Controlled prospective longitudinal study of women with cancer: I. Sexual functioning outcomes.

The incidence and etiology of sexual difficulties for women with survivable cancer were studied. Women with early stage gynecologic cancer (n?=?47) were assessed after diagnosis but prior to treatment and then reassessed at 4, 8, and 12 mo posttreatment. Sexual and medical outcomes were compared with data from members of 2 matched comparison groups who were also assessed longitudinally: women diagnosed and treated for benign gynecologic disease (n?=?8) and gynecologically healthy women (n?=?57). Global sexual behavior disruption did not occur, but the frequency of intercourse declined for women treated for disease, whether malignant or benign. In relation to the sexual response cycle, diminution of sexual excitement is pronounced for women with disease; however, this difficulty is more severe and distressing for women with cancer, possibly due to significant coital and postcoital pain, premature menopause, treatment side effects, or a combination. Changes in desire, orgasm, and resolution phases of the sexual response cycle may also occur, but they are of lesser magnitude or duration or both. 30% of the women treated for cancer were diagnosed with a sexual dysfunction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic growth following breast cancer: A controlled comparison study.

Cancer may be viewed as a psychosocial transition with the potential for positive and negative outcomes. This cross-sectional study (a) compared breast cancer (BC) survivors' (n?=?70) self-reports of depression, well-being, and posttraumatic growth with those of age- and education-matched healthy comparison women (n?=?70) and (b) identified correlates of posttraumatic growth among BC survivors. Groups did not differ in depression or well-being, but the BC group showed a pattern of greater posttraumatic growth, particularly in relating to others, appreciation of life, and spiritual change. BC participants' posttraumatic growth was unrelated to distress or well-being but was positively associated with perceived life-threat, prior talking about breast cancer, income, and time since diagnosis. Research that has focused solely on detection of distress and its correlates may paint an incomplete and potentially misleading picture of adjustment to cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual self-schema and sexual morbidity among gynecologic cancer survivors.

Longitudinal research indicates that approximately 50% of women treated for gynecologic cancer have sexual dysfunctions as they recover and become cancer survivors. This outcome occurs in the context of satisfactory quality of life in other domains. This study, comparing gynecologic cancer survivors (n?=?61) and gynecologically healthy women (n?=?74), documents the reliability of the latter observations with measures of quality of life (general, depressive symptoms, social contacts, and stress), sexual functioning, and health. Of added importance are analyses focused on variables that may predict risk for sexual morbidity. Specifically, sexual self-schema is tested as an important, sexually relevant individual difference. In regression analyses that controlled for estimates of precancer sexual behavior (intercourse frequency), extent of disease–treatment, and menopausal symptoms, sexual self-schema accounted for significant variance in predicting current sexual behavior and responsiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applicability of cognitive adaptation theory to predicting adjustment to heart disease after coronary angioplasty.

The purpose of this study was to determine whether cognitive adaptation theory (i.e., cognitively responding to challenges to world assumptions) would predict positive adjustment to heart disease in the face of a recurrent event. Men and women who were treated for a coronary event with percutaneous transluminal coronary angioplasty (N?=?278) were interviewed in the hospital and then 6 months later. Indicators of cognitive adaptation theory (self-esteem, optimism, mastery) and adjustment were assessed. In general, cognitive adaptation indicators predicted positive adjustment, sometimes showing stronger relations for those who faced a recurrent event. In addition, patients' cognitions were robust over time, meaning that they were not affected by recurrent events. Patients' beliefs about the angioplasty decision, however, showed differential relations to adjustment, depending on whether they sustained a recurrence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotionally expressive coping predicts psychological and physical adjustment to breast cancer.

This study tested the hypothesis that coping through emotional approach, which involves actively processing and expressing emotions, enhances adjustment and health status for breast cancer patients. Patients (n ?=?92) completed measures within 20 weeks following medical treatment and 3 months later. Women who, at study entry, coped through expressing emotions surrounding cancer had fewer medical appointments for cancer-related morbidities, enhanced physical health and vigor, and decreased distress during the next 3 months compared with those low in emotional expression, with age, other coping strategy scores, and initial levels on dependent variables (except medical visits) controlled statistically. Expressive coping also was related to improved quality of life for those who perceived their social contexts as highly receptive. Coping through emotional processing was related to one index of greater distress over time. Analyses including dispositional hope suggested that expressive coping may serve as a successful vehicle for goal pursuit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of preoperative therapy with angiotensin-converting enzyme inhibitors on clinical outcome after cardiovascular surgery

PURPOSE: Quality of life of breast cancer survivors 8 years after diagnosis was compared with that among similarly aged women who had never confronted cancer (controls). METHODS: Survivors of a consecutive series of 227 breast cancer patients first treated in 1984 were approached for this study. Random-digit dialing was used to identify controls with the same age and residential distribution as the survivors. Quality of life was assessed in terms of physical health, functional status, psychologic distress, and social functioning. RESULTS: Participation was obtained from 96% (n = 124) of 129 eligible survivors and 61% (n = 262) of 427 potentially eligible controls. Consistently smaller proportions of survivors reported positive quality-of-life outcomes compared with controls, but these differences were generally small and nonsignificant statistically. When limited to women who remained free of disease over the entire follow-up period (n = 98), survivors' quality of life was similar to that among controls, with the exception of arm problems and sexual satisfaction for those women who lived with a partner. In contrast, survivors who developed recurrence or new primary breast cancer (n = 26) experienced a worse quality of life in all domains except social functioning. CONCLUSION: In most domains and for women without further disease events after diagnosis, quality of life does not seem to be permanently and globally impaired by breast cancer. Consequently, breast cancer survivors who remain free of disease probably do not need organized late psychosocial follow-up to improve quality of life. However, arm problems and sexuality are two areas in which additional effort may be still needed to improve quality of life of long-term survivors.     

Adjustment to infertility.

Psychological adjustment to the threat of being unable to bear children was investigated for 62 women and 45 men. Approximately 37% of women and 1% of men of infertile marriages showed psychological disturbance. Because of the small number of men, the predictors of adjustment for women only were examined by regression analyses. Both event characteristics (medical factors) and subjective variables (cognitive factors) were found to contribute significantly to adjustment. Younger women and women who had not received a diagnosis were more distressed than patients who had. Women who felt responsible for their infertility showed poorer adjustment, and this was most evident when the cause of infertility was not due to male factors. Also, women who believed that their chances of conceiving were lower than the actual medical prognosis were more distressed. Finally, women who were affiliated with Protestant religions showed better adjustment than women of other faiths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing retirement satisfaction and perceptions of retirement experiences.

A 2-part investigation developed a measure of retirement as a life transition. Study 1 generated items from interviews with retirees (n?=?40) and service providers. Item analysis with recent retirees (n?=?86) produced a 51-item Retirement Satisfaction Inventory assessing 6 areas: preretirement work functioning, adjustment and change, reasons for retirement, satisfaction with life in retirement, current sources of enjoyment, and leisure and physical activities. Study 2 examined a heterogeneous sample of men (n?=?159) and women (n?=?243) retirees. Factor analyses produced internally consistent subscales. Moderate, but acceptable, test–retest reliability was demonstrated. Satisfaction scores correlated with concurrent measures and, together with pre- and postretirement experiences, discriminated 4 groups of voluntary and involuntary retirees. Few effects related to gender, SES, length of retirement, and part-time employment were found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life stressors, social resources, and late-life problem drinking.

Life stressors and social resources among late-middle-aged problem and nonproblem drinkers were studied. Problem drinkers (n?=?501) reported more negative life events, chronic stressors, and social resource deficits than did nonproblem drinkers (n?=?609). In a comparison of problem drinkers, men reported more ongoing stressors involving finances and friends and reported fewer resources from children, extended-family members, and friends than did women. Women who are problem drinkers reported more negative life events, more ongoing difficulties with spouses and extended-family members, and fewer resources from spouses. Among both the problem and nonproblem drinkers, more stressors were associated with fewer social resources, but only within certain life domains. Late-middle-aged adults' chronic stressors and social resources helped explain their drinking behavior, depression, and self-confidence even after sex, marital status, and negative life events were considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of stressors on breast cancer incidence in the Women's Health Initiative.

Objective: To examine associations among life events stress, social support, and breast cancer incidence in a cohort of postmenopausal women. Design and main outcome measure: Women's Health Initiative observational study participants, breast cancer free at entry, who provided assessment of stressful life events, social support, and breast cancer risk factors, were prospectively followed for breast cancer incidence (n = 84,334). Results: During an average of 7.6 years of follow-up, 2,481 invasive breast cancers were diagnosed. In age-adjusted proportional hazards models, 1 stressful life event was associated with increased risk, but risk decreased with each additional stressful life event. After adjustment for confounders the decreasing risk was not significant. Stressful life events and social support appeared to interact in relation to breast cancer risk such that women who had greater number of stressful life events and low social support had a decreased risk of breast cancer. Conclusions: This study found no independent association between stressful life events and breast cancer risk. The results are compatible with a more complex model of psychosocial factors interacting in relation to breast cancer risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When Mom or Dad has cancer: Markers of psychological distress in cancer patients, spouses, and children.

This study assessed anxiety/depression and stress response symptoms in adult cancer patients (n?=?117), spouses (n?=?76), and their children (n?=?110, ages 6 to 30 years old) near the patients' diagnoses to identify family members at risk for psychological maladjustment. Patients' and family members' distress was related to appraisals of the seriousness and stressfulness of the cancer but not related to objective characteristics of the disease. Patients and spouses did not differ in anxiety/depression or in stress-response symptoms. Both stress-response and anxiety/depression symptoms differed in children as a function of age, sex of child, and sex of patient. Adolescent girls whose mothers had cancer were the most significantly distressed. Implications for understanding the impact of cancer on the family are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the psychological and hormonal factors in women with and without premenstrual syndrome.

Women with premenstrual syndrome (PMS; n?=?14) were compared with women without premenstrual syndrome (n?=?14). The diagnosis was based on the volunteers' responses to the Premenstrual Assessment Form, their medical history, a physical examination, and the Utah PMS Calendar. After assignment to the non-PMS or PMS group, each subject was studied for one menstrual cycle and was evaluated, once during the follicular phase and twice during the luteal phase. On each of these occasions, circulating concentrations of estradiol and progesterone were determined, and the Depression Adjective Checklist (DACL), the Minnesota Multiphase Personality Inventory (MMPI), and the Attributional Style Questionnaire were completed. Each subject recorded daily her physical symptoms on the Utah PMS Calendar. During the luteal phase, women with PMS had significantly higher levels of depression as measured by the DACL and MMPI than women without PMS. The two groups did not differ in the follicular phase. These findings suggest a luteal phase disorder superimposed on a background free of psychiatric or physiological illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast cancer surgery: Comparing surgical groups and determining individual differences in postoperative sexuality and body change stress.

Women diagnosed and surgically treated for regional breast cancer (N?=?190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was significantly different—with lower rates of activity and fewer signs of sexual responsiveness—than that for women in either of the other groups. Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT. Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Above the glass ceiling? A comparison of matched samples of female and male executives.

In this study the authors compare career and work experiences of executive women and men. Female (n?=?51) and male (n?=?56) financial services executives in comparable jobs were studied through archival information on organizational outcomes and career histories, and survey measures of work experiences. Similarities were found in several organizational outcomes, such as compensation, and many work attitudes. Important differences were found, however, with women having less authority, receiving fewer stock options, and having less international mobility than men. Women at the highest executive levels reported more obstacles than lower level women. The gender differences coupled with women's lower satisfaction with future career opportunities raise questions about whether women are truly above the glass ceiling or have come up against a 2nd, higher ceiling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological and social adjustment to mastectomy: a two-year follow-up study

A consecutive series of 160 women admitted to hospital for breast tumor biopsy was assessed prior to, and at 3, 12, and 24 months following operation for marital, sexual, interpersonal and work adjustment, depression, and personality characteristics by means of rating scales based on structures interviews and standard tests. By 2 years there wery no significant differences in social adjustment between mastectomy patients and benign breast disease controls; 70% of cancer patients were no longer stressed by mastectomy at 1 year. Factors predicting poor adjustment to mastectomy were high preoperative scores on the Hamilton Rating Scale for Depression and the Neuroticism Scale of the Eysenck Personality Inventory; deterioration in sexual adjustment was associated with biological or chronological perimenopausal status. Significantly more cancer than benign disease patients were dissatisfied with the information they received about operation and diagnosis. Implications of these findings for the care of the mastectomy patient are discussed.     

Tobacco withdrawal in women and menstrual cycle phase.

Because negative mood is a characteristic of both tobacco withdrawal and menstrual discomfort, withdrawal may vary by menstrual cycle phase. Tobacco withdrawal, mood, and menstrual discomfort were assessed in premenopausal women who quit smoking during either the follicular (Days 1–14 postmenstrual onset; n?=?41) or luteal (Day 15 or longer postmenstrual onset; n?=?37) phase of the menstrual cycle and maintained biochemically verified smoking abstinence during the postquit week. Women quitting during the luteal phase reported significantly greater increases in tobacco withdrawal and self-reported depressive symptoms than women quitting during the follicular phase. These results indicate that selecting a quit-smoking day early in the follicular phase may attenuate withdrawal and negative affect in premenopausal female smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of HIV counseling and testing for women: Behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n?=?106) and a comparison group of never-tested women (n?=?54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors in the current adjustment of young adult daughters of alcoholic and problem drinking fathers.

The adjustment status of women whose fathers were alcoholic, psychiatrically disturbed, or normal was compared to determine the extent of daughters' vulnerability and whether family climate and social support variables moderated the development of symptomatology. The 240 respondents, who were either university staff members or students, comprised four groups: women with normal fathers (n?=?81), women with alcoholic and problem drinking fathers (n?=?114), women with psychiatrically disturbed fathers (n?=?30), and women with both parents who were alcoholic or problem drinkers (n?=?15). Daughters of alcoholic and problem drinking fathers reported more neurotic and acting-out symptoms than did daughters of normal fathers. However, a similar elevation of neurotic and acting-out symptoms was found among the daughters of psychiatrically disturbed fathers, who in addition had significantly higher depression scores than did the daughters of alcoholic and problem drinking fathers. Daughters' rates of alcohol use did not distinguish the groups. Family climate and social support variables were found to be related to daughters' current adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controlled prospective study of postpartum mood disorders: Psychological, environmental, and hormonal variables.

Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n?=?182) and nonchildbearing (NCB; n?=?179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V)?×?Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V?×?LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V?×?LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V?×?LS interactions support the vulnerability-stress model of postpartum depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)