Predictors of psychosocial adjustment in patients with implantable cardioverter defibrillators

Predictors of psychological distress/adjustment were examined in 25 patients following placement of ICDs. Patients completed a demographic questionnaire and a standardized questionnaire of psychological symptoms (i.e., Symptom Checklist-90 Revised; SCL-90-R). The number of discharges categorized by the patient as inappropriate and appropriate were also ascertained. The number of ICD discharges categorized as inappropriate and diminished levels of physical activity (r = 0.53 and 0.63, P < 0.01, respectively) did significantly relate to overall psychological distress. In addition, after controlling for age and prior psychiatric and physical health status through a stepwise multiple regression analysis, the occurrence of ICD discharges categorized as inappropriate and diminished physical activity continued to significantly predict overall psychological distress (R2 = 0.41, P < 0.01). However, the number of ICD discharges categorized as appropriate did not significantly predict overall psychological distress. The results of this investigation suggest that further refinement of the ICD could reduce the risk of exposure to potential psychological distress, and an analysis of prior and anticipated patient physical activity levels should be a factor when calibrating minimum ICD discharge threshold levels.     

Determinants of pain expression in hospitalized burn patients

This study examines the relationship between extent of injury, degree and type of psychological distress and self-report of pain in burn survivors. One hundred eighty burn patients were interviewed within 2 weeks of their burn trauma. Using a visual analogue scale to assess subjective pain and pain relief, and self-report measures of post-traumatic stress symptoms and general psychological distress, we assessed the relationship between PTSD symptoms, general distress and pain. Subjective pain was unrelated to sex, ethnicity, or total body surface area burned. The most important correlate of subjective pain was general psychological distress. Intrusive PTSD symptoms had no independent power to predict the variance in pain scores. However, among women, more severe avoidant symptoms were associated with greater subjective pain.     

A prospective study of risk and resilience factors associated with posttraumatic stress symptoms and depression symptoms among Jews and Arabs exposed to repeated acts of terrorism in Israel.

In the first prospective study, to our knowledge, of the impact of ongoing terrorism and political violence, we analyzed nationally representative data from 560 Jews and 182 Arabs in Israel over a 6-month period. Based on Conservation of Resources (COR) theory (Hobfoll, 1989, 1998), we predicted that exposure to terrorism and political violence would result in psychosocial and economic resource loss and resource lack, which in turn, would be primary predictors of increases in symptoms of posttraumatic stress (PTS) and depression. We also predicted that trauma exposure and PTS symptoms, in particular, would be related to ethnocentrism and support for political violence. Furthermore, based on theory and prior research, we predicted that posttraumatic growth (PTG) would be related to a worsening of symptoms of distress and that distress would be related to increased ethnocentrism and support for extreme political violence for their “cause.” Women, older individuals, and Arabs (compared with Jews) were more likely to have continued psychological distress over time. In addition, using simultaneous equation modeling, we found good fit for a structural model that partially supported our hypotheses. Psychosocial resource loss, PTG, and social support had direct and indirect effects on psychological distress. Political attitudes tended to harden over time but were not prospectively related to PTS or depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal, abused African American women's response to a culturally informed intervention.

Objective: This study examined (a) the efficacy of a manualized, culturally informed, empowerment-focused psychoeducational group intervention (Nia) designed in accord with the theory of triadic influence or treatment as usual (TAU) for reducing psychological symptomatology (suicidal ideation, depressive symptoms, posttraumatic stress symptoms, general psychological distress), and (b) the effect of Nia versus TAU on the relation between exposure to intimate partner violence (IPV) and psychological symptomatology in these women. Method: Two hundred eight low-socioeconomic-status African American women with a recent history of IPV and a suicide attempt were randomized to Nia or TAU and assessed at baseline, postintervention, and 6- and 12-month follow-up. They were assessed on their levels of IPV (Index of Spouse Abuse), suicidal ideation (Beck Scale for Suicidal Ideation), depressive symptoms (Beck Depression Inventory–II), posttraumatic stress symptoms, and general psychological distress (Brief Symptom Inventory). Results:Hierarchical linear modeling found that women receiving the culturally informed Nia intervention showed more rapid reductions in depressive symptoms and general distress initially, and the between-group difference in depressive symptoms persisted at follow-up. Following intervention, compared with women randomized to TAU, women in Nia exhibited less severe suicidal ideation when exposed to physical and nonphysical IPV. Conclusions:Findings highlight the value of incorporating Nia as an adjunctive intervention for abused, suicidal, low-income women. They underscore the ways the intervention needs to be bolstered to address more directly more mediating and moderating constructs, as well as the need to target more effectively the key outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Brief Symptom Inventory: Measuring psychological distress in spinal cord injury.

Explored the appropriateness of the Brief Symptom Inventory (BSI) as a measure of psychological distress among 79 traumatic spinal cord injured (SCI) patients (aged 18–70 yrs) and emphasized the limitations of using the BSI as a replacement for the SCL-90—Revised (SCL-90—R). Ss' BSI scores were compared with a nonpatient normative group (N?=?974). Ss were significantly more psychologically distressed in somatization, depression, and phobic anxiety than the normative group. However, several somatization symptoms endorsed by these Ss are common physical effects of SCI rather than psychosomatic complaints. When comparing BSI and SCL-90—R scores of the same Ss, significant statistical differences were found with respect to the level of psychological distress being reported by each test. The BSI may not represent an equivalent abbreviated form of the SCL-90—R for the SCI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reaction to trauma: A cognitive processing model.

Integrated existing cognitive processing models of posttrauma reactions into a longitudinal model. Data were obtained after a multiple shooting in a city office block. The S group comprised 158 office workers who were in the building at the time of the shootings. The methodology of this research was a repeated measures survey, with data collection at 4, 8, and 14 mo posttrauma. Measures included the Impact of Events Scale (IES) and the SCL-90—Revised. A path analysis was performed with the IES as an indication of cognitive processing. Intrusion and avoidance were shown to mediate between exposure to trauma and symptom development. Intrusion was also found to be negatively related to subsequent symptom levels. The findings provide provisional support for a cognitive processing model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interleukin-1 beta inhibits glutamate release in hippocampus of young, but not aged, rats

OBJECTIVE: In addition to the physical symptoms of galactorrhoea and amenorrhoea, hyperprolactinaemia in women is also reported to be associated with psychological symptoms. Previous studies have found an increased incidence of depression, anxiety and hostility in female patients with hyperprolactinaemia. In this study, psychological symptoms were assessed in a large population of patients and symptom scores were compared between patients with definite evidence of pituitary adenoma on high-resolution CT scanning and those without, who were presumed to have idiopathic or 'functional' hyperprolactinaemia. DESIGN: Postal survey: population-control study of female patients with hyperprolactinaemia. PATIENTS: Sixty-five women with hyperprolactinaemia were compared with a control group of 26 women with normoprolactinaemic pituitary disease (acromegaly or nonfunctioning pituitary adenoma). The hyperprolactinaemic patients were subdivided according to whether a pituitary adenoma was visible on high-resolution CT scanning (39 patients) or whether they had normal CT scans, in which case they were categorized as having idiopathic or 'functional' hyperprolactinaemia (26 patients). MEASUREMENTS: Patients were sent 2 questionnaires, the Hospital Anxiety and Depression (HAD) Scale and the 90-item Symptom Checklist (SCL-90), to assess psychological wellbeing. RESULTS: Overall, 54% of hyperprolactinaemic patients were found to have definite or borderline anxiety as judged by HAD scores, compared with 27% of normoprolactinaemic control patients. Those with normal CT scans were significantly more likely to have definite or borderline anxiety (73% of patients) than those with CT evidence of a pituitary tumour causing their hyperprolactinaemia (41%, P < 0.003), despite similar levels of serum prolactin. A similar increased proportion of hyperprolactinaemic patients scored highly on the anxiety component of the SCL-90, although mean scores were not different from controls. No differences were seen in scores for depression, but both subgroups of hyperprolactinaemic patients scored more highly than controls for hostility on the SCL-90 questionnaire. CONCLUSION: These findings confirm the presence of significant anxiety in a proportion of women with hyperprolactinaemia. Hyperprolactinaemic women with no abnormality on CT scans displayed more psychological distress than those with definite pituitary microadenomas. These results may provide insight into the pathogenesis of 'functional' hyperprolactinaemia.     

Ethnic differences in posttraumatic distress: Hispanics’ symptoms differ in kind and degree.

This longitudinal study of physical injury survivors examined the degree to which Hispanic and non-Hispanic Caucasians reported similar posttraumatic stress disorder (PTSD) symptoms. Adult physical trauma survivors (N = 677) provided information regarding posttraumatic distress by completing an interview-administered version of the PTSD Symptom Checklist (Civilian version) at 3 time points: within days of trauma exposure and again at 6 and 12 months posttrauma. Structural equation modeling with propensity weights was used in analyzing data. Results replicated prior research indicating that Hispanics report greater overall PTSD symptom severity. However, the size of this effect varied significantly across the 17 individual PTSD symptoms, and several symptoms were not reported more highly by Hispanics. Relative to non-Hispanic Caucasians, Hispanics tended to report higher levels of symptoms that could be regarded as exaggerated or intensified cognitive and sensory perceptions (e.g., hypervigilance, flashbacks). In contrast, few differences were observed for symptoms characteristic of impaired psychological functioning (e.g., difficulty concentrating, sleep disturbance). Findings suggest that the pattern of PTSD symptoms experienced most prominently by Hispanics differs in kind and not merely in degree. Results have implications for theory aimed at explaining this ethnic disparity in posttraumatic psychological distress as well as for clinical intervention with trauma-exposed Hispanics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Symptom severity and diagnoses related to sexual assault history

The current study examines associations between a history of sexual assault or abuse and severity of symptoms and diagnostic categories in an adult clinical outpatient sample. Twelve of 68 men (18%) and 71 of 120 women (59%) reported a history of sexual trauma. Abuse history was associated with mood and anxiety disorder diagnoses. Women were also more likely to receive these diagnoses; abused women were particularly likely to be diagnosed with an anxiety disorder. Abused subjects showed higher scores on every subscale of the SCL-90-R; there were no interactions between sex and history of abuse. Women scored higher than men on subscales indicating anxiety, phobia, and general distress. The results indicate an association between history of sexual trauma and symptom severity across a broad range of psychopathology, and with mood and anxiety disorders. There is no indication of differential gender effects of sexual assault.     

Adjustment following the mass shooting at Virginia Tech: The roles of resource loss and gain.

Unfortunately, many individuals will be exposed to traumatic events during their lifetime. The experience of loss and gain of valued resources may represent important predictors of psychological distress following these experiences. The current study examined the extent to which loss and gain of interpersonal and intrapersonal resources (e.g., hope, intimacy) predicted psychological distress among college women following the mass shooting at Virginia Tech (VT). Participants were 193 college women from whom preevent psychological distress and social support data had been obtained. These women completed surveys regarding their psychological distress, coping, and resource loss and gain 2- and 6-months after the VT shooting. Structural equation modeling supported that resource loss predicted greater psychological distress 6 months after the shooting whereas resource gain was weakly related to lower levels of psychological distress. The study also revealed that social support and psychological distress prior to the shooting predicted resource loss, and social support and active coping with the shooting predicted resource gain. Implications of the results for research examining the roles of resource loss and gain in posttrauma adjustment and the development of interventions following mass trauma are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological symptoms in individuals successful at long-term maintenance of weight loss

Set point theory suggests that successful maintenance of weight loss ("weight suppression") may be associated with psychological distress. This study examined the association between psychological symptoms and body weight suppression by using a registry of 629 women and 155 men who lost at least 13.6 kg (mean loss = 30 +/- 15 kg) and maintained the loss for at least 1 year (mean duration = 5.5 +/- 6.8 years). Participants completed measures of mood, distress, restraint, disinhibition, bingeing, and purging. Maintainers' levels of distress and depression were lower than those of psychiatric samples and resembled those of community-based samples. Binge-eating and purging rates were comparable to rates of community samples. Maintainers' levels of restraint and disinhibition were markedly different from those of eating-disordered samples, resembling levels found in patients recently treated for obesity. There was no evidence that long-term suppression of body weight is associated with psychological distress.     

Deconstructing therapy outcome measurement with rasch analysis of a measure of general clinical distress: The Symptom Checklist-90-Revised.

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994). Using complementary therapy research samples, the instrument's 5-point rating scale was found to exceed clients' ability to make reliable discriminations and could be improved by collapsing it into a 3-point version (combining scale points 1 with 2 and 3 with 4). This revision, in addition to removing 3 misfitting items, increased person separation from 4.90 to 5.07 and item separation from 7.76 to 8.52 (resulting in alphas of .96 and .99, respectively). Some SCL-90-R subscales had low internal consistency reliabilities; SCL-90-R items can be used to define one factor of general clinical distress that is generally stable across both samples, with two small residual factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vicarious traumatization: An empirical study of the effects of trauma work on trauma therapists.

This study examined vicarious traumatization (i.e., the deleterious effects of trauma therapy on the therapist) in 188 self-identified trauma therapists. Participants completed questionnaires about their exposure to survivor clients' trauma material as well as their own psychological well-being. Those newest to the work were experiencing the most psychological difficulties (as measured by the Traumatic Stress Institute Belief Scale; L. A. Pearlman, in press) and Symptom Checklist-90—Revised (L. Derogatis, 1977) symptoms. Trauma therapists with a personal trauma history showed more negative effects from the work than those without a personal history. Trauma work appeared to affect those without a personal trauma history in the area of other-esteem. The study indicates the need for more training in trauma therapy and more supervision and support for both newer and survivor trauma therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress symptoms of survivors of the Marmara region (Turkey) earthquakes: A follow-up study.

This study examined stress-related symptomatology of people in Turkey 1 year after 2 recent earthquakes and compared their symptoms with those at the time of the earthquakes. The survey, using the Symptom Check-List-90-Revised (SCL-90-R; L. R. Derogatis, 1977), enlisted 223 respondents in its 1st administration and 342 in its 2nd, 1 year later. These earthquake survivors had elevated levels on all subscales of the SCL-90-R but lower levels of stress symptoms in the 2nd administration with respect to anxiety, phobic anxiety, and psychotic symptoms. In contrast, there were no significant differences across administrations in measures of obsessive-compulsive behaviors, depression, anger, or paranoid thoughts. Higher overall levels of symptoms were found in women, those with lowest education levels, and those who had experienced loss of relatives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary investigation of family coping styles and psychological well-being among adolescent survivors of Hurricane Katrina.

The relation between family coping styles and psychological well-being was compared for adolescents (12-17 years) displaced by Hurricane Katrina and currently living in a relocation camp (n = 50) and nonaffected adolescents (n = 31) matched on age, race, and socioeconomic status. Adolescents in the Katrina sample reported a family mobilizing strategy that reflected an increased reliance and seeking of extra-familial, community-based support but lower self-esteem and more symptoms of distress and depression. Follow-up analyses suggested that the relations between group differences in participants' hurricane-related trauma experiences and greater psychological distress may be mediated in part by the family coping strategy; exposure to increased levels of community-provided support may have unintended consequences on adolescents' psychological health. These results highlight the importance of future research on both potential benefits and costs of family coping styles in adolescents affected by a large-scale disaster. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marriage amendments and psychological distress in lesbian, gay, and bisexual (LGB) adults.

An online survey of lesbian, gay, and bisexual (LGB) adults (N = 1,552) examined minority stress (I. H. Meyer, 2003) and psychological distress following the 2006 general election in which constitutional amendments to limit marriage to 1 man and 1 woman were on the ballot in 9 states. Following the November election, participants living in states that passed a marriage amendment reported significantly more minority stress (i.e., exposure to negative media messages and negative conversations, negative amendment-related affect, and LGB activism) and higher levels of psychological distress (negative affect, stress, and depressive symptoms) than participants living in the other states. Multiple hierarchical regression analyses revealed significant positive main effects of minority stress factors and state ballot status on psychological distress. In addition, the association between amendment-related affect and psychological distress was significantly higher in states that had passed a marriage amendment compared with other states. Discussion of these findings emphasizes that marriage amendments create an environment associated with negative psychological outcomes for LGB individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

All PTSD symptoms are highly associated with general distress: Ramifications for the dysphoria symptom cluster.

This study used longitudinal data collected from two trauma-exposed samples, survivors of community violence (N = 294) and wildfire evacuees (N = 234), to examine a key claim underlying a proposed reformulation of the symptom structure of posttraumatic stress disorder (PTSD). This theory, which we term the PTSD–dysphoria model, posits that 8 of 17 symptoms of PTSD reflect dysphoria or general psychological distress and might be deemphasized to improve the utility of the PTSD construct (Simms, Watson, & Doebbeling, 2002). For each sample, we analyzed PTSD symptoms and measures of general distress administered at 2 time points. A consistent pattern of findings was observed across assessments for each sample: All 17 PTSD symptoms were highly associated with measures of general distress. Moreover, we found no evidence that dysphoria symptoms were more highly correlated than PTSD-specific symptoms with general distress. Results call into question both the conceptual basis and the clinical utility of differentiating between symptoms that appear to be relatively specific to PTSD and those that seem more broadly characteristic of general psychological distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similarity of prior trauma exposure as a determinant of chronic stress responding to an airline disaster.

The cumulative effects of trauma were examined in 108 workers at the site of a major air disaster at 4 time points over a year following the crash. The influence of trauma history on chronic distress and physiological arousal associated with the crash were examined. Stress levels were expected to differ on the basis of the similarity of prior trauma exposure to work at the crash site. Prior traumatic exposure that was "dissimilar" to this type of work was associated with greater vulnerability to crash-related stress, that is, more distress and crash-related intrusions during the year following the crash. Accumulation of a variety of different traumatic experiences appeared to sensitize workers to the new stressor and to perpetuate chronic stress. Understanding the role of trauma history is important for improving intervention efforts aimed at alleviating stress following a trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents.

Results of a preliminary effectiveness evaluation of a school-based postwar program for war-exposed Bosnian adolescents are described. The evaluation centered on a manualized trauma/grief-focused group psychotherapy protocol for war-traumatized adolescents based on 5 therapeutic foci: traumatic experiences, trauma and loss reminders, postwar adversities, bereavement and the interplay of trauma and grief, and developmental impact. Fifty-five secondary school students (81% girls; age range?=?15–19 years, M?=?16.81) from 10 Bosnian schools participated in the evaluation. Students completed pregroup and postgroup self-report measures of posttraumatic stress, depression, and grief symptoms and postgroup measures of psychosocial adaptation and group satisfaction. The evaluation yielded preliminary but promising results, including reduced psychological distress and positive associations between distress reduction and psychosocial adaptation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)