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Abstract
Studies suggest that the relationship between psychosocial well-being and type 1 diabetes (T1D) is bidirectional, with T1D typically having a negative influence on psychological functioning, which in turn negatively affects the course of T1D. Here, we investigate the potential role of the capacity for mentalizing, or reflective functioning, in children and their mothers in diabetes control. We tested differences in mentalizing as assessed by the Reflective Functioning Scale in two groups of mother-son dyads with good (GDC) versus poor (PDC) diabetes control. Fifty-five boys (8-12 years old) and their mothers were recruited from the Juvenile Diabetes Foundation in Santiago, Chile. The mothers were interviewed with the Parental Development Interview and the children with the Child Attachment Interview, and both were scored for reflective functioning by using the Reflective Functioning Scale. Self-report measures of stress and diabetes outcomes were completed by the mothers and children, and levels of glycated hemoglobin (HbA1c) were assessed as an index of diabetes control. The results showed that both maternal and child reflective functioning were higher in the GDC than the PDC group and were negatively correlated with HbA1c in the total sample. Our findings suggest an important role for mentalizing in diabetes outcomes, but further prospective research is needed.
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Ctori I, Ahmad S, Subramanian A, Oskis A. Associations between adult attachment and vision-related quality of life in visually impaired individuals. PSYCHOL HEALTH MED 2020; 26:940-946. [PMID: 32508123 DOI: 10.1080/13548506.2020.1778749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE An attachment theory framework approach may allow insight into how social and psychosocial factors interact to impact vision-related quality of life (QoL). In this pilot study, we investigated potential associations between adult attachment style and visual function QoL of visually impaired individuals. METHODS We recruited 38 visually impaired individuals (15 females, 23 males; 51.8 ± 16.0 years). Visual function measures included distance and near visual acuity (VA) and contrast sensitivity. All participants completed: the 25-item National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ 25) and the Experiences in Close Relationships-Relationships Structures questionnaire. RESULTS Presenting conditions included inherited retinal dystrophy (n = 10), nystagmus (n = 9), glaucoma (n = 7) and other eye conditions (n = 12). There was a statistically significant negative correlation between the NEI-VFQ-25 composite score (45.5 ± 14.7) and attachment-related anxiety (r = -0.352, p = 0.033). The latter correlation still held when controlling for participants' level of vision (r = -0.352, p = 0.035). Despite the range of conditions and wide age range, these were not significantly correlated with any variable of interest in the current study. CONCLUSION Attachment-related anxiety ought to be taken into account when managing a visually impaired individual. Attachment-based approaches could be used to improve access to support services for visually impaired individuals, as well as self-management of their condition.
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Affiliation(s)
- Irene Ctori
- Applied Vision Research Centre, University of London, London, United Kingdom
| | - Salma Ahmad
- Applied Vision Research Centre, University of London, London, United Kingdom
| | - Ahalya Subramanian
- Applied Vision Research Centre, University of London, London, United Kingdom
| | - Andrea Oskis
- Faculty of Science and Technology, Department of Psychology, Middlesex University, London, United Kingdom
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Ardenghi S, Rampoldi G, Bani M, Strepparava MG. Attachment styles as predictors of self-reported empathy in medical students during pre-clinical years. PATIENT EDUCATION AND COUNSELING 2020; 103:965-970. [PMID: 31735595 DOI: 10.1016/j.pec.2019.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess medical students' attachment profile and to explore its relationship with empathy dimensions. METHODS Three cohorts of medical students were consecutively enrolled in the study at the beginning of their second year, before their clinical internship experience, and assessed using the Attachment Style Questionnaire (a self-report measure of attachment styles) and the Interpersonal Reactivity Index (a self-report measure of empathy). t-test, partial correlations, and multiple linear regression models were used to analyze relationships between attachment styles and gender, age, and empathy dimensions. RESULTS A total of 361 out of 450 (80.2%) Italian second-year medical students participated in the study. Female students considered interpersonal relationships more important and showed a higher need for approval than did their male counterparts. Among the attachment styles, considering relationships as secondary to achievement was the most important significant predictor of both emotional and cognitive empathy variables. CONCLUSIONS This study shows that the attachment styles of medical students are related to self-evaluated empathy, over and above the effects of gender and age differences. PRACTICE IMPLICATIONS The Attachment Style Questionnaire may be a useful tool for medical educators to identify medical students with low empathy scores during their pre-clinical years of study.
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Affiliation(s)
- Stefano Ardenghi
- School of Medicine and Surgery, University of Milano - Bicocca, 20900 Monza, MB, Italy
| | - Giulia Rampoldi
- Department of Human Sciences for Education, University of Milano - Bicocca, 20126 Milano, MI, Italy
| | - Marco Bani
- School of Medicine and Surgery, University of Milano - Bicocca, 20900 Monza, MB, Italy
| | - Maria Grazia Strepparava
- School of Medicine and Surgery, University of Milano - Bicocca, 20900 Monza, MB, Italy; Clinical Psychology Unit, San Gerardo Hospital, 20900 Monza, MB, Italy.
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McCabe E, Miciak M, Dennett L, Manns P, Guptill C, Hall J, Gross DP. Measuring therapeutic relationship in the care of patients with haemophilia: A scoping review. Health Expect 2018; 21:1208-1230. [PMID: 30160003 PMCID: PMC6250875 DOI: 10.1111/hex.12827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We conducted a scoping review of the tools used to measure therapeutic relationship in patients with haemophilia. BACKGROUND Haemophilia is an inherited bleeding disorder caused by a deficiency of a clotting factor in the blood. Therapeutic relationship is foundational to the management of patients with chronic diseases like haemophilia. A reliable and valid measurement tool for assessing therapeutic relationship is needed to evaluate the quality of care received by these patients, and to rigorously study the association between therapeutic relationship and the outcomes of treatment. METHODS We adopted the Arksey and O'Malley framework for scoping studies. The following electronic databases were searched for studies that measured a construct related to therapeutic relationships in haemophilia care: MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus. We inventoried these studies, identified the measurement tools used, and described each tool by purpose, content, measurement properties and target population. We identified gaps in the current evidence and directions for future research. RESULTS There were 253 unique records retrieved in the search, and twenty studies were deemed relevant. Ten measurement tools were identified. None of the tools measured therapeutic relationship as a single entity; however, six tools measured constructs considered part of patient-provider relationship (eg trust, communication, working alliance). There has been little validation testing of these tools in haemophilia patient populations. CONCLUSIONS There is a need for a validated tool for measuring therapeutic relationship in the care of patients with haemophilia. This review provides a foundation for future research in this area.
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Affiliation(s)
- Erin McCabe
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maxi Miciak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Performance Management and Evaluation, Alberta Innovates, Edmonton, AB, Canada
| | - Liz Dennett
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Patricia Manns
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Christine Guptill
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jeremy Hall
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB, Canada
| | - Douglas P Gross
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial. J Psychosom Res 2018; 108:39-46. [PMID: 29602324 DOI: 10.1016/j.jpsychores.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study. METHODS In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months. RESULTS Independent of treatment assignment, attachment was related to change in depression at 18 months (p < 0.01) with secure attachment resulting in a significant reduction (-2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = 0.040) and fearful-avoidant (-0.65, SE = 0.61, p = 0.012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = 0.93, SE = 0.47, p = 0.048). CONCLUSION Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group. TRIAL REGISTRATION www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576.
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Cassedy HF, Enander RA, Robinson RC, Evans HM, Frank B, Tucker C, Miltenberger PD, Pitts S, Stringer CA. Attachment Theory as a Model of Doctor-Patient Interaction. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/jabr.12036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Hannah F. Cassedy
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | - Richard A. Enander
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | - Richard C. Robinson
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | - H. Monroe Evans
- Division of Psychology; Department of Psychiatry; UT Southwestern Medical Center
| | | | - Christy Tucker
- Department of Obstetrics and Gynecology; Baylor University Medical Center
| | | | - Sandra Pitts
- Department of Obstetrics and Gynecology; Baylor University Medical Center
| | - C. Allen Stringer
- Department of Obstetrics and Gynecology; Baylor University Medical Center
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Adellund Holt K, Jensen PT, Gilså Hansen D, Elklit A, Mogensen O. Rehabilitation of women with gynaecological cancer: the association between adult attachment, post-traumatic stress disorder and depression. Psychooncology 2015; 25:691-8. [PMID: 26449611 DOI: 10.1002/pon.3996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We hypothesised that being diagnosed with gynaecological cancer influences adult attachment and occurrence of depression and post-traumatic stress disorder (PTSD). The main aim of the study was to assess changes in the attachment dimensions, PTSD and depression from baseline to 5-month post-treatment. Further, we evaluated the association between attachment avoidance/anxiety dimensions and PTSD/depression among women newly diagnosed with ovarian, endometrial, or cervical cancer. METHODS Consecutive Danish-speaking women aged 20 to 75 years and treated surgically for primary gynaecological cancer were eligible. All patients were offered a rehabilitation programme consisting of two face-to-face sessions and two phone calls carried out by a nurse. Patients were asked to complete the Revised Adult Attachment Scale, the Harvard Trauma Questionnaire and the Major Depression Inventory at baseline and at 5-month follow-up. In all, 151 women consent to participate in the sessions where 51 fulfilled Revised Adult Attachment Scale questionnaire and contribute with socio-demographic data. RESULTS We found significant positive changes within the attachment anxiety dimension among women with ovarian cancer, a significant reduction of PTSD among endometrial cancer patients and insignificant changes in depression among all cancer types. The attachment anxiety dimension significantly increased the odds for PTSD and depression. CONCLUSIONS Depression and PTSD were prevalent among ovarian and cervical cancer patients. The adjustment of rehabilitation according to patients' attachment anxiety dimension contains possibilities for indirect impact on PTSD and depression symptoms. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- K Adellund Holt
- Institute of Clinical Research, Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark.,Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark
| | - P T Jensen
- Department of Obstetrics and Gynaecology, Odense University Hospital, Odense, Denmark.,Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
| | - D Gilså Hansen
- Department of Public Health, National Research Centre of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - A Elklit
- National Center of Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - O Mogensen
- Research Unit of Gynaecology and Obstetrics, University of Southern Denmark, Odense, Denmark
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Cherry MG, Fletcher I, O'Sullivan H. Validating relationships among attachment, emotional intelligence and clinical communication. MEDICAL EDUCATION 2014; 48:988-997. [PMID: 25200019 DOI: 10.1111/medu.12526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/05/2013] [Accepted: 05/19/2014] [Indexed: 06/03/2023]
Abstract
CONTEXT In a previous study, we found that emotional intelligence (EI) mediates the negative influences of Year 1 medical students' attachment styles on their provider-patient communication (PPC). However, in that study, students were examined on a relatively straightforward PPC skill set and were not assessed on their abilities to elicit relevant clinical information from standardised patients. The influence of these psychological variables in more demanding and realistic clinical scenarios warrants investigation. OBJECTIVES This study aimed to validate previous research findings by exploring the mediating effect of EI on the relationship between medical students' attachment styles and their PPC across an ecologically valid PPC objective structured clinical examination (OSCE). METHODS Year 2 medical students completed measures of attachment (the Experiences in Close Relationships-Short Form [ECR-SF], a 12-item measure which provides attachment avoidance and attachment anxiety dimensional scores) and EI (the Mayer-Salovey-Caruso Emotional Intelligence Test [MSCEIT], a 141-item measure on the perception, use, understanding and management of emotions), prior to their summative PPC OSCE. Provider-patient communication was assessed using OSCE scores. Structural equation modelling (SEM) was used to validate our earlier model of the relationships between attachment style, EI and PPC. RESULTS A total of 296 of 382 (77.5%) students participated. Attachment avoidance was significantly negatively correlated with total EI scores (r = -0.23, p < 0.01); total EI was significantly positively correlated with OSCE scores (r = 0.32, p < 0.01). Parsimonious SEM confirmed that EI mediated the negative influence of attachment avoidance on OSCE scores. It significantly predicted 14% of the variance in OSCE scores, twice as much as the 7% observed in the previous study. CONCLUSIONS In more demanding and realistic clinical scenarios, EI makes a greater contribution towards effective PPC. Attachment is perceived to be stable from early adulthood, whereas EI can be developed using targeted educational interventions. The validation of this theoretical model of PPC in Year 2 medical students strengthens the potential educational implications of EI.
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Affiliation(s)
- M Gemma Cherry
- Department of Clinical Psychology, University of Liverpool, Liverpool, UK
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Abstract
This study presents an integrative review of the literature assessing the relationships among a patient's style in coping with a long-term health condition, the patient-practitioner therapeutic alliance, and treatment adherence among chronically ill adults. Evidence-based recommendations to improve nurse practitioner-patient therapeutic alliance and treatment adherence are suggested.
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Affiliation(s)
- Giovana G Silva
- Giovana G. Silva is an adult and geriatric nurse practitioner and Martha K. Swartz is a professor and associate dean at Yale University School of Nursing, West Haven, Conn. Sheila L. Molony is a directory of quality improvement at Connecticut Community Care, Inc., Wethersfield, Conn
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Dutton H, Rowan MS, Liddy C, Maranger J, Ooi TC, Malcolm J, Keely E. Patient Perspectives on Discharge from Specialist Type 2 Diabetes Care Back to Primary Care: A Qualitative Study. Can J Diabetes 2014; 38:191-7. [DOI: 10.1016/j.jcjd.2013.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 11/17/2022]
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Hyrkas K, Wiggins M. A comparison of usual care, a patient-centred education intervention and motivational interviewing to improve medication adherence and readmissions of adults in an acute-care setting. J Nurs Manag 2014; 22:350-61. [PMID: 24612391 DOI: 10.1111/jonm.12221] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 11/28/2022]
Abstract
AIM To compare medication adherence and readmissions in patients who received usual care vs. patient-centred interventions. BACKGROUND Medication adherence is a complex behaviour that may be improved with patient-centred strategies. METHOD A non-concurrent convenience sample of 303 hospitalised patients received either usual care (n = 98) or patient-centred interventions (n = 205). Intervention patients received teach-back and medication tools (n = 137) or motivational interviewing (n = 68). Data were collected at discharge (T1), at 48-72 hours (T2) and 30 days after discharge (T3). RESULTS No significant differences were found in medication adherence, therapeutic alliance, patients' experience and readmissions between groups. Patients in the motivational interview group reported lower confidence with medication adherence at T1 (P = 0.01) and T2 (P = 0.00) than the patient-centred intervention group. Motivational interviewing was a significant predictor (β = -1.55, P = 0.01, OR 0.21, 95% CI 0.06, 0.72) of fewer readmissions. CONCLUSION Overall, patients reported very low levels of non-adherence and very high levels of confidence and importance of medication adherence. IMPLICATIONS FOR NURSING MANAGEMENT Medication adherence continues to be an important area for clinical inquiry. For those patients who lack confidence for medication adherence, comprehensive patient-centred strategies such as motivational interviewing may improve treatment outcomes.
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Affiliation(s)
- Kristiina Hyrkas
- Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, ME, USA; School of Nursing, University of Southern Maine, Portland, ME, USA
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Thompson M. Occupations, habits, and routines: perspectives from persons with diabetes. Scand J Occup Ther 2013; 21:153-60. [DOI: 10.3109/11038128.2013.851278] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
When treatments are ordered for adolescent major depression, or for other adolescent medical illnesses, adherence and clinical outcomes are likely to be unsatisfactory, unless 4 basic principles of the medical treatment of adolescent illness are implemented. These comprise providing effective patient and parent/caregiver education, establishing effective patient and caregiver therapeutic alliances, providing effective treatment, and managing other factors associated with treatment adherence as indicated. The goals of treatment are to achieve the earliest possible response and remission. Failure to treat adolescent major depression successfully has potentially serious consequences, including worsened adherence, long-term morbidity, and suicide attempt. Accordingly, prescribed treatment must be aggressively managed. Doses of an antidepressant medication should be increased as rapidly as can be tolerated, preferably every 1-2 weeks, until full remission is achieved or such dosing is limited by the emergence of unacceptable adverse effects. A full range of medication treatment options must be employed if necessary. Treatment adherence, occurrence of problematic adverse effects, clinical progress, and safety must be systematically monitored. Adolescents with major depression must be assessed for risk of harm to self or others. When this risk appears significant, likelihood of successful outcomes will be enhanced by use of treatment plans that comprehensively address factors associated with treatment nonadherence. Abbreviated and comprehensive plans for the treatment of potentially fatal adolescent illnesses are outlined in this review.
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