Detrimental effects of kin support networks on the course of depression.

On the basis of preliminary findings that, for recovered depressed patients, a good family support network is associated with a subsequent increase in depressive symptoms, a prospective study is presented which examines the specific conditions under which this counterintuitive effect is present. A sample of 168 depressed psychiatric inpatients was assessed 1 and 7 mo after discharge from hospital regarding, among other variables, depressive symptomatology, diagnostic status, and the composition and supportive functions of their social networks. The detrimental effect was restricted to female patients who were recovered at discharge and who were homemakers, and it involved supportive relatives, in particular relatives providing close psychological and emotional support in crises. Possible psychological and psychosocial mediators as well as implications for research and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Recovery Experience Questionnaire: Development and validation of a measure for assessing recuperation and unwinding from work.

Drawing on the mood regulation and job-stress recovery literature, four self-report measures for assessing how individuals unwind and recuperate from work during leisure time were developed (Study 1). Confirmatory factor analyses with a calibration and a cross-validation sample (total N=930) showed that four recovery experiences can be differentiated: psychological detachment from work, relaxation, mastery, and control (Study 2). Examination of the nomological net in a subsample of Study 2 (N=271) revealed moderate relations of the recovery experiences with measures of job stressors and psychological well-being; relations with coping and personality variables were generally low (Study 3). Potential applications for the future use of these short 4-item measures in longitudinal and diary research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Did you have a nice evening?" A day-level study on recovery experiences, sleep, and affect.

In this study, the authors used a within-person design to examine the relation between recovery experiences (psychological detachment, relaxation, mastery experiences) during leisure time, sleep, and affect in the next morning. Daily survey data gathered over the course of 1 work week from 166 public administration employees analyzed with a hierarchical linear modeling approach showed that low psychological detachment from work during the evening predicted negative activation and fatigue, whereas mastery experiences during the evening predicted positive activation and relaxation predicted serenity. Sleep quality showed relations with all affective states variables. This study adds to research on job-stress recovery and affect regulation by showing which specific experiences from the nonwork domain may improve affect before the start of the next working day. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stressors in ICU: patients' evaluation

OBJECTIVE: To study the physical and psychological stressors in the intensive care unit (ICU) and to correlate stressors with different demographic variables. DESIGN: Cross-sectional analytical survey. SETTING: Intensive care unit of a private hospital. PATIENTS AND PARTICIPANTS: 50 randomly selected ICU patients during the first week of their ICU stay. MEASUREMENTS AND RESULTS: The Intensive Care Unit Environmental Stressor Scale was administered to 50 patients. Pain and the impossibility of sleeping due to noise and having tubes in the nose and mouth were considered the most important physical stressors. Loss of self control and lack of understanding about the attitudes and procedures were the main psychological stressors. CONCLUSIONS: Interventions should be aimed at relieving the patient's pain and at controlling the level of noise to make sleep possible. From the psychological standpoint, the independence of the patient should be encouraged, thus stimulating the recovery of self-control. The team should also inform the patient about the procedures which will be carried out.     

Touch relieves stress and pain

The contribution of non-biomedical factors to the experience of pain in the cancer patient has not been well established. Although intensity of pain reports cannot be fully explained by extent of identifiable nociception or neuropathy, behavioral factors have been only modest predictors of cancer pain report. Most studies that have demonstrated associations between pain and behavioral factors were conducted with highly selected groups of patients with all data collected concurrently. Thus the predictive value of the behavioral factors has been indeterminable. In this study, 358 bone marrow transplant patients (196 male, 162 female) completed pretransplant biomedical, physical functioning, psychological and social evaluations. For 25 days following transplantation, patients completed daily visual analogue scale oral pain reports and nurses recorded opioid use. At least once a week oral medicine staff completed a standardized, validated measure of observable oral mucositis as a measure of nociception. Results indicated that psychological and social variables were significant predictors of pain in this sample. Distress, particularly distress specific to the transplant, was the strongest predictor, while self-efficacy and coping style were weaker, but significantly associated with pain report for either men or women. While the psychological and social variables were significant predictors of pain, most of the variance in pain report was explained by biomedical variables rather than psychological or social variables. These results are consistent with those of previous research and indicate that biopsychosocial associations predate the onset of pain, but are at best modest predictors of cancer patients who will report greater or lesser pain. Clinical applications and limits of these data are discussed, particularly in relation to emotional distress, coping style and the differences found in predicting pain in men and women.     

Explanatory Style and Perception of Recovery in Symptomatic Mild Traumatic Brain Injury.

Objective: To examine perception of injury and explanatory style in symptomatic mild traumatic brain injury (MTBI). Study Design: Cross-sectional comparisons. Setting: Outpatient brain injury rehabilitation clinic. Participants: Twenty-two adults with MTBI and 11 with moderate/severe traumatic brain injury (TBI). Measures: Questionnaires addressing self-perception of injury severity and recovery and explanatory style. Results: MTBI patients reported greater injury severity and poorer cognitive recovery and rated their brain injury as affecting more areas of life than the moderate/severe TBI group. Pessimistic explanatory style was associated with poorer perceived recovery. Conclusions: The results provide a stimulus for future research on self-perception and explanatory style as significant psychological variables and should be considered as relevant for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of work in psychological health and well-being: A conceptual, historical, and public policy perspective.

The primary theme of this article, which serves as the introductory contribution of a special section of the American Psychologist, is that work plays a central role in the development, expression, and maintenance of psychological health. The argument underlying this assumption is articulated at the outset of the article in conjunction with a historical review of vocational psychology and industrial/organizational psychology. The article follows with an overview of contemporary vocational psychology and a presentation of the psychology-of-working perspective, which has emerged from critiques of vocational psychology and from multicultural, feminist, and expanded epistemological analyses of psychological explorations of working. Three illustrative lines of inquiry in which research has affected the potential for informing public policy are presented. These three lines of scholarship (role of work in recovery from mental illness; occupational health psychology; and working, racism, and psychological health) are reviewed briefly to furnish exemplars of how the psychological study of working can inform public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of interactions between psychological and clinical factors in determining 6-month mortality among patients with acute myocardial infarction. Application of recursive partitioning techniques to the GISSI-2 database. Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico

BACKGROUND: Clinical and epidemiological studies support the hypothesis that ischaemic cardiovascular diseases are consistently associated with psychological, social and behavioural factors. Nevertheless, the joint effect of clinical characteristics and psychological variables in determining the prognosis of acute myocardial infarction survivors has been seldom investigated. METHODS AND RESULTS: In the framework of the GISSI-2 trial, the impact of psychological factors on 6-month mortality and their interaction with clinical features was included as an ad hoc research project. Overall, 2449 patients were evaluated, 63 of whom died during the study period. All patients undertook a self-administered questionnaire (Cognitive Behavioural Assessment Hospital Form), investigating 16 psychological dimensions relative to three areas (state variables, vital exhaustion, trait variables). The impact of psychological variables on prognosis and their interaction with clinical variables were investigated by using a tree-growing technique (RECursive Partitioning and AMalgamation-RECPAM) applied to survival analysis. This statistical method allowed the identification of three separate classes, characterized by different prognoses: Class I (presence of vital exhaustion), Class II (concomitance of no vital exhaustion, depression and low levels of anxiety) and Class III (all other patients). After adjusting for the clinical variables, Class I was associated with an intermediate prognosis (hazard ratio [HR] = 2.2; 95% confidence intervals [CI], 1.2-4.0) and Class II to the worst (HR = 3.2; 95% CI = 1.6-6.2), as compared to Class III. High levels of neuroticism and extroversion were associated with a better prognosis. When clinical and psychological variables were simultaneously investigated by RECPAM, Type A behaviour was shown to be an important risk predictor among patients with better clinical conditions, i.e. those eligible for exercise test (HR = 2.6, 95% CI = 1.2-5.5). Finally, a striking difference in the impact of the most predictive clinical variables (exercise test ineligibility, late and early ventricular failure) was found among patients with and without vital exhaustion. CONCLUSIONS: This study shows that acute myocardial infarction survivors are heterogeneous with respect to 6-month mortality according to their psychological profile. More important, the impact of these variables appears comparable to that of very well known clinical risk predictors. The availability of a large study population, together with the use of innovative statistical techniques, allowed us to identify subgroups of patients for whom the joint action of clinical and psychological characteristics has been clearly documented. This suggests the need for incorporating psychological evaluation in the care of acute myocardial infarction patients.     

Patient-focused research: Using patient outcome data to enhance treatment effects.

A program of research aimed at improving the quality of psychological interventions is described. Data from over 10,000 patients were analyzed to understand the association between number of treatment sessions and clinically significant improvement. In addition to a potential dose-response relationship, typical recovery curves were generated for patients at varying levels of disturbance and were used to identify patients whose progress was less than expected ("signal" cases). The consequences of passing this information along to therapists were reported. Analyses of dose-response data showed that 50% of patients required 21 sessions of treatment before they met criteria for clinically significant improvement. Seventy-five percent of patients were predicted to improve only after receiving more than 40 treatment sessions in conjunction with other routine contacts, including medication in some cases. Identification of signal cases (potential treatment failures) shows promise as a decision support tool, although further research is needed to elucidate the nature of helpful feedback. Outgrowths of this research include its possible contribution to social policy decisions, reductions in the need for case management, use in supervision, and possible effects on theories of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The determinants of long-term blood pressure stability: control of trough blood pressure during sleep

Little is known regarding the prevalence and course of fatigue in cancer patients after treatment has ended and no recurrence found. The present study examines fatigue in disease-free cancer patients after being treated with radiotherapy (n = 154). The following questions are addressed. First, how do patients describe their fatigue 9 months after radiotherapy and is this different from fatigue in a nonselective sample from the general population (n = 139)? Secondly, to what degree is fatigue in patients associated with sociodemographic, medical, physical and psychological factors? Finally, is it possible to predict which patients will suffer from fatigue 9 months after radiotherapy? Results indicated that fatigue in disease-free cancer patients did not differ significantly from fatigue in the general population. However, for 34% of the patients, fatigue following treatment was worse than anticipated, 39% listed fatigue as one of the three symptoms causing them most distress, 26% of patients worried about their fatigue and patients' overall quality of life was negatively related to fatigue (r = -0.46). Fatigue in disease-free patients was significantly associated with: gender, physical distress, pain rating, sleep quality, functional disability, psychological distress and depression, but not with medical (diagnosis, prognosis, co-morbidity) or treatment-related (target area, total radiation dose, fractionation) variables. The degree of fatigue, functional disability and pain before radiotherapy were the best predictors of fatigue at 9-month follow-up, explaining 30%, 3% and 4% of the variance respectively. These findings are in line with the associations found with fatigue during treatment as reported in the preceding paper in this issue. The significant associations between fatigue and both psychological and physical variables demonstrate the complex aetiology of this symptom in patients and point out the necessity of a multidisciplinary approach for its treatment.     

An integrated model of weekday stress and weekend recovery of students.

In previous research on psychological stress recovery, recovery activities and recovery experiences have been studied separately rather than jointly. The present study advances previous knowledge about stress recovery by integrating the effects of these separate recovery constructs within a single study and examining them outside the work context. We propose and test an integrated model of the stress-recovery process that includes weekday stressors and weekend recovery activity behaviors, psychological recovery experiences, and recovery outcomes. Undergraduates (n = 221) from a Midwestern university reported on Friday about stressors experienced during the week, followed by a weekend during which recovery could occur. On Monday they reported their weekend activities and their current well-being. Results suggest that participating in specific recovery activities during a weekend and accompanying specific subjective recovery experiences reduce negative psychological outcomes. Future research and practical applications of the integrated model of the recovery process are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Etiological factors and temporomandibular treatment outcomes: the effects of trauma and psychological dysfunction

This paper examines the effect of trauma and psychological dysfunction as etiological factors in temporomandibular disorder (TMD). It employs a thoroughly validated measurement system, the TMJ Scale, to determine the effects of traumatic temporomandibular joint injury as well as pre-treatment stress and psychological dysfunction levels upon presenting symptom levels. It also addresses these parameters for the eventual treatment outcome. During the course of the study, 754 patients were evaluated at the author's practice, which is limited to the diagnosis and Phase I treatment of temporomandibular dysfunction. Of those individuals, 693 (91.9%) were found to have clinically treatable temporomandibular disorders. At the time of this study, 201 consecutive patients (29%) have completed treatment and were deemed to have reached Maximum Medical Improvement (MMI). The validated measurement system of the TMJ Scale was readministered to this post treatment population. Data analysis revealed that trauma patients did not differ from non-trauma patients in initial symptom levels, nor in levels of symptom improvement (with the exception of a higher palpation pain level reported by the trauma patients). Stress and psychological dysfunction were predictive of higher initial symptom perception levels, but were not significantly related to treatment outcomes. These findings have important implications for practitioners in the field of temporomandibular studies. If it can be confirmed that psychological variables have no impact on treatment outcome, it would be difficult to justify the now frequently employed "dual axis" classifications and major emphasis placed on psychological treatment for temporomandibular patients.     

Further examination of post-traumatic amnesia and post-coma disturbance as non-linear predictors of outcome after head injury.

The relationship between early neurological variables and cognitive outcome was investigated in a group of 77 severely head-injured patients following C. Haslam et al (1994). At the time of admission, patients were assessed on 7 neurological indices, including durations of post-traumatic amnesia (PTA) and post-coma disturbance (PCD), the latter defined as the period between emergence from coma and end of PTA. PTA and PCD were transformed to address their non-linearity. Two years later, patients underwent examination on selected psychological measures. Recent memory was best predicted by transformed PTA, and speed of information processing was best predicted by transformed PCD. Prediction of both psychological factors was also improved by taking into account surgical evacuation of an extradural hematoma. Findings are consistent with research demonstrating the utility of transformed variables and PCD in prediction of cognitive outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication between patients with breast cancer and health care providers. Determinants and implications

BACKGROUND: This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined. METHODS: Ninety-seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records. RESULTS: A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression anger, and confusion at the 3-month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables. CONCLUSION: Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.     

Effects of disability and bereavement on the mental health and recovery of older adults.

We investigated the role of two major stressors, recent disability and conjugal bereavement, in older adults' self-reports of mental health and recovery from stress. A sample of 246 older adults between the ages of 60–80 was interviewed monthly for 3 months by trained elderly interviewers; Month-10 interview data were also analyzed. Control subjects, who were not experiencing the stressors, were carefully selected from a sample of adults matched on age, sex, and socioeconomic status. Dependent variables were psychological distress and psychological well-being, each with component subscales. The disabled group evidenced significantly lower positive well-being and significantly greater distress than did the other groups. Bereaved subjects demonstrated high levels of depression compared with the disabled subjects, but showed less anxiety. Bereaved subjects showed recovery on several indicators of mental health, but disabled subjects continued to show considerable psychological upset in comparison with the other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of oligonucleotides to c-myb on vascular smooth muscle cell proliferation and neointima formation after porcine coronary angioplasty

In this article, problems associated with several methods commonly employed in research with psychiatric inpatients are discussed and the implications that these problems have for the validity of research with this population are explored, using an investigation of the relationship between moral reasoning and aggression among psychiatric inpatients as a case example. Specific issues examined include the adequacy of hospital records for diagnosing patients, the difficulty of determining when it is appropriate to approach recently admitted patients for research, and problems in the measurement of behavioral and psychological variables such as aggression and moral reasoning. Suggestions and recommendations for addressing these issues in future research are offered.     

Synthesis of new phosphonate ester resins for adsorption of gold from alkaline cyanide solution

Resin ion-exchange technology is a possible alternative to well-established gold recovery processes of carbon adsorption and zinc-dust cementation. The search for a suitable resin for gold recovery from alkaline cyanide solution continues at several research centers. Recent discoveries involving alkyl phosphorus esters for selective gold solvent extraction from alkaline cyanide solution suggest that similar chemistry on a resin substrate might likewise be effective. In this regard, polystyrene-supported phosphonate ester-based resins were synthesized from the poly(styrene/divinylbenzene) copolymers. Gold adsorption/desorption characteristics were established for these resins with respect to functional group chemistry, pH, ionic strength, and temperature. Gold loading was found to be promoted at increased ionic strength with fair selectivity over various cyanoanions. Stripping was possible at higher temperatures and/or low ionic strength of the strip solution. Solvation extraction of an alkali cation/aurocyanide anion ion pair seems to explain the adsorption/desorption phenomena which are discussed in terms of the variables studied.     

Being a stroke patient: a review of the literature

The purpose of this paper is to review the research literature on the patient's experience of stroke. Four qualitative studies on how patients experience stroke were identified. The findings of these studies show that the stroke patient often has clear goals for himself in relation to functional abilities, against which he measures all success and forward progress in his rehabilitation. Even though the stroke patient accepts a lower level of functional ability, he is not willing to accept the rehabilitation professionals' prediction of his ultimate functional level if it is lower than his own goal. Furthermore, stroke patients see recovery as a return to the existence they had lived before the stroke, which is different from the health care providers' view. To the health care provider, recovery is measured in terms of isolated and discrete return of movement, whereas in the eyes of the patients, recovery is a return to previously valued activities. Further, studies on psychosocial function after stroke were reviewed. Recent studies show that the psychological impact of the stroke experience is immense and that stroke patients experience stress on a variety of levels. Also, depression exists in a large portion of the stroke population. The impact of stroke also influences the patient's social existence, as studies have shown that stroke patients do manifest diminished social function. However, the reviewed studies are not without limitations. Further studies, with a qualitative design, are needed to throw light on the patient's experience of being ill with stroke, and the process of his recovery.