Patients' perspectives on the management of emotional distress in primary care settings

OBJECTIVE: To investigate how important treatment for emotional distress is to primary care patients in general and to primary care patients with depression, and to evaluate the types of mental health interventions they desire. DESIGN: Patient surveys. SETTING: Five private primary care practices. MEASUREMENTS AND MAIN RESULTS: Patients' desire for treatment of emotional distress and for specific types of mental health interventions were measured, as well as patients' ratings of the impact of emotional distress, the frequency of depressive symptoms, and mental health functioning. Of the 403 patients, 33% felt that it was "somewhat important" and 30% thought it was "extremely important" that their physician tries to help them with their emotional distress. Patient desire for this help was significantly related to a diagnosis of depression (p < .001), perceptions about the impact of emotional distress (p < .001), and mental health functioning (p < .001). Among patients with presumptive diagnoses of major and minor depression, 84% and 79%, respectively, felt that it was at least somewhat important that they receive this help from their physician. Sixty-one percent of all primary care patients surveyed and 69% of depressed patients desired counseling: 23% of all patients and 33% of depressed patients wanted a medication: and 11% of all patients and 5% of depressed patients desired a referral to a mental health specialist. CONCLUSIONS: A majority of these primary care patients and almost all of the depressed patients felt that it was at least somewhat important to receive help from their physician for emotional distress. The desire for this help seems to be related to the severity of the mental health problem. Most of the patients wanted counseling, but relatively few desired a referral to a mental health specialist.     

Serotoninergic control of the activity and expression of glial GABA transporters in the rat cerebellum

OBJECTIVE: The purpose of the study was to compare staff versus patient perceptions of the causes and emotional impact of verbal and physical aggression on a psychiatric inpatient unit, and the corrective measures each group would endorse. METHODS: Fifty-four patients and 32 nursing staff members responded to similar questions about physical and verbal aggression. They also reported their emotional responses to aggression and steps they would endorse to reduce aggression at the medical center. Data was analyzed by chi-square tests for proportion comparisons between groups. RESULTS: "Verbal Abuse" was viewed an important contributor to physical aggression. Staff stressed patient substance abuse and violent lifestyles. Patients focused on the use of involuntary procedures and cultural differences between patients and staff. CONCLUSIONS: Patients endorsed more restrictive safety measures as long as the measures such as metal detectors and searches were applied to staff and visitors, as well as patients. Patients requested more input into decision-making processes through patient-staff workgroups.     

A quantitative study of the emotional outcome of people caring for stroke survivors

BACKGROUND AND PURPOSE: Although the physical and, to a lesser extent, emotional outcome of stroke survivors has been well documented, there are far fewer data relating to the outcomes of those who care for them. We aimed to describe the outcome of those caring for stroke patients and to identify both patient and caregiver factors that are associated with poor caregiver outcomes. METHODS: As part of a randomized trial to evaluate a stroke family care worker, we identified 417 patients (67% of all referrals to our institution). We followed up 376 survivors of whom 246 identified a caregiver at a 6-month follow-up interview. The patients and caregivers were asked to complete 2 measures of emotional distress ( 30-item General Health Questionnaire [GHQ-30] and Hospital Anxiety and Depression [HAD] Scale). A regression analysis was used to identify factors that were independently associated with poor caregiver outcomes. RESULTS: Fifty-five percent of responding caregivers scored more than 4 on the GHQ-30, indicating that emotional distress is common in this group. Caregivers were more likely to be depressed if the patients were severely dependent (P<0.01) or emotionally distressed themselves (P<0.01). Female caregivers reported more anxiety (median HAD=8) than male caregivers (median HAD=5; P<0.01) but caregivers' levels of anxiety were not so clearly related to the patients' degree of physical disability as their levels of depression. Caregivers suffered more emotional distress if the patients had been dependent before their strokes. CONCLUSIONS: These data may help to identify those caregivers at greatest risk of poor emotional outcomes and thus help in the planning of trials and delivery of interventions aimed at preventing or treating distress among caregivers.     

Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics

We examined the cognitive and sociodemographic characteristics of patients making somatic presentations of depression and anxiety in primary care. Only 15% of patients with depressive symptomatology on self-report, and only 21% of patients with current major depression or anxiety disorders on diagnostic interview, presented psychosocial symptoms to their GP. The remainder of patients with psychiatric distress presented exclusively somatic symptoms and were divided into three groups-initial, facultative and true somatizers-based on their willingness to offer or endorse a psychosocial cause for their symptoms. Somatizers did not differ markedly from psychologizers in sociodemographic characteristics except for a greater proportion of men among the true somatizers. Compared to psychologizers, somatizers reported lower levels of psychological distress, less introspectiveness and less worry about having an emotional problem. Somatizers were also less likely to attribute common somatic symptoms to psychological causes and more likely to endorse normalizing causes. In the 12 months following their initial visit, somatizers made less use of speciality mental health care and were less likely to present emotional problems to their GP. Somatizers were markedly less likely to talk about personal problems to their GP and reported themselves less likely to seek help for anxiety or sadness. Somatization represents a persistent pattern of illness behaviour in which mental health care is not sought despite easily elicited evidence of emotional distress. Somatization is not, however, associated with higher levels of medical health care utilization than that found among patients with frank depression or anxiety.     

The relationship between staff burnout/distress and interactions with residents in two residential homes for older people

OBJECTIVE: The main hypothesis was that staff burnout/distress would be negatively associated with the quantity and quality of social interactions between staff and residents. The subsidiary hypothesis hypothesis was that 'perceived involvement in decision-making' among staff would be positively associated with the quantity and quality of staff-resident interactions. DESIGN: Cross-sectional and within-group. Standardized self-report questionnaires completed by staff; and non-participant, time-sampling observation and coding of staff-resident interactions. SETTING. Two independent (not-for-profit) residential care homes for older people in the UK. PARTICIPANTS: 18 out of 24 residential workers completed questionnaires. MEASURES: The 12-item General Health Questionnaire (GHQ-12); the Maslach Burnout Inventory (MBI); the Perceived Involvement Personal Questionnaire (PIPQ); and the Quality of Interactions Schedule (QUIS). RESULTS: Staff who reported higher levels of personal accomplishment (ie lower levels of burnout on the personal accomplishment subscale) exhibited significantly more staff-resident interactions; and staff who perceived more involvement in decisions relating to their work showed significantly fewer negative staff-resident interactions. Staff distress, emotional exhaustion and depersonalization were not found to be significantly related to the quantity or quality of staff resident interactions. CONCLUSIONS: The results provide some support for the hypotheses. It appears that levels of personal accomplishment and perceived involvement in decision-making among staff may significantly influence the quantity and quality of staff-resident interactions in residential settings. However, the causal relationships are uncertain, and replication of these findings is required in other contexts.     

Nurses' ability to perceive patients' fears related to coronary arteriography

This study describes the congruence of the perceptions of 180 patient-nurse dyads concerning patients' fears related to coronary arteriography (CA). The perceptions were measured with a purpose-designed instrument which listed 26 objects of fear. t-Tests and chi-square tests were used to compare the responses and the associations with demographic data. The results pointed to inconsistencies between patients' and nurses' perceptions. Nurses and patients had congruent perceptions of the 10 most intense fears related to CA. Otherwise nurses tended to overestimate patients' fears. Nurses' perceptions of the intensity of individual patients' fears were incongruent so that before CA there was a tendency to overestimate the intensity of fears and after CA to underestimate it. The results suggest that nurses need to pay more attention to the assessment of individual patients' fears and to avoid stereotypical views of patient fears. The use of an assessment instrument is recommended as one way of enhancing the quality of care.     

Selective speech motor, syntax and cognitive deficits associated with bilateral damage to the putamen and the head of the caudate nucleus: a case study

This article describes emotional distress in 44 women with Human Immunodeficiency Virus (HIV) symptomatic disease. Measures of self-reported symptoms of anxiety and depression revealed that emotional distress was prevalent in this group and may be sufficiently robust to warrant clinical diagnoses. Limits to functioning and disruptions in physical well-being were found to be associated with both anxiety and depression. Additionally, level of optimism was inversely related to anxiety and depression, and social support was inversely related to anxiety. These findings indicate that emotional distress in women with HIV disease is associated with, and could be ameliorated by, interventions targeted at functional status, social support, and level of optimism.     

Family partnership in care: integrating families into the coronary intensive care unit

Since the introduction of Family Partnership in Care in the CICU and other pilot units, many changes have been made. Education sessions are now unit specific rather than in groups with multiple units. This facilitates the discussion of unit-specific educational and implementation needs. In addition, unit-specific sessions allow for some case scenario/role playing activities to facilitate learning and application of the FPCP elements to the unique culture of the unit. Finally, less emphasis is placed on the documentation, while greater emphasis is placed on the philosophy behind the program and the nurses values and attitudes towards families. Overall, the implementation of the FPCP in CICU has had a positive impact on staff and patients. Staff awareness regarding the importance of involving family in the patient's care and the benefits of this has been heightened. Staff who were initially very skeptical have become strong advocates for the program. The successful shift with families in "doing for" to "working with" has enhanced the professional practice of many nursing staff and contributed to the overall unit functioning. Finally, the feedback from patients and their care partners and the independence and informed decision-making fostered by designing a plan of care with staff validates the importance of this program in a critical care area.     

The psychologist as a consultant in a nursing home: Effect on staff morale and turnover.

Many elderly patients have been transferred from long-term psychiatric hospitals to nursing homes, where knowledge of psychological aspects of patient care is generally poor and where emotional and behavioral disorders are poorly tolerated by staff. One solution to this problem is for psychologists to provide in-service training to nursing-home staff in the psychological aspects of patient care, but this approach ignores such problems as poor staff morale and high staff turnover. A 188-bed skilled nursing home was selected for a 12-wk consultation program based on a mental health and organizational development approach. Turnover rates fell from 73.4%, during the quarter prior to consultation, to 27.8%, during the period of consultation, and averaged 33.6% for the next 3 quarters. Staff morale also improved. Results indicate that before training nursing-home staff in the psychological aspects of geriatric care, problems such as high staff turnover and poor morale should be resolved. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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 0-11 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in perspectives of disability among patients, staff, and relatives during rehabilitation of brain injury.

Studied retrospectively changes in behavioral competency ratings of staff, patients, and relatives over the course of an intensive rehabilitation program for 3 groups of 28 seriously brain-damaged patients (aged 19–44 yrs). Group 1 included patients with perspectives similar to those of their social environment. They had more initial emotional distress and showed nonsignificantly less neuropsychological impairment than did Ss in Groups 2 and 3, who greatly underestimated their impairments compared to staff and relative ratings. Ratings of Group 2 Ss became better aligned with staff members and relatives' perspectives at discharge, while Group 3 showed increased divergence from staff and relative ratings. By discharge, Group 1 had reduced emotional distress, while distress increased for Groups 2 and 3. Alignment among perceived behavioral competency ratings was not related to vocational outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life survey among day release patients at View Road Hospital

OBJECTIVES: The aim of this study was to identify factors that contributed to the chronic patient's quality of life from both the patients' and staff's point of view. We were also interested in any lack of congruence between staff and patient perception as these could have significant implications for planning long-term care. METHOD: Fifty of the patients under the Day Release Scheme at View Road Hospital and their staff were given a modified questionnaire concerning the patients' quality of life. RESULTS: Generally the patients reported satisfaction with life domain items covering their living conditions. The majority felt safe in the current setting, enjoyed their work, their regular outings and parole to the nearby shopping centers. Significant differences were observed between the staff and patients' perception in life domain items relating to general well-being, knowledge and education, relationships, in-patient care, leisure and vocational rehabilitation. The staff group perceived having good food, money, good treatment and in employment as being important to their patients' well-being. Patients emphasised having money, family support or a partner, being employed, having time for recreational activities and eating good food. Having good health, medication and feeling at peace were also considered important by many of our patient. CONCLUSIONS: The findings of the study are discussed with regard to implications in planning rehabilitation services and improving the quality of care given to patients.     

Strategies for product education

Staff development departments expend resources on the provision of new product and equipment education. This "how to" article contains practical information that will assist both novice and experienced educators to develop creative and effective learning experiences for product education. This approach can prevent potential patient and/or staff harm or financial losses caused by misuse of new products by an uninformed staff.     

Perceived Partner Reactions to Diagnosis and Treatment of Breast Cancer: Impact on Psychosocial and Psychosexual Adjustment.

Two studies examined breast cancer patients' perceptions of their partners' reactions to their diagnosis and treatment as influences on 3 aspects of patients' well-being: psychosexual adjustment, emotional distress, and marital satisfaction. Study 1, cross-sectional, indicated that partner initiation of sex, frequency of sex, a positive 1st sexual experience after treatment, and especially perception of the partner's emotional involvement in the relationship, were relevant to these outcomes. Study 2, longitudinal, confirmed many of these findings in prospective tests across 1 year of recovery after surgery. Partner involvement prospectively predicted all 3 outcomes. Partner initiation of sex predicted greater marital satisfaction; partner adverse reaction to the scar predicted less marital satisfaction. Rated quality of the 1st sexual experience after treatment predicted less distress. The pattern suggests that women's impressions of their partners' emotional involvement after surgery for breast cancer forecast their adjustment in sexual, marital, and emotional arenas over the following year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Narrating emotional events in schizophrenia.

Research has indicated that schizophrenia patients report similar amounts of experienced emotion in response to emotional material compared with nonpatients. However, less is known about how schizophrenia patients describe and make sense of their emotional life events. We adopted a narrative approach to investigate schizophrenia patients' renderings of their emotional life experiences. In Study 1, patients' (n = 42) positive and negative narratives were similarly personal, tellable, engaged, and appropriate. However, negative narratives were less grammatically clear than positive narratives, and positive narratives were more likely to involve other people than negative narratives. In Study 2, emotional (positive and negative) narratives were less tellable and detached, yet more linear and social compared with neutral narratives for both schizophrenia patients (n = 24) and healthy controls (n = 19). However, patients' narratives about emotional life events were less appropriate to context and less linear, and patients' narratives, whether emotional or not, were less tellable and more detached compared with controls' narratives. Although schizophrenia patients are capable of recounting life events that trigger different emotions, the telling of these life events is fraught with difficulty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdependence in women with breast cancer and their partners: An interindividual model of distress.

Objective: The aim of this investigation was to test whether interdependence in dyads living with breast cancer could account for person–partner crossover effects in distress outcomes. Method: The sample consisted of 95 dyads with early-stage breast cancer. By using reciprocal dyadic data from women with breast cancer and their partners, we fit a structural equation model of the actor–partner interdependence model to examine the interaction of participants’ depression and stress in predicting their partner’s health outcomes. Results: Results revealed a pattern of influence whereby the interaction of high levels of depression coupled with high levels of stress in women with breast cancer was associated with lowered physical health and well-being in their partners. Although depression seemed to be the key mechanism in predicting distressing outcomes, when depression was combined with any additional stress, the level of physical distress was significantly greater. Results provided preliminary empirical support for crossover effects in the physical well-being of close relational partners in a cancer-related context. Further, results showed that distressing outcomes need not be limited to emotional distress but can also include physical distress. Conclusions: The findings from this study illustrate why it is not sufficient to concentrate care solely on the patient with cancer. Monitoring the social well-being of patients as they go through the cancer process could be as important as assessing their psychological state or other peripheral biomarkers. This line of inquiry would be advanced by including methods other than self-report in assessments of psychological and physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimism and Pessimism as Mediators of the Relations Between Self-Discrepancies and Distress Among Asian and European Americans.

The authors examined the role of undesired self-discrepancies in predicting emotional distress among Asian and European Americans, whether undesired self-discrepancies are stronger predictors of distress for Asian than for European Americans, and whether optimism and pessimism mediate the relations between ideal, ought, and undesired self-discrepancies and emotional distress. Self-identified Asian/Asian American (n = 140) and European American (n = 189) college students completed measures of self-discrepancies, optimism/pessimism, social anxiety, and depressive symptoms. Results show that for both Asian Americans and European Americans, greater similarity to the undesired self is equally predictive of symptoms of depression, whereas distance from the undesired self is more predictive of social anxiety for Asian Americans than for European Americans. Furthermore, pessimism fully mediates the relations between undesired self-discrepancies and depressive symptoms for both Asian Americans and European Americans, although pessimism was a stronger predictor of depression for European Americans than for Asians/Asian Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes

Spirituality is a neglected area of study and research in the treatment of addictions. The role of spirituality in the treatment of the dually diagnosed has received particularly scant attention. One hundred and one patients on an in-patient dual-diagnosis unit, as well as the 31 members of the nursing staff who treat them were surveyed. Patients and staff were questioned about their spiritual beliefs and what was the role of spirituality in the patients' recovery from addiction. Staff were questioned about their own spirituality and what they think the patients' level of spirituality is. In addition the staff were asked what they think the patients' view of spiritually is. Results indicate that the patients and staff are equally spiritually oriented. The patients view spirituality as essential to their recovery and value spiritual programming in their treatment more than some concrete items. The nursing staff underestimated both the patients' level of spirituality and this importance placed on spiritual issues. The authors suggest that more attention should be given by staff to spirituality in the treatment of this population.     

Evaluation of a stroke family care worker: results of a randomised controlled trial

OBJECTIVE: To examine the effect of contact with a stroke family care worker on the physical, social, and psychological status of stroke patients and their carers. DESIGN: Randomised controlled trial with broad entry criteria and blinded outcome assessment six months after randomisation. SETTING: A well organised stroke service in an Edinburgh teaching hospital. SUBJECTS: 417 patients with an acute stroke in the previous 30 days randomly allocated to be contacted by a stroke family care worker (210) or to receive standard care (207). The patients represented 67% of all stroke patients assessed at the hospital during the study period. MAIN OUTCOME MEASURES: Patient completed Barthel index, Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, mental adjustment to stroke scale, and patient satisfaction questionnaire; carer completed Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, caregiving bassles scale, and carer satisfaction questionnaire. RESULTS: The groups were balanced for all important baseline variables. There were no significant differences in physical outcomes in patients or carers, though patients in the treatment group were possibly more helpless less well adjusted socially, and more depressed, whereas carers in the treatment group were possibly less hassled and anxious. However, both patients and carers in the group contacted by the stroke family care worker expressed significantly greater satisfaction with certain aspects of their care, in particular those related to communication and support. CONCLUSIONS: The introduction of a stroke family care worker improved patients' and their carers' satisfaction with services and may have had some effect on psychological and social outcomes but did not improve measures of patients' physical wellbeing.     

Diminished hyperaemic response of the hepatic artery to portal venous occlusion (the buffer response) in Asian hybrid minipigs: a comparison of the response to that observed in dogs

This study is part of a larger study of the effect of integrity-promoting care in a Swedish nursing home ward. Compared with assessments on a control ward, improvements were found in the patients' behaviour and in the quality of care after a three-month intervention period. This paper reports on parts of a questionnaire survey on the nursing staff's opinions of their working conditions and demented patients. Most staff members on both the intervention ward and the control ward found their jobs meaningful, engaging and stimulating, but they also felt that they had a heavy work-load. Most of the staff members experienced mental strain because of the patients' disturbed behaviour. Many did not think that the care on their ward would have been good enough for their own close relatives, if they had been suffering from dementia. Only slight changes were found in the staff members opinions after the intervention.