Preventing problems of professional competence in the face of life-threatening illness.

When a psychologist is diagnosed with a serious medical condition and faces the prospect of an arduous treatment regimen and perhaps a bleak prognosis, it may be difficult to attend to one's level of professional competence. Like their clients, psychologists are vulnerable to distress and diminished functioning caused by a life-threatening illness. Psychologists have an ethical responsibility to monitor and ensure professional competence, yet the distress and distraction that accompany serious health problems can inhibit and undermine self-assessments of competence in many ways; distressed psychologists may react with denial, shame, fear, and problematic countertransference responses. The limitations associated with evaluating competence in the context of distress are discussed and several recommendations are offered for psychologists who deliver services, support gravely ill colleagues, and serve in credentialing and regulatory capacities. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Emotional distress and urinary incontinence among older women.

Objective: Examined appraisals of interference and personal tolerance in the prediction of distress among women experiencing urinary incontinence (UI). Design: Interviewed women volunteering for a behavioral treatment for UI. Women were interviewed at baseline; follow-up assessments were conducted 6 weeks and 6 months later. Measures of perceived interference, tolerance, condition-specific emotional distress, symptom severity, general intelligence, and depressive symptoms were administered. Participants: 131 women (mean age = 66.6 years, SD = 8.4; range 55-90) with reported involuntary loss of urine at least once a week prior to participation. Main Outcome Measure: Emotional distress attributed to UI. Results: Path analyses indicated that greater tolerance was associated with less interference imposed by UI. Greater tolerance was also associated with less distress. Symptom severity (frequency of UI episodes, nocturia, and objectively determined fluid loss) indirectly influenced emotional distress through perceived interference. Cognitive appraisals of interference and tolerance were stable over time. Conclusions: These data indicate that appraisals of personal ability to tolerate the condition and interference of the condition on goal-directed behavior and expected activities have greater influence on emotional distress than does severity of condition-specific symptom. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness

This paper reports on the initial efforts to validate a brief self-report inventory, the Systems of Belief Inventory(SBI-15R), for use in quality of life (QOL) and psychosocial research studying adjustment to illness. The SBI-15R was designed to measure religious and spiritual beliefs and practices, and the social support derived from a community sharing those beliefs. The authors proposed this scale to address the need for greater exploration of spiritual and religious beliefs in QOL, stress and coping research. Phase I: Item generation. The research team identified four domains comprised of 35 items that make up spiritual and religious beliefs and practices. The instrument was piloted in a structured interview format on 12 hospitalized patients with varying sites of cancer. Phase II: Formation of SBI-54. After these initial efforts, the research team increased the number of items to 54 and adopted a self-report format. To assess patients reactions to the questionnaire, the new version was piloted on 50 outpatients with malignant melanoma. Phase III: Initial validation. To begin establishing validation, 301 healthy individuals with no history of cancer or serious illness in the prior year were asked to complete the SBI-54 and several other instruments. A principal components analysis with varimax rotation of the SBI-54 identified two factors, in contrast to the four which were hypothesized, one measuring spiritual beliefs and practices, the other measuring social support related to the respondent's religious community. Phase IV: Item reduction of the SBI-54. A shortened version of the SBI-54 with 15 items, five from the items identifying factor I and ten from those identifying factor II, was developed to lessen patient burden. The new SBI-15 correlated highly with the SBI-54, and demonstrated convergent, divergent, and discriminant validity. Revision of SBI-15. The investigators rephrased one statement in order to broaden the applicability of the SBI-15 to patients other than those with a diagnosis of cancer, and to healthy individuals. DISCUSSION. The SBI-15R met tests of internal consistency, test-retest reliability, and convergent, divergent, and discriminant validity in both physically healthy and physically ill individuals. The SBI-15R may have value in measuring religious and spiritual beliefs as a potentially mediating variable in coping with life-threatening illness, and in the measurement of QOL.     

Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study

BACKGROUND: As more oncology care is moved to the outpatient setting, the need for a rapid means for oncologists to identify patients with significant distress has increased. Concurrent with this move has been the pressure to reduce time spent with each patient, adding to the likelihood that a distressed patient will not be recognized and will remain untreated in the current health care environment. METHODS: A pilot program was conducted in a prostate carcinoma oncology clinic to test the feasibility of a two-stage approach that identifies patients in significant distress and refers them for treatment. Two pencil and paper self-report measures were used to detect psychologic distress in patients over the previous week: 1) The Hospital Anxiety and Depression Scale (HADS) and 2) "The Distress Thermometer." Patients who scored above an agreed upon cutoff score on either measure (HADS = 15+; Thermometer = 5+) were referred to the psychiatric liaison in the clinic for evaluation. RESULTS: Compliance in filling out the measures was excellent; only 8 of 121 patients (6.6%) refused. Thirty-one percent of evaluable patients were referred based on elevated scores. Seventeen of 29 patients actually were evaluated. Eight of 17 patients met Diagnostic and Statistical Manual (of Mental Disorders)-IV criteria for a psychiatric disorder. CONCLUSIONS: This approach for rapid screening for distress was acceptable in prostate carcinoma patients, although these older men were reluctant to agree to evaluation and treatment. This simple screening method needs further testing and the identification of barriers on the part of the patient and oncologist that impede the identification of the most distressed patients.     

The changing nature of hope: Development, psychotherapy, and life-threatening illness.

During the course of our work we are sometimes invited to accompany patients on journeys that affect us very deeply. It may be because they invite us to help them develop, or because they persevere in the face of extreme suffering, or because they share extreme joys and accomplishments, or because they share profound disappointment, or because they show us the power of the human spirit and the changing nature of hope. This paper describes a psychotherapy case that touched me for all these reasons. It outlines the poignant ups and downs in the journey of a young woman facing life-threatening illness. It describes the interruption and resumption of her development during emerging adulthood. It relies upon theory and research in human development, family systems, and pediatric/health psychology, and the scholarship concerning grief. The paper discusses countertransference and ethical issues as they arose during psychotherapy. I conclude with reflections on the most significant lessons I learned that have impacted my work and life going forward. Many of the issues discussed pertain not only to working with the special population facing life-threatening illness, but to working with anyone facing uncertainty, disappointment, helplessness, or loss. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Haredi women, haredi men, stress and distress

This report examines data from interviews with 179 strictly-orthodox Jews living in London. The impetus was a debate in this journal on the question whether men or women in the strictly-orthodox (haredi) community are more stressed. Many of the observations made in this journal on the quality of life among haredi men and women in Israel were borne out among the strictly-orthodox London Jews interviewed. Quantitatively, severe stress and clinical levels of depression and anxiety were similar among the men and women studied, but women had overall more eventful lives than men, and were more likely to suffer from borderline depression and anxiety--though these differences were only marginally significant. It is suggested that the London sample studied were probably similar to haredim in Israel, and that the findings might therefore be applicable.     

Effects of AIDS-related bereavement and HIV-related illness on psychological distress among gay men: A 7-year longitudinal study, 1985–1991.

Examined the influence of AIDS-related bereavement on psychological distress from 1985 through 1991. It was predicted that this relation would be influenced by personal knowledge of HIV infections and symptoms consistent with HIV-related illness. Interview data collected each year on a cohort of 746 gay men included information on the deaths and illnesses of network members caused by AIDS, as well as on psychological distress, sedative use, HIV-related symptoms, and HIV infection status. Significant main effects of bereavement were found in each year after controlling for both losses occurring from 1 to 2 yrs previously and for AIDS and HIV health status. The intensity and duration of these bereavement effects diminished over time. Groups of men who were both bereaved and classified as having AIDS or were HIV positive reported the highest level of distress in every year compared with the 3 other groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping style, perceived uncertainty in illness, and distress in individuals with Parkinson's disease and their caregivers.

Examined the relationship of coping style and illness uncertainty to psychological distress in individuals with Parkinson's disease (PD) and their primary caregivers. Design: Correlational methods, within-group theory-driven hierarchical regression analyses, and transactional analyses. Ss were 44 dyads composed of individuals with PD and their caregivers. Main Outcome Measures: Hoehn and Yahr Clinical Disability Rating Scale, Instrumental Activities of Daily Living Scale, Symptom Distress Checklist-90—Revised, Mischel Uncertainty in Illness Scale-Community Form, and Revised Ways of Coping Checklist. Results: Emotion-focused coping was associated with higher levels of distress for persons with PD, whereas both emotion-focused coping and perceived uncertainty were associated with distress for the caregivers. Transactional analyses between patients and caregivers indicated that higher levels of patient problem-focused coping and perceived uncertainty in illness were associated with increased problems in caregiver distress. Adjustment to PD is influenced by several patient and caregiver variables. The results warrant consideration of a variety of clinical interventions involving patient and caregiver education about the disease and methods for managing the associated symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Plasma pyridoxine deficiency is related to increased psychological distress in recently bereaved homosexual men

OBJECTIVE: Previous research has demonstrated that a theoretical model including measures of life stressors, social support, and coping style significantly predicts psychological distress. This study tested plasma pyridoxine (vitamin B6) deficiency status as a predictor of overall psychological distress and specific mood states in this model, controlling for HIV-1 serostatus. METHOD: Subjects included HIV-1+ (N = 76) and HIV-1- (N = 58) recently bereaved homosexual men. At baseline, subjects completed a battery of psychosocial questionnaires, together with a physical examination and venipuncture. The Profile of Mood States (POMS) provided measures of overall psychological distress as well as specific mood states. Pyridoxine deficiency status (a categorical measure of deficient vs. adequate status) was determined with a bioassay of erythrocyte aspartate aminotransferase activity. RESULTS: Pyridoxine deficiency was a significant predictor of increased overall psychological distress in this model, controlling for life stressors, social support, coping style, and HIV-1 serostatus. In post hoc analyses of specific mood state effects, pyridoxine deficiency status was significantly associated with increases in depressed, fatigued, and confused mood levels, but not with those of anxiety, anger, or vigor. DISCUSSION: These findings suggest that adequate pyridoxine status may be necessary to avert psychological distress in the setting of bereavement. Inasmuch as pyridoxine is a cofactor for 5-hydroxytryptophan decarboxylase--an enzyme in the biosynthesis pathway of serotonin--serotonin level in the brain is implicated as the mediating factor.     

Emotional distress following genetic testing for hereditary breast and ovarian cancer: A meta-analytic review.

Objective: Meta-analysis was used to synthesize results of studies on emotional consequences of predictive genetic testing for BRCA1/2 mutations conferring increased risk of breast and ovarian cancer. Design: Studies assessing anxiety or cancer-specific distress before and after provision of test results (k = 20) were analyzed using a random-effects model. Moderator variables included country of data collection and personal cancer history of study participants. Main Outcome Measures: Standardized mean gain effect sizes were calculated for mutation carriers, noncarriers, and those with inconclusive results over short (0–4 weeks), moderate (5–24 weeks), or long (25–52 weeks) periods of time after testing. Results: Distress among carriers increased shortly after receiving results and returned to pretesting levels over time. Distress among noncarriers and those with inconclusive results decreased over time. Some distress patterns differed in studies conducted outside the United States and for individuals with varying cancer histories. Conclusion: Results underscore the importance of time; changes in distress observed shortly after test-result disclosure frequently differed from the pattern of distress seen subsequently. Although emotional consequences of this testing appear minimal, it remains possible that testing may affect cognitive and behavioral outcomes, which have rarely been examined through meta-analysis. Testing may also affect understudied subgroups differently. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive–behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men.

The effects of a 10-week group-based cognitive–behavioral stress management (CBSM) intervention on psychological distress and plasma free testosterone in symptomatic, HIV-seropositive men were examined. Participants were randomized to either CBSM (n?=?42) or a wait-list control group (n?=?23). Men in the CBSM intervention showed significant increases in testosterone, whereas control participants showed significant decreases. Those participating in CBSM had significant distress reductions, whereas controls showed no such change. Alterations in free testosterone were inversely related to changes in distress states over time, independent of any changes in cortisol. These findings demonstrate that a short-term CBSM intervention increases free testosterone levels among symptomatic, HIV-seropositive men, and alterations in free testosterone are associated with changes in psychological distress observed during CBSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional distress regulation takes precedence over impulse control: If you feel bad, do it!

Why do people's impulse controls break down during emotional distress? Some theories propose that distress impairs one's motivation or one's ability to exert self-control, and some postulate self-destructive intentions arising from the moods. Contrary to those theories, three experiments found that believing that one's bad mood was frozen (unchangeable) eliminated the tendency to eat fattening snacks (Experiment 1), seek immediate gratification (Experiment 2), and engage in frivolous procrastination (Experiment 3). The implication is that when people are upset, they indulge immediate impulses to make themselves feel better, which amounts to giving short-term affect regulation priority over other self-regulatory goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptom distress in adult patients with cancer

Symptom distress in the adult population with cancer is of concern to clinicians who care for these patients. Increased research has been directed toward the development and refinement of symptom distress scales, the identification of determinants of symptom distress, the investigation of symptom distress as a predictor, and the examination of the relationship between quality of life and symptom distress. Findings from this research have increased our understanding of symptom distress in adult patients with cancer. However, a major limitation of work to date has been a lack of consensus related to the definition and measurement of the symptom distress construct. The purpose of this article is to address existing conceptual and methodological challenges inherent in the study of symptom distress, and to make recommendations for further research in this area.     

The differential effect of child age on the illness intrusiveness–parent distress relationship in juvenile rheumatic disease.

Objective: Examine age-related patterns of association between parent-reported illness intrusiveness and parent distress in parents of youth with juvenile rheumatic diseases (JRDs). Study Design: Cross-sectional multiple regression analysis tested child age as a moderator in the illness intrusiveness–distress relationship. Participants: Fifty-two parents of children ages 9–17 diagnosed with JRD. Main Outcome Measures: The Illness Intrusiveness Scale—Parent Version and the Brief Symptom Inventory. Results: Parent-reported illness intrusiveness demonstrated a significant main effect on distress for all parents in the sample. This was qualified by an Illness Intrusiveness × Child Age interaction. Illness intrusiveness was found to be significantly related to distress among parents of older youth, but was only marginally related to distress for parents of younger children. Conclusions: Results are consistent with family life cycle development models of adjustment to childhood chronic illness. The clinical implications of the findings are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The microbiology laboratory's role in life-threatening infections

The microbiology laboratory's contribution to the care of patients who are critically ill is explored. The economic and epidemiologic impact of broad-spectrum antibiotic use is discussed, along with methodology of antimicrobial susceptibility testing and the potential value of an antibiogram. The clinical benefits of blood, sputum, urine, spinal fluid, and wound cultures are discussed, with an emphasis on interpretation of culture results. The significance of, and procedures for, proper specimen collection are emphasized throughout the article, and the ramifications of improper specimen collection are presented.     

Sex role attributes, symptom distress, and defensive style among college men and women.

Administered the Personality Research Form-Andro Scale Masculinity and Femininity subscales, the Symptom Check List-90 (Revised), and the Defense Mechanism Inventory to 84 male and 90 female undergraduates. Results indicate that interrelations among sex-role attributes, defense preferences, and symptom distress differed for men and women. Cross-sex-typed Ss mostly accounted for differences in symptom distress within each sex: Masculine women reported relatively low and feminine men reported relatively high degrees of symptom distress. In addition, sex roles interacted with sex in determining defense preferences. The possibility that defensive styles mediated between sex-role attributes and symptom distress was also explored. Among women, an association between masculine attributes and a rejection of self-blaming defenses accounted for the negative relation between masculinity attributes and symptom distress. Among men, sex-role attributes and defensive styles, for the most part, contributed independently to symptom distress. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)