Depressive symptoms associated with physical health problems in midlife women: A longitudinal study

BACKGROUND

It is unclear if the relationship between depression and physical health problems in women is related to age, reproductive stage, obesity or socio-demographic risk factors.

METHODS

Longitudinal data were obtained every 6 months for 36 months in 264 midlife African American, Caucasian and Latina women who began the study as healthy regularly menstruating 40 to 50-year-olds; 75 transitioned to peri- or post-menopause by 36 months. Scores of 16 or higher on the Center for Epidemiologic Studies-Depression (CES-D) scale were used to estimate depression risk.

RESULTS

Depression risk was 28% at study initiation and 25% at 36 months. Significantly more women at risk for depression were unemployed, obese, or hypertensive. Women at risk were more likely to become peri- or post-menopausal during the study period. A higher percentage (38%) of overweight and obese women had CES-D scores ≥ 16 compared to normal weight women (23%; p < .001). Over half (58%) of the 73 women at higher depression risk at the initial visit reported a health problem or chronic illness at 36 months, compared to only 36% of the 191 women with CES-D scores <16 (p = .001).

LIMITATIONS

This was a secondary analysis of data from a relatively healthy sample of women in the decade before menopause. Chronic illness was self-reported and the CES-D is a screening tool for depressive symptoms rather than a clinical diagnostic tool.

CONCLUSIONS

Health care providers may be underestimating the impact of unemployment on depressive symptoms, obesity and chronic health problems in midlife women.

Sleep disturbance in midlife women

Emphasizing midlife women, this review describes sleep and compares self-report sleep data with objective findings from laboratory studies of women. Sleep disturbance is a more prevalent complaint for women than men. Not due to chronologic age per se, it is associated with menopausal symptoms and most importantly with comorbidities and stress. Sleep problems in midlife women should not be attributed only to the menopausal symptom experience and should trigger a clinical evaluation. Assessment guidelines are included.

Poststroke Depression Incidence and Risk Factors

Depression is a frequent complication of stroke, but few nurse researchers have studied poststroke depression (PSD). We reviewed all published research (January 1980-March 2005) that examined the incidence of and risk factors for depression among stroke survivors during the first 3 months after stroke. Many of the 49 studies reviewed were complicated by methodological limitations, including differing definitions of stroke and depression, the use of screening instruments to diagnose depression, selection bias, assessment at different time intervals poststroke, exclusion of patients with physical or cognitive impairments, and failure to control for associated variables. The incidence of PSD ranged from 5% to 63%. A history of depression, increased stroke severity, and poststroke cognitive or physical impairment were found to be risk factors for PSD.

Essential educational content for advanced practice in psychiatric consultation liaison nursing

Psychiatric Consultation Liaison Nursing (PCLN), an advanced practice subspecialty of psychiatric mental health nursing, has evolved over the last 4 decades in response to increased recognition of the importance of psychophysiological interrelationships and their impact on wellness, physical illness, and recovery. PCLN specialists practice in many countries although there are few PCLN programs in schools of nursing. This article defines PCLN, reviews its history, and recommends essential educational content for inclusion in a master's curriculum to prepare graduates for competent and effective PCLN practice. The educational content is based on the work of the PCLN Core Curriculum Task Force of the International Society of Psychiatric Consultation Liaison Nurses and is integrated with the 1990 Standards of Psychiatric Consultation Liaison Nursing Practice and the 2000 Standards of Psychiatric-Mental Health Nursing Practice. The relationship of the PCLN educational content to other national curriculum guidelines is discussed in the proposed PCLN curriculum content.

Statutory and regulatory issues for clinical nurse specialist (CNS) practice: ensuring the public's access to CNS services

The practice environment of healthcare in the United States is fluid, dynamic, and sometimes chaotic. Statutory, regulatory, and credentialing requirements are critical elements of this changeable environment affecting clinical nurse specialists (CNSs) and other advanced practice nurses (APNs). CNSs are estimated to comprise approximately 54,000 APNs, based on the 2000 National Sample Survey of Registered Nurses. Although statutes and regulations related to APNs are reviewed regularly, there has not been a critical analysis of statutes and regulations specifically governing CNS practice in the United States. This lack is largely due to the absence of a national association devoted to CNSs before 1995. However, recently there has been a resurgence of interest and need for CNS services. Therefore, it is particularly important that any statutory and/or regulatory barriers to CNS practice be removed. In 1998, the National Association of Clinical Nurse Specialists Legislative and Regulatory Committee embarked on a critical analysis of state statutes and regulations governing CNS practice. All 50 state boards of nursing and the District of Columbia board of nursing were requested to send copies of their statutes and regulations governing CNS practice. Responses were received from 48 states. This article summarizes the state of regulation of CNS practice and identifies significant barriers to CNS practice that should be systematically addressed. The patchwork quilt of CNS regulation that varies from state to state results in over-restrictive and underinclusive provisions that preclude ease of reciprocity and deprive the public full access to CNS services. Recommendations for addressing the barriers are made.

Role diversification in the education of advanced practice psychiatric nurses

The mode, location, and focus of health care services are changing rapidly, especially delivery of psychiatric services. The high prevalence of psychiatric and medical comorbidity, the national shift in health care to a managed care arrangement with one professional designated as principle provider, and problems with access to comprehensive services for individuals with psychiatric problems interact to create a compelling need for a clear definition of advanced psychiatric-mental health nursing practice. This article is, in part, a response to the national dialogue and debate sparked by the beginning development of a psychiatric nurse practitioner certification exam. However, this debate will be used merely as a starting point to articulate and document the need for a flexible, diverse, and evolving definition of advanced psychiatric-mental health nursing practice that can inform and shape educational programs in the discipline.

Cognitive assessment of the cardiovascular patient in the acute care setting

In acute care setting, patients with cardiovascular disease are at risk for changes in cognition caused by both disease and treatments. Cognitive impairment can result in a number of problems, such as communication difficulties, compromised safety, self-care deficits, and behavioral problems. This article reviews the role of the nurse in cognitive assessment, the incidence of cognitive complications in the cardiovascular patient population, the disorders of delirium and dementia, suggestions for and components of a cognitive assessment, and standardized tools for cognitive assessment.

Ethics in Japanese health care: a perspective for clinical nurse specialists

Bioethical issues relevant to nurses in Japan are described in this article. Significant Japanese values and behavior patterns, the impact of religion on ethical concerns, patient and family roles in illness, and relationships with the physician are described. Within this context, Japanese nursing involvement in ethics and selected ethical issues are explored with examples.

The psychiatric liaison nurse's role with families in acute care

The role of the psychiatric liaison nurse with families has been described. In an attempt to differentiate the psychiatric liaison nurse's role from others on the liaison team, the emphasis is on the role in response to problematic interactions between families and nursing staff that revolve around nursing care and management of the patient. Four common problems reflecting family coping behaviors are identified. Case examples illustrate direct and indirect liaison nurse interventions in two of the problem situations as a suggestion of the possible range of creative approaches that may be used in a systems-oriented liaison approach. The key is recognition of the interdependence of the family, patient, and staff within the total environment and the development of approaches that are based on the principles of management for liaison work with families.