Close relationships and adjustment to a life crisis: the case of breast cancer

When life crises occur, significant others are thought to help alleviate distress and resolve practical problems. Yet life crises may overwhelm significant others, eroding their ability to provide effective support. The accuracy of these contrasting accounts of relationship functioning was evaluated in a study of 102 breast cancer patients and their significant others, interviewed at 4 and 10 months after diagnosis. Results largely confirmed the negative account of relationship functioning. Although significant others provided support in response to patients' physical impairment, they withdrew support in response to patients' emotional distress. Moreover, support from significant others did not alleviate patients' distress or promote physical recovery. These results reveal limits to the effectiveness of close relationships in times of severe stress.     

Predictors of relationship functioning for patients with bipolar disorder and their partners.

Previous investigations have examined family functioning, including marital functioning, as an important predictor of the course of bipolar disorder, but limited research exists identifying the factors that influence relationship functioning in patients with bipolar disorder. In the current study, 56 patients with bipolar disorder and their partners were assessed for Axis II pathology, general family functioning, and relationship distress. Patient mood symptoms and Axis II pathology variables were examined as predictors of general relationship functioning (Family Assessment Device, McMaster Clinical Rating Scale, and Dyadic Adjustment Scale) in regression models. Analyses indicated that patients' depressive symptomatology was associated with patient ratings of general family functioning and couple functioning, while patients' manic symptoms were associated with partners' ratings of the romantic relationship. Partners' total Axis II pathology, but not patients' Axis II pathology, was associated with patient and partner perception of the couple's relationship. These findings highlight the importance of mood and personality pathology to relationship functioning, and represent one of the first investigations to verify the impact of personality pathology on patients' and partners' perceptions of relationship functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are the subjective complaints of traumatically brain injured patients reliable?

The present study was designed to compare the subjective complaints of 50 traumatically brain injured (TBI) patients with the observations of their significant others. The complaints of the TBI patients and their significant others were contrasted according to the severity of the TBI and the type of complaint (physical, cognitive/behavioural and emotional). While no differences were found in physical complaints, the cognitive/behavioural and emotional complaints of TBI patients, regardless of the severity of the initial TBI, were significantly under-reported in comparison to the observations of their significant others. The data suggests that while this finding was most likely due to the TBI patients' poor awareness, it was unlikely to be the result of psychological denial since all of these individuals were evaluated in the context of being a plaintiff in personal injury litigation or a claimant in a Workers' Compensation claim. The data suggests that the cerebral trauma these patients sustained played a major role in their ability to recognize their cognitive, behavioural and emotional symptoms. Finally, the data suggests that clinicians should obtain information about the TBI patients' cognitive/behavioural and emotional functioning from their significant others, rather than rely entirely on the TBI patients' subjective assessment of these problems.     

Sexuality and intimacy following radical prostatectomy: Patient and partner perspectives.

Most research on adjustment following radical prostatectomy has focused on limited assessments of urinary and erectile functioning. In this study, the authors provided a more comprehensive assessment of sexuality from 134 radical prostatectomy patients and their partners and determined the extent to which various components of sexuality are associated with psychosocial adjustment. Measures of sexuality and intimacy modestly predicted patients' emotional distress and quality of life (QoL), with body image and dyadic adjustment playing the most important roles after controlling for medical variables, general physical functioning, and optimistic outlook. Urinary incontinence and other sexuality variables were not unique predictors. In contrast, partner ratings of sexual satisfaction played a more important role in predicting their QoL. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staff perceptions of emotional distress in paitents with burn trauma.

Objective: To compare staff and patient perceptions of patients' emotional distress after acute burn trauma. Design: Staff ratings of patients' psychological states on 6 dimensions of emotional functioning were compared with patient self-report. Results: Staff as a whole and by discipline tended to overestimate depression and underestimate optimism in patients. Moreover, the more experienced (more than 2 years of burn care experience) nurses and occupational/physical therapists were less accurate in estimating depression and optimism than their less experienced counterparts. Conclusion: Consistent with results from spinal cord injury research, findings from the current study indicate a distinct tendency on the part of burn care staff to overestimate their patients' emotional distress and underestimate their positive outlook, supporting the notion that staff may be imposing a "requirement for mourning" on their patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic distress and physical functioning: A longitudinal study of injured survivors of community violence.

This study examines the cross-lagged relationships between posttraumatic distress symptoms and physical functioning, using a sample of 413 persons who were hospitalized for injuries resulting from community violence. Posttraumatic distress was assessed at 1 week, 3 months, and 12 months postinjury, and posttraumatic physical functioning was assessed at 3 months and 12 months. Structural equation modeling was used to assess the prospective relationship between posttraumatic distress symptoms and physical functioning while controlling for demographic characteristics and objective measures of injury severity. Results indicate that posttraumatic distress and physical functioning are reciprocally related. Individuals with high levels of psychological distress at 1 week posttrauma have worse physical functioning at 3 months. Psychological distress at 3 months was not significantly associated with subsequent change in physical functioning at 12 months. Individuals with poor physical functioning at 3 months had higher than expected levels of psychological distress at 12 months. These findings demonstrate a reciprocal relationship between physical and mental health following traumatic injury. Interventions targeting physical recovery may influence subsequent mental health, and therapies aimed at improving early mental health may also have long-term benefits for physical recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autoimmune hyperthyroidism in prepubertal children and adolescents: comparison of clinical and biochemical features at diagnosis and responses to medical therapy

The purpose of this study was: (i) to examine the impact of the clinical severity, anatomical location and treatment of psoriasis on patients' quality of life, and (ii) to investigate the effects of perceptions of psoriasis-related stress on patients' physical and mental health and on areas of disability in everyday life. All patients (n = 204) attending a psoriasis specialty clinic were invited to complete a multidimensional quality of life assessment comprising the Psoriasis Disability Index (PDI), the SF-36 Health Survey and the Psoriasis Life Stress Inventory (PLSI). Results (n = 150) indicated that overall clinical severity of psoriasis as assessed by the Psoriasis Area and Severity Index, and duration of psoriasis, were unrelated to impairment in any areas of quality of life. Anatomical location (social visibility) of psoriasis was associated with self-report of poor physical health (P = 0.01), and there was a modest association with patients' mental health (P = 0.04); however, anatomical location of psoriasis was not significantly associated with self-reported disability in everyday life, or stress scores. Patients who were classified as more reactive to the stress associated with psoriasis (78% of the sample) were functioning less well in terms of their mental health (P = 0.001) and also experienced significantly more disability in all areas of everyday life (P = 0.001). Differences in method of treatment for psoriasis did not significantly affect scores on the psoriasis-specific (PDI; PLSI) or generic (SF-36) quality of life measures. A multiple regression analysis demonstrated that stress resulting from anticipating other people's reactions to their psoriasis contributed more to the variance in patients' disability in everyday life than any other medical or health status variable. The results support the importance of assessing the effects of stress in patients' adjustment to their condition and may indicate a role for adjunctive psychological stress management training for a significant number of patients with psoriasis.     

The relationship of community quality to the health of women and men

Using a 1996 community survey of behavioral risk factors, this cross-sectional study of 804 residents in a rural community examines the relationship of community quality to the health status of women and men. We use two categories of community factors to assess community quality: measures of the social quality of community life, and measures of community quality that focus on the physical environment. Health status is assessed by four measures that examine perceived health status and functioning. Regression results indicate that there is a significant relationship between the quality of the community and health status for both women and men. Specifically, women's perceptions about the social quality of their community are positively associated with their perceived health status and functioning; furthermore, these relationships are significantly different from those of men. Men's perceptions of their physical environment are significantly related to their reported functioning and health, to a limited extent these relationships are different from women. These relationships support our hypothesis that gender differentially affects the relationship between community quality and health.     

Risk, resistance, and psychological distress: A longitudinal analysis with adults and children.

The link between risk and resistance factors and psychological and physical distress was examined cross-sectionally and longitudinally over a 1-year period. Risk factors are negative life events and avoidance coping strategies and, for children, parental emotional and physical distress. Resistance factors include self-confidence, an easygoing disposition, and family support. We studied a community sample of over 400 adults and their children. Each of the predictor variables was significantly associated with concurrent and future psychological and physical distress among adults. Moreover, the sets of risk and resistance variables predicted both current and subsequent distress among adults even when the stable component in distress was controlled. Parental risk and resistance—especially family support and maternal dysfunction—also predicted concurrent psychological and, less strongly, physical distress among the children. The associations involving family support and maternal distress and avoidance coping held in cross-sectional analyses even when the stable component in children's distress was controlled. Although family support was associated with children's future psychological and physical distress in zero-order correlations, the relation did not hold when children's initial distress was controlled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminability in length of lines in the Müller-Lyer figure

OBJECTIVE: To compare patients' health-related quality of life after systemic methotrexate therapy versus laparoscopic salpingostomy for tubal pregnancy. DESIGN: Multicenter randomized clinical trial. SETTING: Departments of obstetrics and gynecology of six Dutch hospitals. PATIENT(S): Hemodynamically stable patients with a laparoscopically confirmed unruptured tubal pregnancy without signs of active bleeding, who were randomly assigned to undergo either systemic methotrexate therapy or laparoscopic salpingostomy. INTERVENTION(S): Standard health-related quality of life questionnaires administered before and 2 days, 2 weeks, 4 weeks. and 16 weeks after confirmative laparoscopy. MAIN OUTCOME MEASURE(S): Health-related quality of life. RESULT(S): Health-related quality of life was impaired most severely 2 days after confirmative laparoscopy in both treatment groups and improved during follow-up. Health-related quality of life was impaired more severely after systemic methotrexate therapy than after laparoscopic salpingostomy. Medically treated patients had more limitations in physical functioning, role functioning, and social functioning; had worse health perceptions, less energy, more pain, more physical symptoms, and a worse overall quality of life; and were more depressed than surgically treated patients. CONCLUSION(S): Systemic methotrexate therapy had a more negative impact on patients' health-related quality of life than did laparoscopic salpingostomy. This negative impact on patients' health-related quality of life of systemic methotrexate therapy should be taken into account when deciding on the appropriate therapy for tubal pregnancy.     

Financial strain, received support, anticipated support, and depressive symptoms in the People's Republic of China.

The purpose of this study is to examine the interface between financial strain, informal received economic support, informal anticipated financial support, and psychological distress in later life. Data provided by a large probability sample of older adults in the People's Republic of China reveal that the relationship between financial difficulty and psychological distress is stronger for older adults who receive more economic assistance. However, the results involving anticipated support are in the opposite direction. More specifically, the association between financial problems and psychological distress is lower for older adults who believe that others stand ready to help in the future should the need arise. A detailed theoretical rationale is developed to explain these results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ovarian Cancer Patients' Psychological Distress: The Role of Physical Impairment, Perceived Unsupportive Family and Friend Behaviors, Perceived Control, and Self-Esteem.

Although research has indicated that illness-related and interpersonal stress are associated with greater psychological distress among cancer patients, little empirical attention has been given to mechanisms that account for these relationships. In the present study, 2 mechanisms for the association between illness-related stress (physical impairment) and interpersonal stress (family and friend unsupportive responses) and psychological distress of 143 ovarian cancer patients were examined cross-sectionally. Separate structural equation models tested whether physical impairment impacted patients' distress via decrements in perceived control over their illness and whether unsupportive behaviors impacted patients' distress via decrements in patients' self-esteem. Results supported the proposed models and suggest that perceived control and self-esteem are 2 mechanisms for explaining how illness-related and interpersonal stress may be associated with psychological distress among women with ovarian cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The social network of the psychotherapy patient.

Examined the social networks of psychotherapy patients to find factors that affected the patients' contributions to the therapeutic process and the effectiveness of treatment. 265 outpatients (aged 18–61 yrs) completed measures of their individual ties, their collective networks, and their network support. Ss were neither interpersonally bereft nor socially isolated. Most Ss had close friends, and most had an ongoing romantic relationship. Most had at least 1 confidant with whom they discussed entering therapy, and most experienced nurturing support from their significant others. Ss were embedded in a network of significant and meaningful ties that could potentially influence their participation in the therapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of life event stress on physical illness: Substantive effects or methodological flaws?

Tested the hypothesis that the reported relationship between life event stress and physical illness is primarily a function of criterion and other content contamination in the stress measure. In particular, conventional life event measures included events related to physical health, which overlap with the criterion; events related to neuroticism, which influences the criterion; and vague or subjective events that could be affected by individual differences in psychological distress, response sets, and retrospective bias. 386 adult males and females (who ranged in age from their early 20's to their 90's) completed a version of the Schedule of Recent Experience, the Seriousness of Illness Rating Scale, the Neuroticism-Extraversion-Openness Inventory, and the Eysenck Personality Inventory. Illness was significantly related to event subscales containing, respectively, health-related events, neuroticism-related events, and subjective events, but not to an "uncontaminated" event subscale. These results support the hypothesis of contamination and suggest that alternative approaches to the conceptualization and measurement of stress may need to be developed. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical applications of hypnosis to three psychosomatic disorders.

Reviews outcomes and methodological soundness of studies of hypnosis in the treatment of skin disorders, headaches, and asthma. Some studies focused on changing physiological functions, others on increasing insight in their patients, and others on altering patients' perceptions of their symptoms. Methodological weaknesses included lack of control groups, nonrandom assignment of patients to treatment conditions, and confounding of treatment effects or lack of control for placebo effects. Additional weaknesses centered around the use of single outcome measures and the failure to assess the specific roles of mediating variables. Most studies showed positive treatment effects. However, there was equivocal evidence that hypnosis can directly influence autonomic functioning. Hypnosis may be valuable in facilitating one's capacity to gain insight into how one's symptoms developed and are maintained. In addition, hypnotic procedures have resulted in some success when used to indirectly alleviate symptoms by altering how individuals perceive their disorders and how these disorders affect their lives. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Type of mastectomy and quality of life for long term breast carcinoma survivors

BACKGROUND: Despite numerous studies of partial mastectomy and psychologic morbidity in the first 24 months following surgery, little is known about the long term psychosocial repercussions of partial and total mastectomy. METHODS: The effect of the type of mastectomy on psychologic adjustment was assessed among 124 breast carcinoma survivors, 47 of whom underwent partial mastectomy and 77 of whom underwent total mastectomy, 8 years after initial treatment. Interviews were also conducted 3 and 18 months after surgery. Psychologic distress was assessed using the Psychiatric Symptom Index. Other outcomes included physical symptoms, patients' perceptions of their own health, satisfaction with the type of surgery performed and with the appearance of the scar, and marital and sexual adjustments. RESULTS: No statistically significant differences between partial and total mastectomy were observed with respect to long term quality of life. Age at diagnosis modified the relation between the type of mastectomy and psychologic distress in both the short term and the long term (P = 0.04). Among women younger than 50 years, partial mastectomy appeared to be protective against distress when compared with total mastectomy. In contrast, among women age 50 years or older, partial mastectomy was associated with higher psychologic distress levels at all interviews. CONCLUSIONS: Assessed globally, partial and total mastectomy appear to be equivalent treatments in terms of patients' long term quality of life. However, both short term and long term distress levels after partial and total mastectomy may depend on patients' age at diagnosis. The findings of this study suggest that the increased use of partial mastectomy may lessen the negative effects of breast carcinoma on younger survivors' quality of life. Nevertheless, total mastectomy may be an appropriate initial treatment for some women who truly choose it.     

Protective buffering and psychological distress among couples coping with breast cancer: The moderating role of relationship satisfaction.

This study examined whether the association between protective buffering and psychological distress was moderated by relationship satisfaction. Protective buffering is defined as hiding worries, denying concerns, and yielding to one's partner in an effort to avoid disagreement and reduce one's partner's upset and burden. Two hundred thirty-five women diagnosed with early stage breast cancer and their partners completed measures of protective buffering, psychological distress, and relationship satisfaction at 3 time points over an 18-month period after cancer diagnosis. The authors hypothesized that protective buffering would result in more distress among patients and partners reporting higher relationship satisfaction than among patients and partners reporting lower levels of relationship satisfaction. Patients' protective buffering predicted more distress among patients rating their relationships as more satisfactory, whereas the patients' buffering did not predict distress among patients rating their relationships as less satisfactory. Partner relationship satisfaction also moderated the association between patients' buffering and partners' distress. These findings elucidate conditions under which protective buffering may have detrimental effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Varieties of transference patterns in psychotherapy

This investigation explored the nature of transference of interpersonal patterns in patients' psychotherapy narratives. The relation between interpersonal patterns with significant others in a patient's life and the pattern with the therapist early in treatment was examined. Cluster analysis was used to categorize similar relationships for each of 35 patients. Many patients revealed multiple interpersonal themes in their relationship narratives. Furthermore, these interpersonal themes correlated significantly with the interpersonal pattern extracted from narratives told about the therapist for many of the patients who discussed the therapeutic relationship during therapy. However, the interpersonal pattern evident in the relationship with the therapist was not necessarily the most pervasive pattern exhibited in the narratives about significant others.     

Dispositional optimism as a predictor of men's decision-related distress after localized prostate cancer.

This study investigated prospectively the relationship between optimism, threat appraisal, seeking support and information, cognitive avoidance, physical treatment side effects, and decision-related distress in 111 men with localized prostate cancer. Men were assessed at diagnosis and 2 and 12 months after treatment. Baseline decision-related distress predicted distress 2 and 12 months after treatment. Optimism was a significant prospective and concurrent predictor of decision-related distress, with the effect mediated by proximal cancer threat appraisal. Seeking support and information and cognitive avoidance were not associated with decision-related distress at any time point. For physical treatment side effects, concurrent urinary symptoms were predictive of decision-related distress 2 months after treatment. Results suggest that decision-related distress is generated by similar processes to that of the psychological distress that follows a cancer diagnosis. Screening for men with high decision-related distress for referral to in-depth decision support is suggested. Outcome expectations may present as a therapy target to increase the effectiveness of decisional support that is utility based. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The overlapping contributions of attachment orientation and social support in predicting life-events distress.

Attachment anxiety, attachment avoidance, and perceived social support are examined as predictors of life-events distress. Clients at initial intake to an addiction treatment centre and university students in their graduating year were administered measures of attachment orientation, social support, and the experience of distressing life events. Hypotheses were tested across different categories of distressing life events (overall distress, bereavement, relationship dissolution, crime victimization, and severe accidents). We found that attachment anxiety and attachment avoidance have varying predictive utility for distress, depending on the type of event. Social support did not account for variance beyond attachment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)