatment for hematologic malignancies in relationship to quality of life, coping, and self-reported adherence to physicians' recommendations. RESULTS Controlling for pain severity, physical fatigue, and depression, self-regulatory fatigue scores were incrementally associated with decreased quality of life, use of avoidance coping strategies, and decreased adherence to physicians' recommendations. CONCLUSION These results emphasize the potential role of self-regulatory capacity in coping with and adjusting to hematologic cancers and future research is warranted.
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Harding S, Sanipour F, Moss T. Existence of benefit finding and posttraumatic growth in people treated for head and neck cancer: a systematic review. PeerJ 2014; 2:e256. [PMID: 24688840 PMCID: PMC3933269 DOI: 10.7717/peerj.256] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/12/2014] [Indexed: 11/20/2022] Open
Abstract
Background. The impact of head and neck cancer (HNC) in long-term survivors differs widely among individuals, and a significant number of them suffer from the negative effects of disease, whereas others report significant positive effect. This systematic review investigated the evidence the implications of treatment for HNC and subsequent development of Benefit Finding (BF) or Posttraumatic Growth (PTG). Purpose. To understand how differing medical, psychological and social characteristics of HNC may lead to BF/PTG and subsequently inform post-treatment interventions to encourage positive outcomes. Method. In February 2012, five databases including Pubmed, and Psych Info, were searched, for peer-reviewed English-language publications. Search strings included key words pertaining to HNC, BF, and PTG. One thousand three hundred and sixty three publications were identified, reviewed, and reduced following Cochrane guidelines and inclusion/exclusion criteria specified by a group of maxillofacial consultants and psychologists. Publications were then quality assessed using the CASP Cohort Critical Appraisal tool. Findings. Five manuscripts met the search and selection criteria, and were sourced for review. All studies were identified as being level IIb evidence which is a medium level of quality. The majority of studies investigated benefit finding (80%) and were split between recruiting participant via cancer clinics and postal survey. They focused on the medical, psychological and social characteristics of the patient following completion of treatment for HNC. Conclusion. Demographic factors across the papers showed similar patterns of relationships across BF and PTG; that higher education/qualification and cohabitation/marriage are associated with increased BF/PTG. Similarly, overlap with disease characteristics and psychosocial factors where hope and optimism were both positively correlated with increased reported BF/PTG.
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Affiliation(s)
- Sam Harding
- Department of Psychology, University of the West of England , Bristol , United Kingdom
| | - Fatimeh Sanipour
- Department of Psychology, University of the West of England , Bristol , United Kingdom
| | - Timothy Moss
- Centre for Appearance Research, University of the West of England , Bristol , United Kingdom
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Wachen JS, Patidar SM, Mulligan EA, Naik AD, Moye J. Cancer-related PTSD symptoms in a veteran sample: association with age, combat PTSD, and quality of life. Psychooncology 2014; 23:921-7. [PMID: 24519893 DOI: 10.1002/pon.3494] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/03/2014] [Accepted: 01/10/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The diagnosis and treatment of cancer is a potentially traumatic experience that may evoke posttraumatic stress symptoms (PTSS) among survivors. This paper describes the rates of endorsement of cancer-related PTSS along with the relationship of demographic, cancer, and combat variables on PTSS and quality of life. METHODS Veterans (N = 166) with head and neck, esophageal, gastric, or colorectal cancers were recruited through tumor registries at two regional Veterans Administration Medical Centers. Standardized scales were used to assess self-report of PTSS, combat, and quality of life. RESULTS Most participants (86%) reported experiencing at least some cancer-related PTSS; 10% scored above a clinical cutoff for probable PTSD. In linear regressions, younger age and current combat PTSS were associated with cancer-related PTSS, whereas disease and treatment characteristics were not; in turn, cancer-related PTSS were negatively associated with physical and social quality of life. CONCLUSIONS Individual characteristics and psychosocial factors may play a larger role than disease-related variables in determining how an individual responds to the stress of cancer diagnosis and treatment. Given the rates of reported cancer-related PTSS in this sample, and other non-veteran samples, clinicians should consider screening these following diagnosis and treatment, particularly in younger adults and those with previous trauma histories.
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Mulligan EA, Wachen JS, Naik AD, Gosian J, Moye J. Cancer as a Criterion A Traumatic Stressor for Veterans: Prevalence and Correlates. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2014; 6:S73-S81. [PMID: 25741406 DOI: 10.1037/a0033721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The diagnosis of cancer is an uncontrollable stressor posing the threat of death and disfigurement, often followed by repeated exposure to aversive reminders in the form of noxious treatments, persisting side effects, reengagement at times of surveillance, and the threat of recurrence. The phenomenon of cancer as a traumatic stressor is explored in this study, with a focus on the prevalence and correlates of posttraumatic stress disorder (PTSD) Criterion A in a sample of 170 mostly male adults who received health care at VA Medical Centers in Boston or Houston. Participants were interviewed 6 months after diagnosis with head and neck, gastro-esophageal, or colorectal cancers. Approximately half-42.9% to 65.9% depending on cut-score used-perceived cancer to be a traumatic stressor involving actual/threatened death or injury or threat to physical integrity as well as fear, helplessness, or horror. Younger veterans and those with current combat PTSD symptoms were more likely to perceive cancer as a traumatic stressor, as were those who perceived their prognosis as uncertain; 12% had PTSD symptoms above a PCLC cut score of 50, which is similar to incidence rates of PTSD associated with other traumatic stressors. Cancer, therefore, appears to be a serious and for some, traumatic stressor, suggesting the importance of screening for cancer related PTSD in cancer survivors, particularly those most at risk.
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Affiliation(s)
| | | | - Aanand D Naik
- Health Services Research and Development, Michael E. DeBakey VAMC, Houston, Texas, and Baylor College of Medicine
| | | | - Jennifer Moye
- VA Boston Health Care System, Boston, Massachusetts and Harvard Medical School
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Goldfinger JZ, Edmondson D, Kronish IM, Fei K, Balakrishnan R, Tuhrim S, Horowitz CR. Correlates of post-traumatic stress disorder in stroke survivors. J Stroke Cerebrovasc Dis 2013; 23:1099-105. [PMID: 24144593 DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/15/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) can occur after life-threatening events, including illness, but correlates of PTSD after stroke or transient ischemic attack (TIA) have not been well described. METHODS We measured the prevalence of stroke-induced PTSD with the PTSD Checklist Specific for stroke (PCL-S) in adults who had a stroke or TIA within 5 years. A PCL-S score of 50 or more indicated likely PTSD. We tested for potential predictors of stroke-associated PTSD, including demographics, stroke history, disability, medical comorbidities, depression, and emotional support and then examined the association between poststroke PTSD and measures of physical and mental health. RESULTS Of 535 participants, 95 (18%) had a PCL-S score of 50 or more; the mean score was 35.4 ± 13.7 (range 17-80 of 85). In logistic regression analysis, low income (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.01-3.61), recurrent stroke or TIA (OR 1.86, 1.10-3.16), more disability (OR 1.79, 1.43-2.23), and increased comorbidities (OR 1.90, 1.05-3.45) were independently associated with PTSD. Older age (OR .93, .90-.95), marriage or partnership (OR .52, .28-.98), and having emotional support (OR .25, .11-.54) were protective against developing PTSD. Participants with likely PTSD had worse physical and mental health. CONCLUSIONS In this racially and ethnically diverse cohort of stroke and TIA survivors, stroke-induced PTSD was associated with younger age, recurrent strokes, greater disability, and comorbidities. PTSD was associated with a substantially increased physical, mental, and quality of life burden in this already vulnerable population. Having social support was protective, suggesting a potential target for intervention.
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Affiliation(s)
- Judith Z Goldfinger
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York.
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York
| | - Kezhen Fei
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, New York
| | - Revathi Balakrishnan
- Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Stanley Tuhrim
- Department of Neurology, Mount Sinai School of Medicine, New York, New York
| | - Carol R Horowitz
- Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, New York
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Late onset and persistence of post-traumatic stress disorder symptoms in survivors of critical care. Can Respir J 2013; 20:429-33. [PMID: 24032124 DOI: 10.1155/2013/861517] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several recent studies have reported that post-traumatic stress disorder (PTSD) is a frequent occurrence in survivors of an intensive care unit (ICU) admission. OBJECTIVE To assess the frequency of PTSD symptoms at three and nine months post-ICU admission and examine possible risk factors that predispose to the development of PTSD symptoms. METHOD Using the following scales: Davidson Trauma Scale, Impact of Event Scale and the Post-traumatic Symptom Scale, 69 ICU survivors were assessed for PTSD symptoms at three months post-ICU admission. Of the original 69 patients, 37 completed the same questionnaires at the second follow-up at nine months post-ICU admission. Mean symptom levels for avoidance, intrusive thoughts and hyperarousal were calculated, and risk factors for the development of PTSD symptomatology were examined. RESULTS Depending on which scale was used, 16% to 33% of ICU survivors met the criteria for PTSD at either three or nine months. Younger age and the use of a prescription psychoactive medication at time of ICU admission were both independently associated with a higher risk of developing PTSD symptoms. Interestingly, symptoms of hyperarousal worsened during the follow-up interval for female patients, while they remained constant for males. CONCLUSION The frequency of PTSD symptoms was high in patients who survived an admission to the ICU. Depending on sex, symptoms may present and evolve differently. The adoption of screening tools and a multicentre ICU database in Canada is recommended to identify patients who are most at risk.
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Syme ML, Delaney E, Wachen JS, Gosian J, Moye J. Sexual self-esteem and psychosocial functioning in military veterans after cancer. J Psychosoc Oncol 2013; 31:1-12. [PMID: 23311968 DOI: 10.1080/07347332.2012.741096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Little is known about the sexual well-being of male Veteran cancer survivors, or the relationship of sexual concerns to psychosocial adaptation postcancer. This study examined the association between sexual self-esteem and psychosocial concerns in male Veteran cancer survivors. Forty-one male survivors were recruited from a Veterans Affairs (VA) hospital to participate in a pilot study addressing cancer survivorship care for Veterans. Sixty- to 90-minute interviews were conducted, assessing sociodemographic, medical, stress/burden (cancer-related posttraumatic stress disorder [PTSD], depression), and resource (social support, post-traumatic growth) variables. Twenty-one (51.2%) Veteran cancer survivors reported lowered sexual self-esteem as a result of cancer, which corresponded to significantly higher levels of depression and cancer-related PTSD. The lowered sexual self-esteem group also indicated significantly lower social support. Veteran cancer survivors with lowered sexual self-esteem tend to have higher levels of stress and lower levels of resources, putting them at risk for lowered quality of life. This increased risk highlights the importance of addressing sexual well-being in the survivorship care of Veterans.
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Affiliation(s)
- Maggie L Syme
- San Diego State University, Department of Psychology, SDSU/UCSD Cancer Center Comprehensive Partnership, San Diego, CA 92120, USA.
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Vin-Raviv N, Hillyer GC, Hershman DL, Galea S, Leoce N, Bovbjerg DH, Kushi LH, Kroenke C, Lamerato L, Ambrosone CB, Valdimorsdottir H, Jandorf L, Mandelblatt JS, Tsai WY, Neugut AI. Racial disparities in posttraumatic stress after diagnosis of localized breast cancer: the BQUAL study. J Natl Cancer Inst 2013; 105:563-72. [PMID: 23434900 DOI: 10.1093/jnci/djt024] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Little is known about the development of posttraumatic stress disorder (PTSD) over time among women diagnosed with breast cancer. This study examines changes in PTSD symptoms in the first 6 months after diagnosis and assesses racial/ethnic differences in PTSD symptomatology over time. METHODS We recruited women with newly diagnosed breast cancer, stages I to III, from three sites in the United States. Three telephone interviews were conducted: baseline at about 2 to 3 months after diagnosis, first follow-up at 4 months after diagnosis, and second follow-up at 6 months after diagnosis. We measured traumatic stress in each interview using the Impact of Events Scale; recorded sociodemographic, tumor, and treatment factors; and used generalized estimating equations and polytomous logistic regression modeling to examine the associations between variables of interest and PTSD. RESULTS Of 1139 participants, 23% reported symptoms consistent with a diagnosis of PTSD at baseline, 16.5% at first follow-up, and 12.6% at the second follow-up. Persistent PTSD was observed among 12.1% participants, as defined by having PTSD at two consecutive interviews. Among participants without PTSD at baseline, 6.6% developed PTSD at the first follow-up interview. Younger age at diagnosis, being black (odds ratio [OR] = 1.48 vs white, 95% confidence interval [CI] =1.04 to 2.10), and being Asian (OR = 1.69 vs white, 95% CI = 1.10 to 2.59) were associated with PTSD. CONCLUSIONS Nearly one-quarter of women newly diagnosed with breast cancer reported symptoms consistent with PTSD shortly after diagnosis, with increased risk among black and Asian women. Early identification of PTSD may present an opportunity to provide interventions to manage symptoms.
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Affiliation(s)
- Neomi Vin-Raviv
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Edmondson D, Horowitz CR, Goldfinger JZ, Fei K, Kronish IM. Concerns about medications mediate the association of posttraumatic stress disorder with adherence to medication in stroke survivors. Br J Health Psychol 2013; 18:799-813. [PMID: 23294320 DOI: 10.1111/bjhp.12022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 11/07/2012] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Post-traumatic stress disorder (PTSD) can be a consequence of acute medical events and has been associated with non-adherence to medications. We tested whether increased concerns about medications could explain the association between PTSD and non-adherence to medication in stroke survivors. DESIGN We surveyed 535 participants aged 40 years or older who had at least one stroke or transient ischaemic attack in the previous 5 years. METHODS We assessed PTSD using the PTSD checklist-specific for stroke, medication adherence with the Morisky Medication Adherence Questionnaire, and beliefs about medications with the Beliefs about Medicines Questionnaire. We used logistic regression to test whether concerns about medications mediated the association between stroke-induced PTSD and non-adherence to medication. Covariates for adjusted analyses included age, sex, race, comorbid medical conditions, stroke-related disability, years since last stroke/TIA, and depression. RESULTS Symptoms of PTSD were correlated with greater concerns about medications (r = 0.45; p < .001), and both were associated with medication non-adherence. Adjustment for concerns about medications attenuated the relationship between PTSD and non-adherence to medication, from an odds ratio [OR] of 1.04 (95% confidence interval [CI], 1.01-1.06; OR, 1.63 per 1 SD) to an OR of 1.02 (95% CI, 1.00-1.05; OR, 1.32 per 1 SD), and increased concerns about medications remained associated with increased odds of non-adherence to medication (OR, 1.17; 95% CI, 1.10-1.25; OR, 1.72 per 1 SD) in this fully adjusted model. A bootstrap mediation test suggested that the indirect effect was statistically significant and explained 38% of the association of PTSD to medication non-adherence, and the direct effect of PTSD symptoms on medication non-adherence was no longer significant. CONCLUSION Increased concerns about medications explain a significant proportion of the association between PTSD symptoms and non-adherence to medication in stroke survivors.
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Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, USA
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Mechanisms of psychological resiliency in women after mastectomy. Contemp Oncol (Pozn) 2012; 16:341-4. [PMID: 23788906 PMCID: PMC3687422 DOI: 10.5114/wo.2012.30065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 03/09/2012] [Accepted: 03/19/2012] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY To investigate into the mechanisms of resiliency in women after mastectomy. We hypothesized that the mechanism of resiliency in women with breast cancer would involve facilitation of adaptive coping strategies and inhibition of maladaptive strategies. We tested a mediational model in which resiliency was related to satisfaction with life through coping strategies. MATERIAL AND METHODS Thirty women after mastectomy aged 28-69 years (M = 53.23, SD = 9.00) completed the Ego Resiliency Scale, Mental Adjustment to Cancer Scale, and Satisfaction with Life Scale. RESULTS The bootstrapping technique revealed that there were significant indirect effects for positive reframing (95% CI: 0.01-0.36), hopelessness/helplessness (95% CI: 0.18-0.83) and anxious preoccupation (95% CI: 0.001-0.55) but not for fighting spirit. The models explained up to 33% of the variance in satisfaction with life. CONCLUSIONS Coping strategies fully explain the effect of resiliency on satisfaction with life in women after mastectomy. This finding provides additional evidence of the fundamental role of coping strategies in the mechanisms of resiliency. We obtained similar results in patients with type II diabetes and rheumatoid arthritis. The lack of significant associations of fighting spirit with resiliency suggests that this coping strategy may be beneficial for somatic health but its contribution to the mechanisms of psychological resiliency is complex.
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Jahn AL, Herman L, Schuster J, Naik A, Moye J. Distress and Resilience After Cancer in Veterans. RESEARCH IN HUMAN DEVELOPMENT 2012; 9:229-247. [PMID: 25774100 DOI: 10.1080/15427609.2012.705555] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Levi Herman
- Michael E. DeBakey VAMC, Houston, TX, and Baylor College of Medicine
| | | | - Aanand Naik
- Michael E. DeBakey VAMC, Houston, TX, and Baylor College of Medicine
| | - Jennifer Moye
- VA Boston Healthcare System and Harvard Medical School
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Kronish IM, Edmondson D, Goldfinger JZ, Fei K, Horowitz CR. Posttraumatic stress disorder and adherence to medications in survivors of strokes and transient ischemic attacks. Stroke 2012; 43:2192-7. [PMID: 22618380 DOI: 10.1161/strokeaha.112.655209] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Posttraumatic stress disorder (PTSD) can be triggered by life-threatening medical events such as strokes and transient ischemic attacks (TIAs). Little is known regarding how PTSD triggered by medical events affects patients' adherence to medications. METHODS We surveyed 535 participants, age ≥40 years old, who had at least 1 stroke or TIA in the previous 5 years. PTSD was assessed using the PTSD Checklist-Specific for stroke; a score ≥50 on this scale is highly specific for PTSD diagnosis. Medication adherence was measured using the 8-item Morisky scale. Logistic regression was used to test whether PTSD after stroke/TIA was associated with increased risk of medication nonadherence. Covariates for adjusted analyses included sociodemographics, Charlson comorbidity index, modified Rankin Scale score, years since last stroke/TIA, and depression. RESULTS Eighteen percent of participants had likely PTSD (PTSD Checklist-Specific for stroke ≥50), and 41% were nonadherent to medications according to the Morisky scale. A greater proportion of participants with likely PTSD were nonadherent to medications than other participants (67% versus 35%, P<0.001). In the adjusted model, participants with likely PTSD were nearly 3 times more likely (relative risk, 2.7; 95% CI, 1.7-4.2) to be nonadherent compared with participants without PTSD (PTSD Checklist-Specific for stroke <25) even after controlling for depression, and there was a graded association between PTSD severity and medication nonadherence. CONCLUSION PTSD is common after stroke/TIA. Patients who have PTSD after stroke or TIA are at increased risk for medication nonadherence.
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Affiliation(s)
- Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA.
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Varela VS, Ng A, Mauch P, Recklitis CJ. Posttraumatic stress disorder (PTSD) in survivors of Hodgkin's lymphoma: prevalence of PTSD and partial PTSD compared with sibling controls. Psychooncology 2011; 22:434-40. [PMID: 22162210 DOI: 10.1002/pon.2109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 10/24/2011] [Accepted: 11/04/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Studies of posttraumatic stress disorder (PTSD) document a significant proportion of cancer survivors reporting severe posttraumatic stress symptoms, even when they do not meet full diagnostic criteria. However, few studies have directly examined the clinical significance of these 'partial PTSD' symptoms in survivors. This study aimed to investigate the prevalence of PTSD symptoms in a cohort of long-term survivors of Hodgkin's lymphoma (HL) and to explore the clinical relevance of the partial PTSD phenomenon by assessing impairment of function secondary to sub-threshold symptomatology. METHODS The Posttraumatic Diagnostic Scale was completed by 105 HL survivors and 101 sibling controls. Survivors' age at time of participation ranged from 24 to 71 years, age at time of diagnosis ranged from 6 to 61 years, and the median time since diagnosis was 16 years (range = 7-34). RESULTS Posttraumatic stress disorder prevalence was not significantly higher in HL survivors (13%) compared with sibling controls (6.9%, p = 0.098). However, a significantly larger proportion of survivors (35.2%) met criteria for partial PTSD compared with siblings (17.8%, p = 0.004). Moreover, the majority of the survivors with partial PTSD (86.5%) reported experiencing some functional impairment related to these posttraumatic stress symptoms. CONCLUSIONS A significant number of HL survivors experience posttraumatic stress symptoms severe enough to result in functional impairment. This finding underscores the importance of future research detailing the psychological and functional outcomes in survivors with partial PTSD and of careful clinical practice that assesses for functional impairment secondary to partial PTSD symptomatology, in male and female survivors, even years after completion of therapy.
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DeRosa BW, Kazak AE, Doshi K, Schwartz LA, Ginsberg J, Mao JJ, Straton J, Hobbie W, Rourke MT, Carlson C, Ittenbach RF. Development and validation of the health competence beliefs inventory in young adults with and without a history of childhood cancer. Ann Behav Med 2011; 41:48-58. [PMID: 20936390 DOI: 10.1007/s12160-010-9228-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adolescent and young adult survivors of childhood cancer are a vulnerable population. Health beliefs may be related to necessary follow-up care. PURPOSE This study seeks to develop a measure of health beliefs for adolescents and young adults with and without a history of cancer. METHODS Inductive and deductive methods and focus groups were used to develop the Health Competence Beliefs Inventory. Cancer survivors (n = 138) and comparison participants (n = 130) completed the Health Competence Beliefs Inventory and other measures. Healthcare providers reported current medical problems. RESULTS A series of iterative exploratory factor analyses generated a 21-item four-factor solution: (1) Health Perceptions; (2) Satisfaction with Healthcare; (3) Cognitive Competence; and (4) Autonomy. Survivors reported significantly different Health Competence Beliefs Inventory scale scores than comparisons (p < .05). The Health Competence Beliefs Inventory was associated with beliefs, affect, quality of life, posttraumatic stress symptoms, and medical problems. CONCLUSIONS The Health Competence Beliefs Inventory is a promising measure of adolescent and young adult perceptions of health and well-being.
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Hines DA, Douglas EM. Symptoms of Posttraumatic Stress Disorder in Men Who Sustain Intimate Partner Violence: A Study of Helpseeking and Community Samples. PSYCHOLOGY OF MEN & MASCULINITY 2011; 12:112-127. [PMID: 21841915 PMCID: PMC3155425 DOI: 10.1037/a0022983] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extensive work has documented an association between sustaining intimate partner violence (IPV) and posttraumatic stress disorder (PTSD) among women, yet little research has documented the same association in men, even though men comprise 25-50% of all IPV victims in a given year. Previous studies also show that women who sustain intimate terrorism (IT), a form of IPV that is characterized by much violence and controlling behavior, are at even greater risk for PTSD than women who sustain common couple violence (CCV), a lower level of more minor, reciprocal IPV. However, no research has documented this trend in men who sustain IT versus CCV. The present study investigates the associations among sustaining IPV and PTSD among both a clinical and community sample of men. The clinical sample is comprised of 302 men who sustained IT from their female partners and sought help. The community sample is comprised of 520 men, 16% of whom sustained CCV. Analyses showed that in both samples, the associations between sustaining several types of IPV and PTSD were significant, and that men who sustained IT were at exponentially increased risk of exceeding the clinical cut-off on the PTSD measure than men who sustained CCV or no violence. The path models predicting PTSD symptoms differed for both samples, indicating that perhaps treatment implications differ by group as well.
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Anagnostopoulos F, Slater J, Fitzsimmons D. Intrusive thoughts and psychological adjustment to breast cancer: exploring the moderating and mediating role of global meaning and emotional expressivity. J Clin Psychol Med Settings 2010; 17:137-49. [PMID: 20376541 DOI: 10.1007/s10880-010-9191-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to investigate the moderating and mediating role of global meaning and emotional expressivity in the relationship between intrusive thoughts and psychological adjustment (as indicated by mental health status) in a sample of breast cancer patients (N=153). Coping with cancer was also included as an intervening variable to be tested. Moderating effects were explored using a series of hierarchical regression analysis, while multiple mediated effects were tested through bootstrapping procedures. Results showed that global personal meaning had both direct and indirect (mediating) effects on psychological adjustment. Emotional expressivity had neither moderating nor mediating effects on psychological adjustment. These results indicated that a strong sense of personal meaning and purpose in life, and an integrated understanding of self and life may lessen the impact of intrusive thoughts on breast cancer patients' psychological adjustment and mental health status. Implications of the findings for clinical practice and recommendations for future research are discussed.
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Affiliation(s)
- Fotios Anagnostopoulos
- Department of Psychology, Panteion University, 136, Syngrou Avenue, 176 71, Athens, Greece.
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Levin AO, Carpenter KM, Fowler JM, Brothers BM, Andersen BL, Maxwell GL. Sexual morbidity associated with poorer psychological adjustment among gynecological cancer survivors. Int J Gynecol Cancer 2010; 20:461-70. [PMID: 20375814 DOI: 10.1111/igc.0b013e3181d24ce0] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Sexual morbidity is a distressing and undertreated problem in gynecological cancer survivorship known to occur early and persist well beyond the period of physical recovery. Although often studied as a separate domain, sexuality represents an integral component of psychological adjustment and quality of life (QoL) that is adversely affected by cancer treatments. The present study tests the association between sexual morbidity, and adverse psychological adjustment and QoL outcomes. METHODS A cross-sectional design was used. The participants were gynecological (cervical, endometrial, ovarian, and vulvar) cancer survivors who were partnered (N = 186), whose cancer was diagnosed 2 to 10 years previously, and who were at least 6 months post any cancer therapy. Most had been found to have early-stage disease (70%) and were treated with hysterectomy (77%), chemotherapy (43%), and/or radiotherapy (23%). Sexual morbidity was operationalized as a multidimensional construct including sexual behavior, sexual functioning, and subjective sexual satisfaction, assessed by patient self-report. Outcomes included self-reported depressive symptoms, traumatic stress symptoms, cancer-specific stress, stress about body changes, and QoL. Nurse-rated of performance status and disruptive signs/symptoms of treatment toxicity, as well as relevant sociodemographic and disease variables were collected as potential controls. RESULTS Hierarchical multiple regression analyses tested sexual morbidity as a predictor of poor outcomes. All statistical models were significant, accounting for 12% to 53% of the variance in psychological adjustment/QoL. Sexual morbidity covaried with worsened depressive symptoms, body change stress, and psychological QoL beyond the negative contributions of (older) age, (poorer) performance status, and (greater) fatigue. Notably, disease and treatment variables were not statistically significant correlates of psychological adjustment or QoL. CONCLUSIONS These findings suggest that prevention or treatment of sexual morbidity might foster improved psychological adjustment/QoL. Given the high rates of sexual morbidity in this population and the connection between sexuality and broader psychological adjustment/QoL, there is a clear need for better integration of sexuality rehabilitation into routine clinical care.
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Affiliation(s)
- Anna O Levin
- Department of Psychology, The Ohio State University, Psychology Bldg 159, 1835 Neil Ave, Columbus, OH 43210-1222, USA
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Kline A, Falca-Dodson M, Sussner B, Ciccone DS, Chandler H, Callahan L, Losonczy M. Effects of repeated deployment to Iraq and Afghanistan on the health of New Jersey Army National Guard troops: implications for military readiness. Am J Public Health 2009; 100:276-83. [PMID: 20019304 DOI: 10.2105/ajph.2009.162925] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the effects of prior military service in Iraq or Afghanistan on the health of New Jersey Army National Guard members preparing for deployment to Iraq. METHODS We analyzed anonymous, self-administered predeployment surveys from 2543 National Guard members deployed to Iraq in 2008. We used bivariate and multivariate analyses to measure the effects of prior service in Afghanistan (Operation Enduring Freedom [OEF]) or Iraq (Operation Iraqi Freedom [OIF]) on mental and physical health. RESULTS Nearly 25% of respondents reported at least 1 previous OEF or OIF deployment. Previously deployed soldiers were more than 3 times as likely as soldiers with no previous deployments to screen positive for posttraumatic stress disorder (adjusted odds ratio [AOR]=3.69; 95% confidence interval [CI]=2.59, 5.24) and major depression (AOR=3.07; 95% CI=1.81, 5.19), more than twice as likely to report chronic pain (AOR=2.20; 95% CI=1.78, 2.72) and more than 90% more likely to score below the general population norm on physical functioning (AOR=1.94; 95% CI=1.51, 2.48). CONCLUSIONS Repeated OEF and OIF deployments may adversely affect the military readiness of New Jersey National Guard combat soldiers.
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Affiliation(s)
- Anna Kline
- Department of Veterans Affairs, New Jersey Health Care System, Lyons Campus, Mental Health and Behavioral Sciences (Bldg 143), 151 Knollcroft Rd, Lyons, NJ 07939-5000, USA.
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Mental health service utilization after physical trauma: the importance of physician referral. Med Care 2009; 47:1077-83. [PMID: 19648831 DOI: 10.1097/mlr.0b013e3181a80fc9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the availability of effective treatments for posttraumatic stress reactions after serious physical injuries, many sufferers do not use mental health services. Attempts to understand the factors that facilitate mental health service use have often focused on patient-related factors without assessing provider behavior. OBJECTIVES To examine the relative influence of patient-related factors and physician referral on mental health service utilization among patients after a traumatic physical injury. DESIGN A fully structured interview was administered prospectively by trained lay persons to Los Angeles Country trauma center injury patients. A total of 677 patients completed an initial interview. Of those who completed an initial interview, 70% (n = 476) completed a 6-month follow-up interview and 68% (n = 462) completed a 12-month interview. MEASURES We examined 3 classes of patient characteristics hypothesized to be related to mental health service use: need (eg, posttraumatic stress symptoms), predisposing factors (eg, gender), and enabling resources (eg, health insurance). Additionally, we looked at physician referral to mental health treatment as a provider behavior hypothesized to predict service use. RESULTS Age, posttraumatic stress disorder symptom severity, previous mental health treatment, and physician referral were all associated with mental health service use. Physician referral demonstrated the strongest relationship with mental health service utilization. While controlling for other factors, the odds of mental health service use were nearly 8 times higher for those respondents receiving a physician referral than for those without a referral. CONCLUSIONS Findings highlight the importance of physician referral in facilitating access to mental health services for trauma injury survivors.
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Mosher CE, DuHamel KN, Rini CM, Li Y, Isola L, Labay L, Rowley S, Papadopoulos E, Moskowitz C, Scigliano E, Grosskreutz C, Redd WH. Barriers to mental health service use among hematopoietic SCT survivors. Bone Marrow Transplant 2009; 45:570-9. [PMID: 19597417 PMCID: PMC2866642 DOI: 10.1038/bmt.2009.166] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study examined barriers to mental health service use and their demographic, medical, and psychosocial correlates among hematopoietic stem cell transplant (HSCT) survivors. A sample of 253 HSCT survivors who were 1- to 3-years post-transplant completed measures of demographic, physical, psychological, and social characteristics as well as a newly modified measure of barriers to mental health service use. Only 50% of distressed HSCT survivors had received mental health services. An exploratory factor analysis of the barriers to mental health service use scale yielded four factors: Scheduling Barriers, Knowledge Barriers, Emotional Barriers, and Illness-related Barriers. Patients with higher social constraints (perceived problems discussing the illness experience with significant others) reported higher levels of all four types of barriers. General distress and transplant-related posttraumatic stress symptoms were positively associated with emotional, knowledge, and illness-related barriers to mental health service use, whereas physical and functional well-being were inversely associated with these barriers. Having more knowledge barriers and more emotional barriers predicted a lower likelihood of receiving mental health services, as did lower levels of education and general distress. Results suggest that a significant number of HSCT survivors may benefit from education about mental health services that is tailored to individual barriers.
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Affiliation(s)
- C E Mosher
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA.
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Salsman JM, Segerstrom SC, Brechting EH, Carlson CR, Andrykowski MA. Posttraumatic growth and PTSD symptomatology among colorectal cancer survivors: a 3-month longitudinal examination of cognitive processing. Psychooncology 2009; 18:30-41. [PMID: 18481837 DOI: 10.1002/pon.1367] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The experience of cancer can be understood as a psychosocial transition, producing both positive and negative outcomes. Cognitive processing may facilitate psychological adjustment. METHODS Fifty-five post-treatment, colorectal cancer survivors (M=65.9 years old; SD=12.7), an average of 13 months post-diagnosis, were recruited from a state cancer registry and completed baseline and 3-month questionnaires assessing dispositional (social desirability), cognitive processing (cognitive intrusions, cognitive rehearsal), and psychological adjustment variables (posttraumatic growth (PTG), posttraumatic stress disorder (PTSD) symptomatology, depression, anxiety, positive affectivity). RESULTS PTSD symptomatology was positively associated with depression, anxiety, and negatively associated with positive affectivity. In contrast, PTG scores were unrelated to PTSD symptomatology, depression, anxiety, and positive affectivity. In addition, PTG was independent of social desirability. Notably, after controlling for age at diagnosis and education, multiple regression analyses indicated that cognitive processing (intrusions, rehearsal) was differentially predictive of psychological adjustment. Baseline cognitive intrusions predicted 3-month PTSD symptomatology and there was a trend for baseline cognitive rehearsal predicting 3-month PTG. CONCLUSIONS Additional research is needed to clarify the association between PTG and other indices of psychological adjustment, further delineate the nature of cognitive processing, and understand the trajectory of PTG over time for survivors with colorectal cancer.
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Affiliation(s)
- John M Salsman
- Evanston Northwestern Healthcare, Evanston, Illinois, USA.
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Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, Lytle LA, Ahmed RL. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials 2009; 30:233-45. [PMID: 19171204 DOI: 10.1016/j.cct.2009.01.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 12/15/2008] [Accepted: 01/04/2009] [Indexed: 01/02/2023]
Abstract
Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm. Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse. In clinical practice, this often translates into risk aversive guidance to avoid using the arm. This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living. Further, such guidance poses an additional barrier to staying physically active, potentially translating to weight gain, which has been shown to be associated with worse clinical course for women with lymphedema. We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity. Theoretically, this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side. The Physical Activity and Lymphedema (PAL) Trial is a recently completed randomized controlled exercise intervention trial that recruited 295 breast cancer survivors (141 with lymphedema at study entry, 154 at risk for lymphedema at study entry). The purpose of this report is to provide detail regarding the study design, statistical design, and protocol of the PAL trial.
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Affiliation(s)
- Kathryn H Schmitz
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA.
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Harris IA, Young JM, Rae H, Jalaludin BB, Solomon MJ. Predictors of post-traumatic stress disorder following major trauma. ANZ J Surg 2008; 78:583-7. [PMID: 18593415 DOI: 10.1111/j.1445-2197.2008.04578.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is a common sequel to physical trauma, but there is disagreement regarding the predictors of this condition. This study aims to examine the role of physical, psychosocial and compensation-related factors in the development of PTSD following major trauma. METHODS Participants were consecutive adult patients presenting to one major trauma centre with major trauma (Injury Severity Score 16 or higher). Baseline characteristics and clinical data were obtained from the hospital trauma database. The presence of PTSD (as measured by the PTSD Checklist, civilian version) and additional data were obtained from a questionnaire mailed to patients between 1 and 6 years after the injury. Multiple linear regression was used to identify significant independent associations with PTSD. RESULTS Among 355 patients (61.0% response fraction), 129 (36.3%, 95% confidence interval 43.2-53.2%) were classed as having PTSD. Symptoms of PTSD were not significantly related to measures of injury severity, the time since the injury, education level, household income or employment status at the time of injury. PTSD was significantly associated with younger age (P < 0.0001), the presence of chronic illnesses (P < 0.0001), unemployment at the time of follow up (P < 0.0001), use of a lawyer (P < 0.0001), blaming others for the injury (P = 0.003) and having an unsettled compensation claim (P = 0.007). CONCLUSION Post-traumatic stress disorder after major trauma was not related to measures of injury severity, but was related to other factors, such as blaming others for the accident and the processes involved in claiming compensation.
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Affiliation(s)
- Ian A Harris
- Orthopaedic Department, Liverpool Hospital, Sydney, New South Wales, Australia.
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Landmark BT, Bøhler A, Loberg K, Wahl AK. Women with newly diagnosed breast cancer and their perceptions of needs in a health-care context. J Clin Nurs 2008; 17:192-200. [DOI: 10.1111/j.1365-2702.2008.02340.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Griffiths JA, Morgan K, Barber VS, Young JD. Study protocol: the Intensive Care Outcome Network ('ICON') study. BMC Health Serv Res 2008; 8:132. [PMID: 18559099 PMCID: PMC2441614 DOI: 10.1186/1472-6963-8-132] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 06/17/2008] [Indexed: 11/19/2022] Open
Abstract
Background Extended follow-up of survivors of ICU treatment has shown many patients suffer long-term physical and psychological consequences that affect their health-related quality of life. The current lack of rigorous longitudinal studies means that the true prevalence of these physical and psychological problems remains undetermined. Methods/Design The ICON (Intensive Care Outcome Network) study is a multi-centre, longitudinal study of survivors of critical illness. Patients will be recruited prior to hospital discharge from 20–30 ICUs in the UK and will be assessed at 3, 6, and 12 months following ICU discharge for health-related quality of life as measured by the Short Form-36 (SF-36) and the EuroQoL (EQ-5D); anxiety and depression as measured by the Hospital Anxiety and Depression Scale (HADS); and post traumatic stress disorder (PTSD) symptoms as measured by the PTSD Civilian Checklist (PCL-C). Postal questionnaires will be used. Discussion The ICON study will create a valuable UK database detailing the prevalence of physical and psychological morbidity experienced by patients as they recover from critical illness. Knowledge of the prevalence of physical and psychological morbidity in ICU survivors is important because research to generate models of causality, prognosis and treatment effects is dependent on accurate determination of prevalence. The results will also inform economic modelling of the long-term burden of critical illness. Trial Registration ISRCTN69112866
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Affiliation(s)
- John A Griffiths
- ICS Trials Group, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
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Barnes VA, Davis H, Treiber FA. Perceived stress, heart rate, and blood pressure among adolescents with family members deployed in Operation Iraqi Freedom. Mil Med 2007; 172:40-3. [PMID: 17274264 PMCID: PMC3289099 DOI: 10.7205/milmed.172.1.40] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study compared the impact of the 2003 Operation Iraqi Freedom on heart rate (HR) and blood pressure (BP) and self-reported stress levels among three groups of self-categorized adolescents: (1) military dependents with family members deployed; (2) military dependents with no family members deployed; (3) civilian dependents. At the onset and end of the "major hostilities" of Operation Iraqi Freedom, 121 adolescents (mean age = 15.8 +/- 1.1 years) completed questionnaires evaluating the psychological impact of the war and were evaluated for HR and BP. The military deployed dependents exhibited significantly higher HR than other groups at both evaluations (both p < 0.04). Ethnicity by group interactions indicated that European American-deployed dependents had higher stress scores at both time points (p < 0.02). Military dependent European Americans exhibited higher systolic BP compared to the other groups on the second evaluation (p < 0.03).
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Affiliation(s)
- Vernon A Barnes
- Department of Pediatrics, Medical College of Georgia, Augusta, GA 30912, USA
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