Trauma History and Social Support Among American Indian/Alaska Native and Non-Native Survivors of Intimate Partner Violence

Social support (SS) is one of the most important protective factors against the deleterious effects of trauma exposure on mental health, but only a few studies have looked at predictors of SS among trauma-exposed populations. This study examines what predicts SS from friends, family, and other significant individuals in an ethnically diverse group of 61 women residing in Alaskan shelters for women who have experienced Intimate Partner Violence (IPV). Results from bivariate tests indicated that survivors who identified as American Indian or Alaska Native (AIAN) reported significantly higher SS from family (M = 5.04, SD = 1.74) in comparison with those who do not identify as AIAN (M = 3.80, SD = 2.31), t(56) = 2.24, p < .05. Income was positively correlated with higher SS from friends, r(59) = .33, p < .05. Lifetime history of interpersonal trauma was significantly and negatively related to variation in SS across multiple domains. When sociodemographic variables, trauma history, and violent relationship history were entered into a multiple regression, this model predicted 34% (p < .001) of the variance in Overall SS and 22% (p < .01), 32% (p < .001), and 17% (p < .05) of SS from family, friends, and other significant individuals, respectively. Taken together, these preliminary results suggest that income, race, lifetime interpersonal trauma history, and number of violent partners are important predictors of SS among women IPV survivors residing in shelters.

Association of illness perception with chemotherapy-induced nausea and vomiting: a Turkish Oncology Group (TOG) study

Chemotherapy-induced nausea and vomiting (CINV) may be linked to the psychological status of cancer patients. Therefore, the authors aimed to better understand the underlying risk factors for CINV using the Brief Illness Perception Questionnaire. A total of 238 patients were recruited during three cycles of chemotherapy. Patient, disease and treatment characteristics were noted at the onset of chemotherapy. The Brief Illness Perception Questionnaire was administered face-to-face prior to chemotherapy. The relationship between illness perceptions and CINV was analyzed using Spearman's rank correlation. Positive illness perception parameters, including personal and treatment control, were negatively correlated, whereas negative illness perception parameters, including consequences, timeline, identity, concern and emotions, were positively correlated with CINV after adjusting for age, sex and emetogenic potential of chemotherapy (p < 0.001). Illness perception may be an underlying risk factor for CINV.

Regarding the Necessity of Functional Assessment Including Motor Control Assessment of Post-Mastectomy Patients Qualified for Latissimus Dorsi Breast Reconstruction Procedure-Pilot Study

The purpose of the paper is a functional assessment of post-mastectomy patients who underwent latissimus dorsi breast reconstruction (LDBR), and of healthy women, through an analysis of selected muscle function parameters, including motor control assessment. Twenty participants were included in the study (ten LDBR-procedure individuals and ten healthy controls). The research consisted of a DASH (The Disabilities of the Arm, Shoulder and Hand) questionnaire assessment, shoulder area static assessment, shoulder mobility assessment, latissimus dorsi flexibility assessment and shoulder motor control assessment. LDBR-procedure individuals-when compared to healthy controls-exhibited a decrease in physical aspects of quality of life, shoulder area postural alterations, limitations in shoulder mobility and decrease in shoulder motor control. LDBR procedure may have an influence on limiting shoulder active mobility, as well as on decrease of shoulder motor and postural control. Standard functional assessment diversified on motor control assessment of post-mastectomy patients qualified for the LDBR procedure seems to be necessary.

Using a Gratitude Intervention to Improve the Lives of Women With Breast Cancer: A Daily Diary Study

Gratitude can be understood in two ways: as a state of being grateful for things and people, and as a disposition. Research suggests that focusing on reasons for being grateful promotes various aspects of well-being. The present study examined the effectiveness of a gratitude intervention for women with breast cancer. Each day for 2 weeks, 42 women with breast cancer described their psychological well-being, social support, and coping strategies. Women in the intervention condition reported the reasons why they felt grateful that day. Moreover, all participants took part in a pre-test session where trait measures were taken to control for dispositional differences. Listing the reasons for gratitude led to higher levels of daily psychological functioning, greater perceived support, and greater use of adaptive coping strategies. These results suggest that gratitude interventions may improve the lives of oncological patients.

Depression predicts longitudinal declines in social support among women with newly diagnosed breast cancer

OBJECTIVE

Among breast cancer survivors, low social support is associated with adverse clinical and psychosocial outcomes. This study prospectively examined longitudinal trends in perceived social support in women with newly diagnosed breast cancer as a function of depression status prior to initiation of cancer treatment.

METHODS

One hundred ten patients with newly diagnosed breast cancer and 59 age-matched noncancer controls completed behavioral measures at four assessments: prior to treatment and at 1 month, 1 year, and 2 years post-treatment. Participants reported their perceived tangible and emotional/informational support using the Medical Outcomes Study Social Support Survey and were categorized as "depressed" or "non-depressed" based on the Brief Symptom Inventory-18 (BSI-18). Analyses first compared longitudinal trends in support between patients and controls and then examined differences in longitudinal trends as a function of depression status in patients only, controlling for key covariates.

RESULTS

Both tangible and emotional/informational support decreased among breast cancer patients but increased or remained unchanged among noncancer controls across the assessments. Among patients, depressed individuals experienced a significant decline in both tangible (P = 0.004) and emotional/informational support (P = 0.013) between 1 month and 1 year post-treatment, which remained unchanged between 1 year and 2 years post-treatment. In contrast, nondepressed individuals had stable levels across all assessments. Depressed patients also had lower levels of both support types compared with nondepressed patients across all assessments.

CONCLUSIONS

Breast cancer patients with depressive symptomatology have an elevated risk for declines in perceived social support over time.

Relationship between social support, quality of life, and Th2 cytokines in a biobehavioral cancer survivorship trial

OBJECTIVE

Benefits of social support (SS) during cancer survivorship are complex. This study examines change in SS over time in cervical cancer (CXCA) survivors who have completed definitive treatment and how changing SS impacts quality of life (QOL) and T-helper type 2 (Th2) cytokines.

METHODS

We conducted a randomized trial in 204 CXCA survivors to test if psychosocial telephone counseling (PTC) could improve QOL compared to usual care (UC). Although PTC did not target SS, data were collected at baseline, 4 and 9 months post-enrollment using the Medical Outcomes Survey Social Support scale. Biospecimens were collected to investigate associations with patient-reported outcomes. Data were analyzed using multivariate linear models and stepwise regression.

RESULTS

Participants' mean age was 43. PTC participants experienced increasing SS compared to UC at 4 months (PTC-UC = 5.1; p = 0.055) and 9 months (PTC-UC = 6.0; p = 0.046). Higher baseline SS and increasing SS were independently associated with improved QOL at 4 and 9 months after adjusting for patient characteristics (p < 0.05). Differences between study arms were not statistically significant. Improvements in QOL at 4 months were observed with increases in emotional/informational and tangible SS. Increasing SS predicted significant longitudinal decreases in IL-4 and IL-13 at 4 months that were larger in the PTC arm (interactions p = 0.041 and p = 0.057, respectively).

CONCLUSION

Improved SS was significantly associated with improved QOL independent of patient characteristics and study arm. Decreasing Th2 cytokines with increasing SS and QOL are consistent with a biobehavioral paradigm in which modulation of the chronic stress response is associated with shifts in immune stance.

Illness perception is a strong parameter on anxiety and depression scores in early-stage breast cancer survivors: a single-center cross-sectional study of Turkish patients

BACKGROUND

Illness perception has been suggested to have a significant effect on anxiety and depression in cancer patients. In this cross-sectional study, we aimed to evaluate this on Turkish breast cancer patients with follow-up periods up to 12 years.

PATIENTS AND METHODS

A total of 225 patients (with 6 months to 12 years follow-up) were recruited in this cross-sectional study. The patients were divided into three groups of follow-up: 6 months-2 years, 2-5 years, and >5 years. Beck Depression Inventory, Beck Anxiety Inventory, Duke-University of North Carolina Functional Social Support Questionnaire, and Brief Illness Perception Questionnaire were used to assess the depression, anxiety, functional social support (FSS), and illness perception, respectively. Statistical significance of the associations was analyzed using Spearman correlation, Student's t, Mann-Whitney U, and ANOVA tests.

RESULTS

Rates of moderate-severe anxiety and depression scores were not correlated with follow-up period and disease stage, whereas all these parameters were associated significantly with FSS and age. Parameters of illness perception were also not correlated with follow-up period and stage of disease. However, illness perception scores were noticeably better with increments in FSS. Also, the parameters of illness perception were strongly associated with the depression/anxiety score.

CONCLUSION

Illness perception is an important determinant of the depression/anxiety score in Turkish breast cancer patients.

Psychosocial Factors Related to the Correspondence of Recipient and Provider Perceptions of Social Support among Patients Diagnosed with or at Risk for Malignant Melanoma

This study examined considered perceptions of social support and factors contributing to increased support among 18 patients diagnosed with or at risk for malignant melanoma and their partners. Partner support, perceived stress, emotional approach coping and partner empathy were evaluated. Results showed lack of correspondence between patient and partner reports of support. Greater correspondence between reports was associated with increased patient emotional approach coping. Partners reported increased empathy following the patients’ diagnoses and more perceived stress than patients. Patients indicated greater use of emotional approach coping than their partners. Male partners reported engaging in less emotional expression than female partners. Interventions might incorporate partner participation to resolve misperceptions of support and to foster factors that promote increased support.

Couple relationships in families with dependent children after a diagnosis of maternal breast cancer in the United Kingdom: Perspectives from mothers and fathers

This article examines the facilitators and the barriers to couple relationships in families in the UK with dependent children after a diagnosis of maternal breast cancer. Qualitative data were collected through in-depth semi-structured interviews with 23 participants, including 10 couples and three women whose partners did not take part. Recorded interviews were analyzed using a thematic approach identifying themes and patterns in the interview transcripts and categorizing them using a framework. Key individual and contextual factors perceived as barriers or facilitators to couple relationships included: being a "young" family with young children, frustration and resentment from male partners, women's reactions to the illness, individual communication styles, differing needs for "personal space," body image concerns, and social support. Findings indicated the need for strengthening "family focus" in services with adequate support for male partners. Health and family services should consider variability in the experiences of couples with dependent children and be sensitive to the needs of partners alongside the women.

A closer look at unmet needs at the end of primary treatment for breast cancer: a longitudinal pilot study

This study describes the nature of unmet needs (UN) as women with breast cancer transition from "patient" to "survivor." Data are from a longitudinal study of 90 women with stage I-III breast cancer. Data were collected 2-3 weeks before, and 10 weeks after, completion of radiation. A modified Cancer Survivors' Unmet Needs (CaSUN) instrument measured UN. Most participants reported ≥1 unmet need at baseline (80.00%) and follow-up (69.31%), with UN across physical, healthcare, information, psychosocial, and survivorship domains. Total number of UN declined over time, t(87) = 3.00, p < .01. UN likely to persist from baseline to follow-up involved cancer recurrence concerns, stress management, household responsibilities, and others not acknowledging/understanding cancer. Younger women (p = .01) and those with more severe (p < .01), life-interfering (p = .01) symptoms had greater burden of UN. This study highlights the dynamics of UN in the weeks before and after primary treatment. Future studies should identify long-term consequences of persistent UN.

Long-term fatigue state in postoperative patients with breast cancer

OBJECTIVE

To investigate the prevalence of long-term fatigue, anxiety, depression and social support, and the relationships among these symptoms in postoperative patients with breast cancer.

METHODS

A total of 180 postoperative patients with breast cancer meeting criterion were recruited in this cross-sectional study. The Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale (HADS) and The Social Support Survey-Chinese version were used to assessing the fatigue, anxiety and depression, Social support of participants. The magnitude of the relationship among the symptoms of fatigue and other variables was measured by Spearman Rho correlation.

RESULTS

The prevalence of long-term fatigue was 52.7%, and 18.3% occurred moderate/severe fatigue. Two-thirds of patients had a basal social support, only 12.8% of patients had better-perceived social support. Results of HADS showed that 16.7% and 21.1% of the participants have anxiety or depression disorder. Moderate/severe fatigue was negatively correlated with social support (r=-0.158, P=0.038) and positively correlated with age (r=0.132, P=0.042), chemotherapy (r=0.297, P=0.027), anxiety (r=0.324, P=0.018) and depression (r=0.211, P=0.034).

CONCLUSIONS

Long-term fatigue was highly prevalent among over half of postoperative patients with breast cancer, and moderate/severe fatigue was associated with social and psychological factors such as social support, anxiety and depression. Our results suggest that overall nursing care may be a more effective manner in improving fatigue and quality of life.

Emotions and social relationships for breast and gynecologic patients: a qualitative study of coping with recurrence

BACKGROUND

In contrast to the large literature on patients' coping with an initial diagnosis of cancer, there have been few quantitative or qualitative studies of patients coping with recurrence. A qualitative study was undertaken to aid in the development of a tailored intervention for these patients.

METHODS

Individuals (N=35) receiving follow-up care for recurrent breast or gynecologic cancer at a university-affiliated cancer center participated in an individual or a group interview. Transcripts of interviews were analyzed using a coding format with two areas of emphasis. First, we focused on patients' emotions, as there is specificity between emotions and the corresponding ways in which individuals choose to manage them. Secondly, we considered the patients' social environments and relationships, as they too appear key in the adjustment to, and survival from, cancer.

RESULTS

Patients identified notable differences in their responses to an initial diagnosis of cancer and their current ones to recurrence, including the following: (i) depressive symptoms being problematic; (ii) with the passing years and the women's own aging, there is shrinkage in the size of social networks; and (iii) additional losses come from social support erosion, arising from a) intentional distancing by social contacts, b) friends and family not understanding that cancer recurrence is a chronic illness, and/or c) patients stemming their support requests across time.

CONCLUSION

The contribution of these findings to the selection of intervention strategies is discussed.

Uncertainty management and information seeking in cancer survivorship

Uncertainty is a common experience among people coping with chronic illness. For many individuals, managing information is used as a means of coping with illness-related uncertainty. In-depth interviews with 60 cancer survivors and partners were conducted. Many of the participants in this study reported feeling uncertain about the challenges awaiting them in cancer survivorship and reported experiencing various information behaviors and challenges relating to their uncertainty management. These results have important implications for health care providers and imply that continued care and information provision, after cancer treatment is complete, would facilitate adaptive survivorship.

Structural and reliability analysis of quality of relationship index in cancer patients

Among psychosocial factors affecting emotional adjustment and quality of life, social support is one of the most important and widely studied in cancer patients, but little is known about the perception of support in specific significant relationships in patients with cancer. This study examined the psychometric properties of the Quality of Relationship Inventory (QRI) by evaluating its factor structure and its convergent and discriminant validity in a sample of cancer patients. A total of 388 patients completed the QRI. Convergent validity was evaluated by testing the correlations between the QRI subscales and measures of general social support, anxiety and depression symptoms. Discriminant validity was examined by testing group comparison. The QRI's longitudinal invariance across time was also tested. Principal axis factor analysis with promax rotation identified three factors accounting for 42.99% of variance: perceived social support, depth, and interpersonal conflict. Estimates of reliability with McDonald's ω coefficient were satisfactory for all the QRI subscales (ω ranging from 0.75 - 0.85). Satisfaction from general social support was negatively correlated with the interpersonal conflict subscale and positively with the depth subscale. The interpersonal conflict and social support scales were correlated with depression and anxiety scores. We also found a relative stability of QRI subscales (measured 3 months after the first evaluation) and differences between partner status and gender groups. The Quality of Relationship Inventory is a valid tool for assessing the quality of social support in a particular relationship with cancer patients.

What happens now? Psychosocial care for cancer survivors after medical treatment completion

The growing population of adults living with a history of cancer in the United States mandates attention to quality of life and health in this group, as well as to the implementation of evidence-based interventions to address psychosocial and physical concerns at completion of medical treatments and beyond. The goals of this article are to document the need for attention to psychosocial domains during the re-entry and later phases of the cancer survivor trajectory, offer an overview of current evidence on efficacy of psychosocial interventions during those phases, and offer suggestions for application and research regarding post-treatment psychosocial care.

Enacted support during stressful life events in middle and older adulthood: an examination of the interpersonal context

Individuals often turn to their close social ties for support during stressful life events. Although a great deal of work examines perceived support (i.e., support believed to be available should an event occur), less is known about enacted support (i.e., support actually provided during stressful events), especially among middle-aged and older people. The present study investigated whether enacted support (emotional or instrumental) varies by relationship quality and stress appraisals. Participants included 152 adults (principal respondents; aged 50 to 69 years, 63% women) who had experienced three or more stressful life events in the last year and 180 of their identified supportive ties (core network members). Multilevel models revealed that higher quality relationships enact high levels of support irrespective of high or low stress appraisals. In contrast, lower quality relationships enact greater support under conditions of higher stress but less support under conditions of lower stress, suggesting that lower quality relationships are mobilized only under higher levels of stress. Findings are consistent with the support provision process model and highlight the importance of considering relationship context and the stress continuum in studies of enacted support among older adults.

Unmitigated agency, social support, and psychological adjustment in men with cancer

Unmitigated agency (UA), a gender-linked characteristic, has been associated with poorer cancer adjustment. Support from one's social network typically predicts adjustment but may be poorly matched to UA. The influence of UA on the utility of social support on adjustment over time is examined. Men with cancer (N=55) were assessed initially and 6 months later on three indicators of adjustment. Multilevel modeling analyses varied by adjustment indicator. UA was associated with increased cancer-related psychosocial symptoms but not depressive symptoms or cancer-related thought intrusion. Social support predicted fewer depressive symptoms and less cancer-related thought intrusion. However, a cross-level interaction revealed that the utility of social support on cancer-related thought intrusion was weaker for men with greater levels of UA. Men with cancer likely respond differently to changes in social support depending on their endorsement of UA.

Distress and emotional well-being in breast cancer patients prior to radiotherapy: an expectancy-based model

Understanding precursors to distress and emotional well-being (EWB) experienced in anticipation of radiotherapy would facilitate the ability to intervene with this emotional upset (i.e. higher distress, lower EWB). Thus, this study tested an expectancy-based model for explaining emotional upset in breast cancer patients prior to radiotherapy. Women affected by breast cancer (N = 106) were recruited and participants completed questionnaires prior to commencing radiotherapy. Structural equation modelling was used to test a cross-sectional model, which assessed the ability of dispositional optimism (Life Orientation Test-Revised - two factors), response expectancies (Visual Analog Scale items), medical (type of surgery, cancer stage and chemotherapy history) and demographic (age, race, ethnicity, education and marital status) variables to predict both EWB (Functional Assessment of Chronic Illness Therapy - Emotional Well-being Subscale) and distress (Profile of Mood States - short version). The model represented a good fit to the data accounting for 65% of the variance in EWB and 69% in distress. Significant predictors of emotional upset were pessimism, response expectancies, Latina ethnicity, cancer stage and having had a mastectomy. These variables explained a large portion of emotional upset experienced prior to radiotherapy for breast cancer and are important to consider when aiming to reduce distress and improve EWB in this context.

The sequelae of anxiety in breast cancer: a human response to illness model

PURPOSE/OBJECTIVES

To provide a critical review of the empirical literature on anxiety in women with breast cancer using the physiologic, pathophysiologic, behavior, and experiential perspectives of the Human Response to Illness (HRTI) Model.

DATA SOURCES

Research articles, clinical articles, and Internet sources on breast cancer and anxiety. Literature sources included CINAHL, PubMed, and PsycINFO, incorporating English language reports through March 2009.

DATA SYNTHESIS

Patients with breast cancer experience fluctuating levels of anxiety throughout their diagnosis and treatment trajectory. Anxiety may influence an individual's response to treatment, treatment decision making, and overall quality of life.

CONCLUSIONS

Research consistently demonstrates that anxiety in patients with breast cancer can have a negative effect on patient outcomes.

IMPLICATIONS FOR NURSING

The insight gained from exploring anxiety within the context of the four interrelated perspectives of the HRTI model fosters the provision of optimal care for patients suffering with anxiety throughout their breast cancer illness trajectory.

When the going gets tough, does support get going? Determinants of spousal support provision to type 2 diabetic patients

Although spousal support has been linked to positive outcomes in various health-related contexts, some research has found that the amount of social support provided to those who are chronically ill deteriorates over time. The current study refines the literature by considering multiple factors associated with spouses' provision of emotional support to partners with Type 2 diabetes. This diary study (N = 126 couples) examined the roles that stressor (disease severity and diabetes-specific anxiety), recipient (negative and positive affect), provider (negative and positive affect), and relationship (tension and enjoyment) factors play in spouses' provision of emotional support. Daily disease severity, patients' and spouses' daily negative affect, and spouses' daily relationship enjoyment were predictors of support provision. Wives, but not husbands, provided more support on days when patients experienced diabetes-specific anxiety. Results advance understanding of support provision in the context of a chronic stressor.

Predicting stress-related problems in long-term breast cancer survivors

INTRODUCTION

Little is known about the early clinical and psychosocial factors associated with subsequent stress-related problems in breast cancer survivors.

METHODS

We used data collected at 3, 7, 11, and 15 months post-diagnosis to predict stress-related problems in 86 breast cancer survivors at 6 years post-diagnosis. We examined two common stress-related problems: (a) emotional distress and (b) intrusion and avoidance. Hypothesized risk factors included perceived stressfulness of the cancer; fear of the future; poor perceived health; initial stress-related problems; avoidance coping; and second cancer experience. Hypothesized protective factors included active coping (seeking social support; positive problem solving); optimism; and social support.

RESULTS

Hierarchical multiple regression analyses, controlling for age and education, indicated that positive problem-solving coping at 3 months and emotional distress at 7 months significantly predicted 6-year emotional distress (R(2)=.24, P<.01). Second cancer experience and 3-month intrusion and avoidance significantly predicted 6-year intrusion and avoidance (R(2)=.38, P<.001). In both cases, risk and/or protective factors measured at 11 and 15 months did not add significantly to the regression equations.

DISCUSSION/CONCLUSION

Symptoms of intrusion and avoidance should be monitored carefully during the first 3 months following diagnosis because they signal the risk that these symptoms will persist in the long-term. Elevated emotional distress at 7-months post-diagnosis and second-cancer experiences may signal the need for psychosocial intervention. Overreliance on positive problem solving to cope early in the disease trajectory may be detrimental in the longer term.

Distress among inflammatory bowel disease patients at high risk for colorectal cancer: a preliminary investigation of the effects of family history of cancer, disease duration, and perceived social support

Patients with inflammatory bowel disease (IBD) are one of only three groups at high risk for colorectal cancer (CRC), a leading cause of cancer-related mortality. Yet, no research has examined psychological effects of their high-risk status. The present study offered an initial investigation of three potential predictors of patient distress: disease duration, family history of cancer, and perceived social support. Longer disease duration and stronger family history of cancer are associated with elevated CRC risk in this already high-risk population. Perceived support was conceptualized as a resource that could decrease vulnerability to distress or buffer adverse psychological effects of disease duration and family history. Men and women (n = 223) with IBD participating in a colon disease family registry completed measures for this cross-sectional study. Family history of CRC and non-colorectal cancers among first-degree relatives (FDRs) and more distant relatives (DRs) was examined separately. Hierarchical multiple regression analyses revealed that having greater perceived support predicted lower generalized distress (p<0.001). Having an FDR history of CRC predicted higher CRC-specific distress (p = 0.02). Having a DR history of CRC also predicted higher CRC-specific distress, but only among patients diagnosed more recently (p = 0.03). Clinical implications of these findings are discussed along with future research directions.

Emotional support for men and women with cancer: do patients receive what their partners provide?

OBJECTIVES

In the context of mainly gastrointestinal cancer surgery, the study examines the course of spousal support in 173 dyads over half a year to illuminate the function of gender in support transactions.

METHOD

Provided and received emotional support were assessed in 108 male patient/female partner couples and 65 female patient/male partner couples. Using the Berlin Social Support Scales, assessments took place during the week before cancer surgery, 1 month, and 6 months after cancer surgery.

RESULTS

Gender differences emerged for support received and provided. Support received from partners was initially high for all patients, remained high over time for men, but decreased for women. Provided support decreased for male partners, but remained high in female partners. The effects were of medium size. Patients' received support was reflected by partners' reports of support provided. Women who reported received support 6 months after surgery had partners who had reported support provision 5 months earlier.

CONCLUSIONS

Alternative sources of support, in particular for women, such as their network of friends or professional help, may need to be identified. A couple-coping intervention could be implemented to help partners learn about each other's needs in times of crisis and ways to cope with adversity.

Coping, distress, and marital adjustment in couples with cancer: an examination of the personal and social context

We examined the links between coping and psychological outcomes in 53 patients who had undergone radiotherapy for cancer. Patients completed a coping survey and a measure of perceived support during a six-week course of radiation therapy and reported about their mental health and marital satisfaction one month following treatment. The prospective associations between coping and psychological distress and martial satisfaction depended upon the supportive context in which patients were coping. Seeking emotional support and using positive reappraisal were more effective (i.e., were significantly and positively correlated with marital satisfaction) for people low in spousal support than for people high in such support. Although men and women reported coping similarly with the cancer and had similar levels of adjustment, the association between coping and outcomes differed by gender; the associations for women were significantly stronger than they were for men. Results thus suggest that both individual and environmental characteristics moderate the associations between coping and outcomes in cancer survivors.

Predictors of spouses' provided support for patients receiving laparoscopic radical prostatectomy peri-surgery

Close relationships are usually the most important source of social support. But even in close relationships, symptoms of distress in one or both partners may undermine support processes. Seventy-seven patients receiving laparoscopic radical prostatectomy (44-73 years) and their spouses (38-72 years) provided data 1 day prior to surgery as well as 2 days and 2 weeks post-surgery. Our assumption that the commonly found support-eroding potential of receivers' depressive symptoms would not be evident during early stages of an acute crisis situation, such as major tumor surgery, tended to be supported by the data. However, depressive symptoms and degree of patient-reported post-operative pain were associated with a delayed decrease in spousal instrumental support provision 2 weeks after surgery. Spousal depression was largely unrelated to the provision of support. The present findings hint at the limits of a loved-one's capacity to assist in times of need.

Psychosocial Concerns and Interventions for Cancer Survivors

In light of the increasing population living with a history of cancer in the United States, it is important to attend to quality of life and health in this group, and to develop effective interventions to address psychosocial and physical concerns across the course of the cancer trajectory. The goals of this article are to document the need for attention to psychosocial domains; offer a brief overview of the current status of the empirical literature on effects of psychosocial interventions with cancer survivors, relying on systematic reviews and meta-analyses conducted in the last decade; highlight recent examples of randomized, controlled psychosocial intervention trials directed toward cancer survivors after the completion of primary medical treatments (ie, the re-entry phase and beyond); and identify directions for application and research.

Health psychology: psychological adjustment to chronic disease

Chronic diseases carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing on cancer, cardiovascular disease, and rheumatic diseases, we review longitudinal investigations of distal (socioeconomic variables, culture/ethnicity, and gender-related processes) and proximal (interpersonal relationships, personality attributes, cognitive appraisals, and coping processes) risk and protective factors for adjustment across time. We observe that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify critical issues for future research.

Self-efficacy, coping, and difficulties interacting with health care professionals among women living with breast cancer in rural communities

This study examined self-efficacy, coping, and social support in relation to difficulties interacting with physicians and nurses among women living with breast cancer. One hundred women living in rural, mountainous communities of northeastern California were recruited, with 89 providing complete data for this study. All women completed a battery of questionnaires that included the CARES--Medical Interaction Subscale and measures of self-efficacy, coping, satisfaction with social support, and demographic and medical characteristics. In a multiple regression analysis, difficulties interacting with medical professionals were found to be greater among women who were not married, who used more behavioral disengagement or less self-distraction to cope with breast cancer, and who reported less self-efficacy for affect regulation and for seeking and understanding medical information. Emotional venting and satisfaction with social support for dealing with cancer-related stress were not, however, significantly related to difficulties in interacting with the medical team. This model accounted for an adjusted value of 42% of the variance. Further research is needed to identify possible causal relationships related to these findings and to determine what interventions might be warranted to improve medical interactions for women with breast cancer living in rural areas.

Mismatches in Social Support and Psychosocial Adjustment to Breast Cancer

Emotional support is known to provide psychosocial benefits for women with breast cancer, but women can experience a mismatch between support that is wanted and support that is received from their personal supporter. The role of wanted and unwanted support in psychosocial adjustment was examined in 79 women recovering from breast cancer. Four distinct patterns of desired support actions were found using cluster analysis. Patterns of wanted support were not related to better or worse psychosocial adjustment. However, a misalignment of support between the provider and the receiver significantly influenced psychosocial adjustment, and unwanted but received support (support commission) was uniquely associated with poor psychosocial adjustment. Clinical interventions using the support instrument could help match support providers' actions to receivers' preferences.

Social support as a mediator of optimism and distress in breast cancer survivors

Breast cancer patients can experience emotional distress as a result of diagnosis and treatment. Higher levels of optimism and social support are associated with less emotional distress in cancer patients. This 12-month prospective study followed 69 women who had completed treatment for Stages 0-II breast cancer. At 3-month intervals, participants completed measures of mood disturbance, optimism, and social support. As hypothesized, affective social support mediated the relationship between optimism and distress in early-stage breast cancer survivors at baseline and 6 months but not at 1 year. In contrast, confidant social support did not mediate the optimism-distress relationship at any time point. Clinical and research implications of these findings are discussed.

The role of social support and self-esteem in the presence and course of depressive symptoms: a comparison of cancer patients and individuals from the general population

The key focus of this longitudinal study in the Netherlands was to determine the role of social support (i.e. perceived availability of emotional support, lack of received problem-focused emotional support, and negative interactions) and positive and negative self-esteem in depressive symptoms in 475 recently diagnosed cancer patients and 255 individuals without cancer from the general population. Patients and the comparison group were interviewed and filled in a questionnaire at two points in time: 3 months (T1) and 15 months (T2) after diagnosis. The results indicated that social support and self-esteem were weakly to moderately related to each other. Negative self-esteem was more strongly related to all three types of social support, compared to positive self-esteem. Regression analyses showed that social support and self-esteem were independently related to depressive symptoms (concurrently), such that lower levels of social support and self-esteem were strongly associated with higher levels of depressive symptoms. This finding suggests that these two resources supplement each other additively. A longitudinal analysis showed that social support and self-esteem also predicted future levels of depressive symptoms, although the explained variance was much lower than in a cross-sectional analysis. Comparisons between cancer patients and the comparison group generally revealed no significant differences between the two groups in the associations of social support and self-esteem with depressive symptoms. The only exception was a lack of problem-focused emotional support. At three months after diagnosis, a lack of this type of support, characterised by reassuring, comforting, problem-solving, and advice, was more strongly related to depressive symptoms in patients than in the comparison group.