1
|
Dischinger MI, Lange L, Vehling S. Loss of resources and demoralization in the chronically ill. Gen Hosp Psychiatry 2019; 61:10-15. [PMID: 31518884 DOI: 10.1016/j.genhosppsych.2019.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The study examined whether the association between the severity of physical symptoms and demoralization is mediated by loss of resources in individuals with chronic conditions including conventional diagnoses, functional somatic syndromes, and medically unexplained symptoms. METHOD This cross-sectional study evaluated N = 194 patients (mean age = 46, 83.5% female) who reported at least 3 months of persistent physical symptoms using the following self-report instruments: PHQ-15 (modified), Loss of Resources Inventory, Psychosocial Questionnaire - Demoralization Subscale, and PHQ-8. The mediation hypothesis was tested by multiple regression analyses controlling for age, race, employment status, income, educational attainment, and depression. RESULTS Participants experienced M = 9.3 out of 16 possible health-related losses (SD = 4.4). Average to severe demoralization scores were indicated by 59.1% of individuals, of which only 17.1% experienced high demoralization. Loss of resources fully mediated the effect of symptom severity on demoralization, explaining 56% of the variance of demoralization and inhibiting the initially significant effect of symptom severity on demoralization to nonsignificant levels [from b = 0.67, 95% CI (0.26, 1.07) to b = 0.03, 95% CI (-0.27, 0.32)]. CONCLUSION Early recognition of the loss of resources phenomena and interventions to reduce its progression through the introduction of resource gains may diminish, or even prevent, the installation of demoralization in individuals with chronic symptoms.
Collapse
Affiliation(s)
- M I Dischinger
- Department of Psychology, University of North Florida, Jacksonville, FL, United States.
| | - L Lange
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - S Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Vehling S, Tian Y, Malfitano C, Shnall J, Watt S, Mehnert A, Rydall A, Zimmermann C, Hales S, Lo C, Rodin G. Attachment security and existential distress among patients with advanced cancer. J Psychosom Res 2019; 116:93-99. [PMID: 30655000 DOI: 10.1016/j.jpsychores.2018.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Felt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer. METHOD A mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance. RESULTS The prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = -0.54, 95%CI: -0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization. CONCLUSION Attachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals.
Collapse
Affiliation(s)
- S Vehling
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Y Tian
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - C Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - J Shnall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - S Watt
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - A Mehnert
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - A Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - C Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Canada
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Scheffold K, Philipp R, Vehling S, Koranyi S, Engelmann D, Schulz-Kindermann F, Härter M, Mehnert A. Spiritualität und Bindung im Kontext fortgeschrittener Krebserkrankung – eine Mediation. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K Scheffold
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - R Philipp
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - S Vehling
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - S Koranyi
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - D Engelmann
- Universitätsmedizin Leipzig, Abteilung für Medizinische Psychologie und Medizinische Soziologie, Leipzig, Deutschland
| | - F Schulz-Kindermann
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - M Härter
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - A Mehnert
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| |
Collapse
|
4
|
Hartung TJ, Mehnert A, Vehling S. Depressionssymptome bei Menschen mit Krebs: Zusammenhang und Zentralität im Vergleich zur Allgemeinbevölkerung. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- TJ Hartung
- Universitätsmedizin Leipzig, Abteilung für Medizinische Psychologie und Medizinische Soziologie, Leipzig, Deutschland
| | - A Mehnert
- Universitätsmedizin Leipzig, Abteilung für Medizinische Psychologie und Medizinische Soziologie, Leipzig, Deutschland
| | | |
Collapse
|
5
|
Vehling S, Mehnert A. Suizidgedanken, Demoralisierung und Hoffnungslosigkeit im Verlauf einer Krebserkrankung – eine längsschnittliche Untersuchung. Psychother Psych Med 2018. [DOI: 10.1055/s-0038-1667952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Vehling
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - A Mehnert
- Universitätsmedizin Leipzig, Abteilung für Medizinische Psychologie und Medizinische Soziologie, Leipzig, Deutschland
| |
Collapse
|
6
|
Philipp R, Vehling S, Mehnert A. Prädiktoren von Todesakzeptanz bei Krebspatienten. Psychother Psychosom Med Psychol 2018. [DOI: 10.1055/s-0038-1667974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- R Philipp
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - S Vehling
- Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, W26, Hamburg, Deutschland
| | - A Mehnert
- Universitätsmedizin Leipzig, Abteilung für Medizinische Psychologie und Medizinische Soziologie, Leipzig, Deutschland
| |
Collapse
|
7
|
Vehling S, Gerstorf D, Schulz-Kindermann F, Oechsle K, Philipp R, Scheffold K, Härter M, Mehnert A, Lo C. The daily dynamics of loss orientation and life engagement in advanced cancer: A pilot study to characterise patterns of adaptation at the end of life. Eur J Cancer Care (Engl) 2018; 27:e12842. [DOI: 10.1111/ecc.12842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Palliative Care Unit; Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - D. Gerstorf
- Department of Psychology; Humboldt University Berlin; Berlin Germany
| | - F. Schulz-Kindermann
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Oechsle
- Palliative Care Unit; Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - R. Philipp
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Scheffold
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Härter
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Mehnert
- Department of Medical Psychology and Sociology; University Medical Center Leipzig; Leipzig Germany
| | - C. Lo
- Department of Supportive Care; Princess Margaret Cancer Centre; University Health Network; Toronto ON Canada
- Department of Psychiatry; University of Toronto; Toronto ON Canada
- Department of Psychology; University of Guelph-Humber; Toronto ON Canada
| |
Collapse
|
8
|
Mehnert A, Hartung T, Friedrich M, Vehling S, Brähler E, Härter M, Keller M, Schulz H, Wegscheider K, Weis J, Koch U, Faller H. One in two cancer patients is significantly distressed: Prevalence and indicators of distress. Psychooncology 2017; 27:75-82. [DOI: 10.1002/pon.4464] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 01/09/2023]
Affiliation(s)
- A. Mehnert
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - T.J. Hartung
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - M. Friedrich
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - S. Vehling
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - E. Brähler
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
- Department of Psychosomatic Medicine and Psychotherapy; Universal Medical Center Mainz; Mainz Germany
| | - M. Härter
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Keller
- Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine; University Hospital Heidelberg; Heidelberg Germany
| | - H. Schulz
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - K. Wegscheider
- Department of Medical Biometry and Epidemiology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - J. Weis
- Department of Psychooncology; UKF Reha gGmbh University Clinic Center Freiburg; Freiburg im Breisgau Germany
| | - U. Koch
- Department and Outpatient Clinic of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
- Deanery; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - H. Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken; University of Würzburg; Würzburg Germany
| |
Collapse
|
9
|
Philipp R, Mehnert A, Lehmann C, Oechsle K, Bokemeyer C, Krüll A, Vehling S. Detrimental social interactions predict loss of dignity among patients with cancer. Support Care Cancer 2016; 24:2751-8. [DOI: 10.1007/s00520-016-3090-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/14/2016] [Indexed: 11/29/2022]
|
10
|
Vehling S, Mehnert A, Hartmann M, Oing C, Bokemeyer C, Oechsle K. Anxiety and depression in long-term testicular germ cell tumor survivors. Gen Hosp Psychiatry 2016; 38:21-5. [PMID: 26439320 DOI: 10.1016/j.genhosppsych.2015.09.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Despite a good prognosis, the typically young age at diagnosis and physical sequelae may cause psychological distress in germ cell tumor survivors. We aimed to determine the frequency of anxiety and depression and analyze the impact of demographic and disease-related factors. METHOD We enrolled N=164 testicular germ cell tumor survivors receiving routine follow-up care at the University Cancer Center Hamburg and a specialized private practice (mean, 11.6 years after diagnosis). Patients completed the Generalized Anxiety Disorder Screener-7, the Patient Health Questionnaire-9 and the Memorial Symptom Assessment Scale-Short Form. RESULTS We found clinically significant anxiety present in 6.1% and depression present in 7.9% of survivors. A higher number of physical symptoms and having children were significantly associated with higher levels of both anxiety and depression in multivariate regression analyses controlling for age at diagnosis, cohabitation, socioeconomic status, time since diagnosis, metastatic disease and relapse. Younger age at diagnosis and shorter time since diagnosis were significantly associated with higher anxiety. CONCLUSION Although rates of clinically relevant anxiety and depression were comparably low, attention toward persisting physical symptoms and psychosocial needs related to a young age at diagnosis and having children will contribute to address potential long-term psychological distress in germ cell tumor survivors.
Collapse
Affiliation(s)
- S Vehling
- Department of Medical Psychology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany.
| | - A Mehnert
- Department of Medical Psychology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany; Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Germany
| | - M Hartmann
- Department of Urology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| | - K Oechsle
- Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg, Eppendorf, Hamburg, Germany
| |
Collapse
|
11
|
Ernst J, Friedrich M, Lehmann C, Vehling S, Oechsle K, Koch U, Mehnert A. [Communication Bad News by Physicians: The German Version of the MPP (Measure of Patients' Preferences) Questionnaire to the Communicative Preferences of Cancer Patients]. Gesundheitswesen 2015; 78:520-5. [PMID: 25664906 DOI: 10.1055/s-0034-1396849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Breaking bad news is as one of the most distressing tasks that doctors face with high demands on their communication and psychosocial skills. Patient preferences for communicating bad news influence the course of such consultations. The purpose of this study was to evaluate the psychometric characteristics of the German version of the Measure of Patients' Preferences (MPP), a questionnaire that has been validated in several international studies. METHOD Statistical analyses were performed in a sample of N=270 cancer patients during early treatment phase (mixed cancer entities, mean age 56.9 years, 46.7% female). In this prospective study with 2 assessment times, the factorial structure of the MPP-D was examined using principal components analysis with varimax rotation. RESULTS Factor analysis resulted in a 9-factor solution, the 3 factor structure of the original version was not replicated. Cronbachs α was>0.80 for 7 of the MPP-D subscales indicating good to excellent reliability. CONCLUSION Further psychometric testing and optimisation of the measure is recommended.
Collapse
Affiliation(s)
- J Ernst
- Medizinische Psychologie und Medizinische Soziologie, Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - M Friedrich
- Medizinische Psychologie und Medizinische Soziologie, Psychosoziale Onkologie, Universität Leipzig, Leipzig
| | - C Lehmann
- Hamburg, Deutsche Gesellschaft für Rehabilitationswissenschaften e.V., DGVT-Ausbildungszentrum Hamburg
| | - S Vehling
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - K Oechsle
- II. Medizinische Klinik und Poliklinik für Onkologie, Hämatologie mit der Sektion Pneumologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - U Koch
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - A Mehnert
- Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig, Leipzig
| |
Collapse
|
12
|
Scheffold K, Mehnert A, Müller V, Koch U, Härter M, Vehling S. Sources of meaning in cancer patients - influences on global meaning, anxiety and depression in a longitudinal study. Eur J Cancer Care (Engl) 2013; 23:472-80. [DOI: 10.1111/ecc.12152] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- K. Scheffold
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Mehnert
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - V. Müller
- University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - U. Koch
- University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Härter
- University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - S. Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| |
Collapse
|
13
|
Mehnert A, Vehling S, Höcker A, Lehmann C, Koch U. Demoralization and depression in patients with advanced cancer: Prevalence and related symptoms. Psychother Psychosom Med Psychol 2011. [DOI: 10.1055/s-0031-1272406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|