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)     

Catastrophizing mediates associations between pain severity, psychological distress, and functional disability among persons with spinal cord injury.

Objective: To examine associations between pain severity, psychological distress, catastrophizing, and indices of functional disability in a sample of persons with spinal cord injury (SCI). Catastrophizing was examined as a potential mediator of associations between pain severity, psychological distress, and functional disability. Design and Participants: Questionnaires assessing pain severity, psychological distress, catastrophizing, pain interference, and community integration were completed by 237 persons with SCI. Results: Psychological distress and pain severity were associated significantly with greater functional disability. Moreover, the association between pain severity and functional disability was strongest among persons with high psychological distress. Catastrophizing appeared to mediate the associations between pain severity, psychological distress, and functional disability. Conclusions: Pain severity and psychological distress have the potential for both direct and interactive effects on functional disability, possibly through the mediating effects of catastrophizing. (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)     

Chicken microchromosomes are hyperacetylated, early replicating, and gene rich

Persons with chronic pain often report a range of physical symptoms beyond their primary pain complaint itself. We predicted that non-specific physical symptom complaints would correlate more strongly with pain-related distress than with general measures of distress, and that they would contribute directly to disability. Results from 210 adults with chronic pain showed that collateral physical complaints are common in persons with chronic pain. Correlational analyses showed that greater reporting of physical complaints was associated with reports of higher pain severity, higher levels of depression, more cognitive, escape/avoidance, fearful appraisal, and physiological symptoms of pain-related anxiety and more physical and psychosocial disability. Regression analyses showed that, with pain-related anxiety variables entered either before or after depression, physiological symptoms of pain-related anxiety significantly predicted physical complaints. In comparison with cognitive and somatic depression symptoms physiological symptoms of pain-related anxiety were the stronger predictor.     

Treatment of Depression Following Spinal Cord Injury: An Evidence-Based Review.

Study Design: Evaluative research review. Objective: Depression is a significant secondary complication of spinal cord injuries (SCI); this study applies the D. L. Sackett (1989) research criteria to evaluate the quality of intervention studies of the treatment of depression among persons with SCI. Method: An extensive range of peer-reviewed published research was identified through established databases, critical reviews, and published meta-analyses. Results: Nine studies met the inclusion criteria. One antidepressant study was rated above Level III; although the psychological intervention studies had control groups, these were not randomized. Conclusion: This review demonstrates the need for randomized clinical trials of psychological and pharmacological interventions for depression and distress among persons with SCI. so that informed decisions concerning cost-effective treatments can be made. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Antibody responses to tetanus toxoid and Haemophilus influenzae type b conjugate vaccines following autologous peripheral blood stem cell transplantation (PBSCT)

OBJECTIVE: Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury (SCI), there are little data to support this assertion. To date, reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published. This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation. DESIGN: The study employed a nonrandomized controlled trial, and measures were taken on three occasions: before, immediately after, and 12 months after treatment. SETTING, OUTCOME MEASURES, AND INTERVENTION: Anxiety, depressive mood, and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital, who participated in specialized group cognitive behavior therapy (CBT) during rehabilitation. CONTROLS: The intervention group's responses on the measures were compared with a control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization. RESULTS: There were no overall group differences on anxiety, depressive mood, and self-esteem, although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group. However, those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury, compared to similar persons in the control group. CONCLUSIONS: While it appears not everyone who experiences SCI needs CBT, at least in the hospital phase of their rehabilitation, those who report high levels of depressive mood benefited greatly from CBT.     

Comorbid anxiety disorders and treatment of depression in people with multiple sclerosis.

Objective: Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders. Design: Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment. Results: Participants with comorbid anxiety disorders improved to a similar degree during treatment as those without anxiety disorders. Outcomes during follow-up were mixed, and thus we divided the anxiety diagnoses into distress and fear disorders. The distress disorder (GAD) was associated with elevated anxiety symptoms during and after treatment. In contrast, fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia) were linked to depression, specifically during follow-up, across 3 different measures. Conclusions: People with GAD receiving treatment for depression may benefit from additional services targeting anxiety more specifically, while those with comorbid fear disorders may benefit from services targeting maintenance of gains after treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inflammatory bowel disease: a study of the association between anxiety and depression, physical morbidity, and nutritional status

BACKGROUND: The etiology of inflammatory bowel disease is unclear, and the role played by anxiety and depression is highly controversial. Anxiety and depression in patients with inflammatory bowel disease could be secondary to disabling symptoms, but the interaction between physical morbidity and psychologic illness in these subjects has not been sufficiently investigated. Patients with inflammatory bowel disease are nevertheless frequently undernourished, but there are no studies on the association between anxiety and depression and malnutrition. This study was designed to characterize anxiety and depression in subjects affected by inflammatory bowel disease and to establish the influence of physical morbidity and/or nutritional status on psychologic disorders. METHODS: Seventy-nine consecutive patients, 43 with Crohn's disease (CD) and 36 with ulcerative colitis (UC), were enrolled in the study. An index of the disease activity and physical morbidity was obtained by the simplified Crohn's Disease Activity Index and Truelove-Witts criteria and using the Clinical Rating Scale. Thirty-six healthy volunteers were studied as controls. All the subjects were given the State and Trait Anxiety Inventory (STAI) test and the Zung self-rating Depression Scale. RESULTS: The percentage of subjects with state anxiety was significantly higher in the CD (P < 0.001) and UC (P < 0.001) groups than in control subjects. There was no significant difference in trait anxiety among groups. The percentage of subjects with depression was significantly higher in the CD (P < 0.05) and UC (P < 0.05) groups than in control subjects. State anxiety and depression were significantly associated with physical morbidity and correlated with malnutrition in CD and UC patients. CONCLUSION: Anxiety and depression in patients with inflammatory bowel disease could be reactive to the disabling symptoms and to malnutrition. As measured with the STAI, personality trait of anxiety does not seem to play an important role in inflammatory bowel disease.     

Perceptions of children and community members concerning the circumstances of orphans in rural Zimbabwe

This study examined two groups of people who were pursuing treatment for obesity: either medical intervention (a hospital group; N = 20) or support for dietary restriction (a community group; N = 18). This study addressed four questions: (1) Were there differences between the two groups in terms of their psychological distress (as measured by the Symptom Checklist)? (2) Does binge eating moderate psychological distress? (3) Do feelings of ineffectiveness moderate psychological distress? and (4) Which variables best accounted for group membership (i.e., type of treatment sought)? Results suggested that the hospital group was significantly more distressed than the community group. However, there were no differences between the two groups with respect to binge eating or feelings of ineffectiveness. These findings suggest that it is the effects of morbid obesity that are most likely to moderate psychological distress.     

Prediction of handicap and emotional distress in patients with recurrent vertigo: symptoms, coping strategies, control beliefs and reciprocal causation

Factors predicting handicap and distress were examined in a longitudinal study of 101 patients suffering from recurrent vertigo (dizziness). Analysis of a questionnaire assessing coping strategies yielded four distinct individualised coping styles: problem-focused information-seeking; distraction; denial; and relinquishing responsibility. After controlling for the severity of physical and psychological symptoms and distress, handicap was negatively related to internal locus of control and positively correlated with relinquishing responsibility. Symptoms of somatic anxiety predicted an increase in handicap over a 7 month period, while handicap and somatic anxiety symptoms predicted an increase in distress. These results are interpreted in terms of a reciprocal causal relationship between handicap and distress, mediated partly by somatic symptoms. Parallels with pain, panic and phobia suggest that patients with vertigo might benefit from psychological therapies.     

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.     

Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness?

BACKGROUND/AIMS: Psychiatric illness and psychological behavioral pathologies may be present in celiac disease and in IBD patients. In these subjects anxiety and depression could be a main cause in the reduction of the compliance to the treatment. Aim of our study was to carry out a psychometric evaluation using appropriate means to determine the level of anxiety and depression and to distinguish between "state" and "trait" forms. The correction of such disturbances would improve the quality of life and the patients' compliance to treatment. MATERIAL AND METHODS: Sixteen adult celiac patients, 16 subjects affected by IBD and 16 healthy control subjects matched for sex, residence and marital status were studied by psychological assessment. All the subjects were given the State and Trait Anxiety Inventory and the Ipat Depression Scale Questionnaire. RESULTS: State anxiety was present in a higher percentage of celiac subjects and in the patients affected by IBD with respect to the healthy controls. Anxiety as a trait was present in a similar percentage in all the subjects evaluated. Depressive syndrome was present in a percentage of celiac patients statistically superior versus the healthy control group (p < 0.01). CONCLUSION: Our results shown that anxiety is present as a "reactive" form and personality trait anxiety has no effect in celiac and IBD patients. As regard depression, our data confirm a possible linkage between brain functions and malabsorption.     

Quality of life for individuals with traumatic brain injury: comparison with others living in the community

OBJECTIVES: To provide a conceptual overview of approaches to quality of life (QOL) measurement and an extensive review of research relating to QOL after TBI; to document subjective QOL of individuals with traumatic brain injury (TBI); to explore how subjective QOL differs for people with TBI in comparison to individuals with no disability (ND) and those with spinal cord injury (SCI); and to document the perceptions of unmet important needs and the relationship between such perceptions and subjective QOL. DESIGN: Interview-based data focusing on current perceptions of QOL and unmet important needs, obtained from individuals with TBI, SCI, or ND. Covariance and partial regression analyses were used to explore group differences and to document relationships between variables. SETTING: Individuals drawn from diverse communities across New York State. PARTICIPANTS: TBI group: 430 individuals who identified themselves as having TBI; SCI group: 101 individuals with spinal cord injury; ND group: 187 people who identified themselves as having no disability. Participants were recruited through recruitment ads in general circulation newspapers and newsletters and through contacting a wide variety of community agencies. MAIN OUTCOME MEASURES: Two summary QOL indicators: a Global QOL Measure based on two items tapping the individual's emotion-based view of QOL, and a summary score adapted from Flanagan"s Scale of Needs, reflecting the individual's perceptions of total unmet important needs. RESULTS: Both summary QOL indicators were correlated with demographic characteristics. Unmet important needs were stronger in the TBI group than in the SCI and ND groups. Most areas of unmet important need were moderately correlated with the summary QOL indicators. Analyses of covariance showed that severity of injury was a more powerful modulator of post-TBI QOL judgments than the mere fact of TBI. For example, those with the most severe injury (ie, loss of consciousness [LOC] >1 month) rated their QOL similar to that in the ND group, whereas individuals who had experienced only a brief LOC (<20 minutes) viewed their QOL as significantly lower than that in the ND and SCI groups and lower than other TBI severity subgroups. CONCLUSIONS: This exploration of subjective QOL strengthens the argument that after TBI, the insider"s reaction to injury varies greatly within the population. Thus, severity of injury strongly affects perceptions of QOL. The use of a multimethod approach for exploring the reactions and perceptions of QOL has proven useful in this study.     

Depression among African Americans, Latinos, and Caucasians with spinal cord injury: A exploratory study.

Objective: Explored the relationship between depression and racial–ethnic group membership among people with spinal cord injury (SCI). No literature exists on this topic, and research on related areas reveals variable findings with regard to ethnic–racial differences in depression. Study Design: During their annual physical exams at an SCI clinic in Southern California, 171 Ss with SCI completed the Older Adult Health and Mood Questionnaire, a clinically validated measure of depressive symptomatology. Participants: Forty-six Caucasians, 28 African Americans, and 97 Latinos over 21 years of age with either tetraplegia or paraplegia. Main Outcome Measures: Depression scores, diagnoses, and item clusters. 42% of the Ss reported clinically significant symptomatology; 18% reported possible major depression. Latino Ss reported higher overall depression scores than either African American or Caucasian Ss, who did not differ from each other. Latinos also had a greater prevalence of possible major depression, along with higher item clusters reflecting loss of pleasure and greater feelings of hopelessness and fatigue. Conclusions: These findings suggest a need for routine screening for depression after SCI, particularly among individuals from Latino backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: A randomized clinical trial.

Purpose: To compare coping effectiveness training (CET) with supportive group therapy (SGT) for anxiety, depression, and adjustment to injury in an acute spinal cord injury/dysfunction (SCI/D) rehabilitation population. CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups (Kennedy, Duff, Evans, & Beedie, 2003; King & Kennedy, 1999). The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition, SGT. Research Method: Participants (N = 40) entering a hospital-based program were assigned to treatment condition using block randomization. Questionnaire mood measures were completed at program admission, program discharge, and 3-month postdischarge follow-up. Adjustment to disability was assessed at follow-up only. Analyses of variance tested for group differences in anxiety, depression, and adjustment to injury. Results: Both groups reported reductions in mood symptoms with no differences between treatment conditions. However, similar reductions were obtained after fewer sessions of CET. Symptoms of depression increased in both groups following hospital discharge. Conclusions: Clinical and research implications, including innovative interventions during the period after discharge, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of pediatric loss of control eating and psychological outcomes.

Loss of control (LOC) eating in youth is associated cross-sectionally with eating-related and psychosocial distress and is predictive of excessive weight gain. However, few longitudinal studies have examined the psychological impact and persistence of pediatric LOC eating. We administered the Eating Disorder Examination and self-reported measures of depressive and anxiety symptoms to 195 boys and girls (mean age = 10.4 years, SD = 1.5) at baseline and again 4.7 years (SD = 1.2) later to 118 of these youth. Missing data were imputed. Baseline report of LOC was associated with the development of partial- or full-syndrome binge eating disorder (p = .03), even after accounting for the contribution of sex, race, baseline characteristics (age, disordered eating attitudes, and mood symptoms), body mass index growth between baseline and follow-up, and years in study. Half (52.2%; 95% CI [1.15, 6.22]) of children who endorsed experiencing LOC at baseline reported persistence of LOC at follow-up (p = .02). Compared with children who never reported LOC eating or reported LOC only at baseline, those with persistent LOC experienced significantly greater increases in disordered eating attitudes (ps p = .027) over time. These data suggest that LOC eating in children is a problematic behavior that frequently persists into adolescence and that persistent LOC eating is associated with worsening of emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury.

Study Design: Systematic review. Objective: To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). Method: Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. Results: Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. Conclusions: CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological problems of spinal cord injury patients: Emotional distress as a function of time and locus of control.

A scale assessing psychological problems was developed and administered to 136 male VA hospital spinal cord injury (SCI) patients (under 30 yrs of age). Results suggest that reaction to SCI was dominated by emotional distress and was best predicted by external locus of control and by recent injury. The scale was correlated with self-reports of anxiety, adjustment, affiliation, and sociability in a college population. Results do not support a simple stage theory of reaction to SCI but are consistent with other studies of coping patterns in SCI patients. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure to missile attacks: the impact of the Persian Gulf War on physical health behaviours and psychological distress in high and low risk areas in Israel

The purpose of this study was to compare residents of an area (Tel-Aviv), which was severely afflicted by SCUD missiles during the Persian Gulf War (high risk region), to residents of a low-risk region (Jerusalem) in terms of: (a) changes in physical health, in use of medical or psychological services, and in health behaviours during the period of the war compared to the preceding month; (b) levels of psychological distress (somatization and anxiety) during the war; (c) characteristics of persons at highest risk for psychological distress. Respondents were randomly chosen and interviewed by telephone (N = 545 in Tel-Aviv, N = 406 in Jerusalem). The respondents in both regions reported significant yet similar deterioration in physical health status, and an increase in detrimental health behaviours during the Gulf War. Tel-Aviv residents had significantly higher levels of psychological distress as compared to residents of Jerusalem: in somatization 18 vs 12% respectively (OR = 2.44, CI = 1.39-4.28), in anxiety 34 vs 26% respectively (OR = 1.62, CI = 1.1-2.42). In addition to place of residence, age, ethnicity, religiosity and self-assessed health were identified as characteristics of persons at greater risk for psychological distress.     

Perceived coping as a mediator between attachment and psychological distress: A structural equation modeling approach.

This study examined perceived coping (perceived problem-solving ability and progress in coping with problems) as a mediator between adult attachment (anxiety and avoidance) and psychological distress (depression, hopelessness, anxiety, anger, and interpersonal problems). Survey data from 515 undergraduate students were analyzed using structural equation modeling. Results indicated that perceived coping fully mediated the relationship between attachment anxiety and psychological distress and partially mediated the relationship between attachment avoidance and psychological distress. These findings suggest not only that it is important to consider attachment anxiety or avoidance in understanding distress but also that perceived coping plays an important role in these relationships. Implications for these more complex relations are discussed for both counseling interventions and further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)