The efficacy of intensive individual play therapy for chronically ill children.

Examined the effectiveness of play therapy for children (aged 7-11 yrs) diagnosed with insulin-dependent diabetes mellitus (IDDM). Specifically, the intent of the study was to determine the effectiveness of an intensive play therapy intervention in (a) reducing symptoms of anxiety in children with IDDM, (b) reducing the overall behavior difficulties in children with IDDM, (c) increasing healthy adjustment in children with IDDM, (d) increasing diabetic's children's adherence to their diabetic regime, and (e) having an impact on these emotional and behavioral symptoms over time. The experimental group comprised 9 boys and 6 girls. Analysis of covariance revealed that the children in the experimental group significantly improved their adaptation to their diabetes following intensive play therapy. Results indicate that intensive play therapy may be an effective intervention for children diagnosed with IDDM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer

PURPOSE/OBJECTIVES: To test the efficacy of structured symptom assessment on level and rate of change in symptom distress over time. DESIGN: Prospective six-month randomized control trial. SETTING: Outpatient oncology offices and clinics in California. SAMPLE: 48 subjects newly diagnosed with advanced lung cancer, predominantly non-small cell. Most subjects received chemotherapy, 50% were women, and their average age was 62 years. 190 observations were analyzed. METHODS: Subjects were assigned randomly to structured assessment or usual care. Both groups completed the Symptom Distress Scale (SDS) monthly. After bivariate screening of potential predictors, a multivariate regression model for level and rate of change in SDS scores was created. MAIN RESEARCH VARIABLES: Symptom distress, functional status, and emotional distress. FINDINGS: Fatigue was the most common severely distressing symptom. In a multivariate model, chemotherapy and systematic assessment were associated with less symptom distress over time. Higher scores in depression and more functional limitations were related to higher levels of overall distress. Weight loss had a small impact. CONCLUSIONS: Systematic use of structured symptom assessment forestalled increased symptom distress over time. Chemotherapy lessened symptom distress, but the impact diminished with time. Subjects with more depression and greater functional limitations had greater symptom distress. IMPLICATIONS FOR NURSING PRACTICE: During the course of advanced lung cancer, systematic ongoing nursing assessment of symptoms may be the first step in enhancing interventions to decrease distress. Patients at highest risk for symptom distress are those who experience emotional distress and functional limitations.     

Psychosocial status of children with diabetes in the first 2 years after diagnosis

OBJECTIVE: The purpose of this study was to determine the pattern of adjustment over time of a cohort of children with newly diagnosed diabetes compared with a cohort of peer-selected children without diabetes over the first 2 years after the diagnosis of insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: Children (n = 89 with IDDM, n = 53 without IDDM) ages 8-14 years were studied with the Children's Depression Inventory, State-Trait Anxiety Inventory for Children, Child and Adolescent Adjustment Profile, Self-Perception Profile for Children, and a general health scale. Initial data were collected within 6 weeks of the diagnosis of IDDM and at 3, 6, 12, and 24 months thereafter. RESULTS: There were no demographic differences between the two groups. Initially, children with diabetes were more depressed, more dependent, and more withdrawn than their peers. By 1 year postdiagnosis, there were no significant differences in psychosocial status between the two groups. By 2 years postdiagnosis, depression, dependency, and withdrawal were significantly higher in children with diabetes than in their peers without IDDM. Self-perceived competence remained similar between the two groups at all time points. CONCLUSIONS: After an initial period of adjustment, children with IDDM have equivalent psychosocial status to children without IDDM, but by 2 years after diagnosis, they have experienced twice the amount of depression and adjustment problems as their peers. Interventions should be aimed at this critical period between 1 and 2 years postdiagnosis.     

A meta-analytic review of the influence of pediatric cancer on parent and family functioning.

This study used meta-analytic methods to compare the functioning of parents of children with cancer to parents of physically healthy children or normative samples. A meta-analysis using fixed effects, weighted least squares methods was conducted on 29 studies examining psychological distress and marital and family functioning among parents of children with cancer. Mothers and fathers of children newly diagnosed with cancer reported significantly greater distress than comparison samples. Mothers reported greater distress than fathers up to 12 months postdiagnosis. Mothers of children with cancer reported higher levels of family conflict than mothers of healthy children. Findings suggest that pediatric cancer impacts parents' perceptions of self- and family functioning, especially within the 1st year following diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics

We examined the cognitive and sociodemographic characteristics of patients making somatic presentations of depression and anxiety in primary care. Only 15% of patients with depressive symptomatology on self-report, and only 21% of patients with current major depression or anxiety disorders on diagnostic interview, presented psychosocial symptoms to their GP. The remainder of patients with psychiatric distress presented exclusively somatic symptoms and were divided into three groups-initial, facultative and true somatizers-based on their willingness to offer or endorse a psychosocial cause for their symptoms. Somatizers did not differ markedly from psychologizers in sociodemographic characteristics except for a greater proportion of men among the true somatizers. Compared to psychologizers, somatizers reported lower levels of psychological distress, less introspectiveness and less worry about having an emotional problem. Somatizers were also less likely to attribute common somatic symptoms to psychological causes and more likely to endorse normalizing causes. In the 12 months following their initial visit, somatizers made less use of speciality mental health care and were less likely to present emotional problems to their GP. Somatizers were markedly less likely to talk about personal problems to their GP and reported themselves less likely to seek help for anxiety or sadness. Somatization represents a persistent pattern of illness behaviour in which mental health care is not sought despite easily elicited evidence of emotional distress. Somatization is not, however, associated with higher levels of medical health care utilization than that found among patients with frank depression or anxiety.     

Emotional exchange in mother-child dyads: Stability, mutual influence, and associations with maternal depression and child problem behavior.

This study examined the stability of the child and maternal affective expression and maternal responsiveness and the mutual influence of child and maternal expression of emotion. The authors tested whether maternal depression and child problem behavior were associated with the pattern of emotional exchange within the mother-child dyads. The sample consisted of 69 mother-child dyads (children aged 2-5 years), with 32 of the mothers having childhood-onset depression. Mothers were mostly stable in their affective expression (positive and negative) and responsiveness, whereas children were only stable in positive expression. Within the dyads, mothers seemed to play a more important role in regulating children's later emotional expression. Maternal depression was associated with concurrent maternal responsiveness and their reduced positive expression over time. Results are discussed in relation to the differential function of parental general positivity and responsiveness and the interpersonal transmission of emotional problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biomedical and psychiatric risk factors for retinopathy among children with IDDM

OBJECTIVE: Illness duration and glycemic control influence the development of retinopathy in childhood-onset insulin-dependent diabetes mellitus (IDDM). Psychiatric disorders and sociodemographic factors also affect diabetes-related outcomes. However, biomedical and psychosocial factors have not been examined together in modeling the risk of retinopathy. RESEARCH DESIGN AND METHODS: We conducted a single-site prospective longitudinal study of 66 children (aged 8-13 years) newly diagnosed with IDDM. Repeated assessments served to derive psychiatric diagnoses. Poor glycemic control was defined as the upper 15th percentile of all HbA1 values. After a median follow-up of 10 years, severity of retinopathy was determined. It was modeled with a stepwise polychotomous regression procedure using antecedent biomedical and psychosocial variables. RESULTS: Young adults with childhood-onset IDDM were found to be at increased risk of retinopathy the longer they had IDDM, the more persistently they evidenced poor antecedent glycemic control, and the longer they suffered from depressive illness. These three factors operated individually and additively, with duration of IDDM conferring a baseline level of risk. In depressed patients (27%), depression onset antedated the detection of retinopathy generally by 7 years. CONCLUSIONS: Duration of childhood-onset IDDM confers a baseline level of risk of retinopathy irrespective of glycemic control; antecedent clinical depression is also a risk factor. Depression therefore may serve as a marker of vulnerability and help to identify a subgroup of patients at risk for complications. The findings raise the question whether timely treatment of depression could forestall diabetic retinopathy.     

The medical context of hypochondriacal traits

OBJECTIVE: This study examines the effects of two medical contexts on the relationship of hypochondriacal traits and their potential correlates. METHOD: Correlates of hypochondriacal traits were compared from a matched sample of fifty-five general medical inpatients with a sample of fifty-five medical inpatients referred for psychiatric evaluation. Patients completed questionnaires assessing emotional distress and health attitudes, beliefs, and behaviors, and their attending physician completed ratings of the patient's illness and illness behavior. RESULTS: Patients referred for psychiatric consultation exhibited significantly higher levels of hypochondriacal illness presentation than the matched nonreferred sample. Moderated regression analyses revealed three trends regarding the interactive effects of group status on the relationship of hypochondriacal traits to their potential correlates: 1) presence of angry feelings and interpersonal friction was positively associated with hypochondriacal concerns for the psychiatric referred patients only, 2) the tendency to deny life stresses and attribute all problems to the effects of illness was positively associated with a misinterpretation of the severity of their illness and hypochondriacal illness presentation for the psychiatric referred patients, whereas this association was negative for the nonreferred medical patients, and 3) the association of reports of emotional distress symptoms with hypochondriacal illness preparation was negative for the psychiatric referred patients and positive for the nonreferred medical patients. CONCLUSIONS: Study results suggest that hypochondriasis may not represent a uniform nosological disorder and that the context of its study can significantly influence etiologic findings.     

Development of justification in disputes with mother and sibling.

The development of children's use of justification in disputes with their mothers and siblings and its relation to the social and emotional context of family disputes were studied in a longitudinal study of 43 children observed at home at 18, 24, and 36 months. By 36 months, children used justifications in about one third of their disputes with both mother and sibling, chiefly in terms of their own feelings, but also in terms of social rules and the material consequences of actions. Children's emotional behavior and use of justification differed according to the topic of dispute: Anger and distress were most often expressed at 18 months, and justification at 36 months was most often given by children in disputes about rights and conventions. Mothers, too, were more likely to justify in disputes over rights, and there was a significant association between child and mother justification. The significance of emotional experience and of family discourse in the development of reasoning about social issues is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Caretaking behaviors by adolescent children of mothers with and without a history of depression.

In a sample of 72 mothers with and without a history of depression and their adolescent children, maternal depression history, current maternal depressive symptoms, intrusive and withdrawn parental behavior, and adolescent caretaking behaviors were examined as predictors of adjustment in these youth. Two types of caretaking behaviors were examined: emotional (e.g., caring for a parent's emotional distress) and instrumental (e.g., looking after younger siblings). Although adolescents of mothers with and without a history of depression were comparable on levels of both types of caretaking, caretaking was associated with adolescents' reports of anxiety–depression and mothers' reports of social competence only for adolescents of mothers with a history of depression. Moreover, regression models showed that among children of mothers with a history of depression, emotional, but not instrumental, caretaking was related to adolescents' anxiety–depression symptoms and social competence after controlling for current parental depressive symptoms and stressful parenting behaviors. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Activation of 5-HT2 receptors facilitates depolarization of neocortical neurons by N-methyl-D-aspartate

We prospectively studied 63 children with transient hyperglycemia to determine their risk of acquiring insulin-dependent diabetes mellitus (IDDM) and to evaluate the predictive value of immunologic markers of prediabetes and of the intravenous glucose tolerance test. Children with transient hyperglycemia were identified by a prospective systematic review of the laboratory reports of a large children's hospital and an office-based pediatric practice and by referral from pediatricians. Transient hyperglycemia occurred in 0.46% of children seen in the children's hospital and in 0.013% of children attending a pediatric office practice. Insulin-dependent diabetes mellitus developed within 18 months of identification in 32% of children in whom transient hyperglycemia was discovered in the absence of a serious illness, compared with 2.3% of children identified during a serious illness (relative risk, 13.9; 95% confidence interval, 1.56 to 123.5). Islet cell antibodies and competitive insulin autoantibodies each had a 100% positive predictive value for IDDM; the negative predictive value of islet cell antibodies and competitive insulin autoantibodies was 96% and 98%, respectively. The stimulated insulin release during an intravenous glucose tolerance test, adjusted for age, had the highest overall accuracy of prediction. All children less than 6 years of age with stimulated insulin release levels < 85 pmol/L (12 microU/ml) subsequently had IDDM, as did an 11-year-old child whose stimulated insulin release level was below the 1st percentile of 170 pmol/L (24 microU/ml). To date, no child whose stimulated insulin release level was above the 5th percentile has had IDDM. We conclude that when transient hyperglycemia occurs during a serious intercurrent illness, the risk of progression to IDDM is low. In contrast, one third of children in whom transient hyperglycemia is identified without a serious illness can be expected to have IDDM within 1 year. A combination of islet cell antibodies, competitive insulin autoantibodies, and stimulated insulin release levels during an intravenous glucose tolerance test can accurately distinguish children with prediabetes from those with presumed benign transient increases in plasma glucose concentrations.     

Psychosocial correlates of recurrent childhood pain: A comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders.

Pediatric patients with recurrent abdominal pain (RAP) were compared with patients with peptic disease, patients with emotional disorders, and well children with regard to (1) emotional and somatic symptoms and (2) theoretically derived variables, including negative life events, competence, family functioning, and the modeling and encouragement of illness behavior. RAP patients had levels of emotional distress and somatic complaints higher than those of well children and lower than those of psychiatric patients, but not different from those of patients with peptic disease. RAP patients had fewer negative life events, better family functioning, and higher competence than children with emotional disorders. In comparison with well children and psychiatric patients, both RAP and peptic disease patients had a higher incidence of illness in other family members and perceived greater parental encouragement of illness behavior for abdominal symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anxiety and depression in adolescent cancer: findings in patients and parents at the time of diagnosis

Adolescent cancer is uncommon and presents an exceptional stress for the young patient and their parents. The emotional needs of adolescents with cancer are a major factor in the recommendation for the establishment of adolescent cancer units in major cancer centres in the U.K. However, there have been no prospective, longitudinal studies assessing the psychological impact of a diagnosis of cancer on the adolescent patient and their family. In 1994 we began a longitudinal study of the emotional impact of the diagnosis of cancer in patients and their families presenting to an adolescent cancer unit and of the coping strategies they employ. This first report presents the results of the study at the time of diagnosis in 42 adolescents, 34 mothers and 27 fathers. The Beck Depression Inventory (BDI) was used to assess depression and anxiety levels were measured using Spielberger's State Trait Anxiety Inventory (STAI). Adolescents and their parents completed the questionnaires on first admission to the adolescent cancer unit. The median time since cancer diagnosis was approximately 3 weeks. To provide normative data for the U.K. adolescent population, control values were obtained from 173 pupils of the same age and background. The results showed that, contrary to expectation, adolescents with cancer were no more anxious or depressed than the control adolescent population. Nevertheless, a substantial minority of patients and controls had elevated anxiety or depression scores. Girls were significantly more anxious (P = 0.011) and depressed (P < 0.0001) than boys. Mothers were the most anxious family members and were significantly more anxious than fathers (P = 0.038). Parental anxiety scores, especially mothers, were much higher than reported norms. There was no significant difference between mothers' and fathers' depression scores. Although at the time of diagnosis adolescent cancer patients are not more anxious or depressed than their healthy peers, many adolescents without cancer are anxious or depressed. Staff on adolescent cancer units should therefore be aware of the frequency of emotional disturbance in this population. Mothers are the most anxious family members. Although the findings are relatively reassuring at the time of diagnosis, follow-up data from this cohort will show whether anxiety and depression change with treatment involving intensive chemotherapy, surgery and radiotherapy and will indicate the coping strategies which patients and their families adopt in dealing with both the disease and its treatment.     

The impact of asthma and asthma-like illness in Seattle school children

The impact of asthma and asthma-like illness was measured in a population of 5-9-year-old Seattle public school children. Child health information was obtained from a survey of 1665 parents of first and second grade students to assess medical services use and impaired physical functioning among diagnosed asthmatics and those with current wheezing, defined as wheezing in the past 12 months without a diagnosis of asthma, relative to an asymptomatic population with neither condition. Relative to the asymptomatic population, the prevalence of respiratory-related activity limitation, and perception of poorer child health was larger among diagnosed asthmatics than children with current wheezing. However, the prevalence of sleep disturbances, school absences, medical services use, and parental concern over their child's health was similar for both the asthmatic and wheezing groups relative to the asymptomatic group. Also, in both symptomatic groups, a history of moderate or severe wheezing was associated with an increased prevalence of respiratory-related sleep disturbances and activity limitation. The similarity between the impact of diagnosed asthma and undiagnosed asthma-like illness suggests that the overall social and economic burden of asthma may be higher than previously estimated.     

Effect of bacille Calmette-Guérin vaccination on C-peptide secretion in children newly diagnosed with IDDM

OBJECTIVE: To determine whether administration of bacille Calmette-Guérin (BCG) vaccination to newly diagnosed IDDM patients can help preserve C-peptide secretion over the subsequent 18 months. RESEARCH DESIGN AND METHODS: Twenty-six IDDM patients, all of whom had been diagnosed within the previous year, had basal C-peptide levels >0.06 nmol/l, and had negative reactions to Mantoux's test, were randomized pairwise as they presented and were given either 0.1 ml (100 microg) BCG vaccine or 0.1 ml saline intradermally Both the patients and the investigators were blinded to the treatment. Fasting and glucagon-induced C-peptide levels and HbA1c were measured in all patients at enrollment and at 1, 3, 6, 9, 12, and 18 months after vaccination, and insulin dose was recorded at each visit. RESULTS: At enrollment, there was no significant difference in age, duration of diabetes, insulin dose, HbA1c, or fasting C-peptide levels between the BCG-vaccinated and control groups. The mean basal and stimulated C-peptide levels in the BCG-treated group did not differ significantly from those in the control group at any time during the 18 months of follow-up, and there was no difference in insulin dose or HbA1c at any time between the groups. CONCLUSIONS: BCG vaccination in children who have been recently diagnosed with IDDM does not affect the progressive decline in C-peptide levels or alter the clinical course of the disease.     

Using Problem-Solving Skills Training to Reduce Negative Affectivity in Mothers of Children With Newly Diagnosed Cancer: Report of a Multisite Randomized Trial.

Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n = 213) or UPC plus 8 sessions of PSST (PSST; n = 217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

People living with HIV infection who attend and do not attend support groups: a pilot study of needs, characteristics and experiences

People living with Human Immunodeficiency Virus (HIV) confront a myriad of stressors over the course of their infection. Social support groups offer a means of addressing the support needs of people living with HIV. In the present study, 34 persons who had attended HIV support groups and 29 who had not attended groups completed measures of distress, coping, and social connectedness, and participated in open-ended interviews concerning their support group experiences. Results showed that those who attended support groups knew they were HIV-seropositive for a longer time, reported less emotional distress, and had more social contact than did non-attenders. However, non-attenders endorsed avoidant coping strategies to a greater extent. Analyses showed that time since testing positive accounted for differences between groups in social connectedness but not differences in anxiety, depression, or avoidance coping. Thus, HIV-seropositive persons become socially reconnected with time, but individuals with avoidant coping styles experience greater emotional distress and are unlikely to seek support groups. A sizeable proportion of people with HIV may therefore need supportive interventions, particularly nearer to the time that they test HIV-seropositive.     

Longitudinal effects of adaptability on behavior problems and maternal depression in families of adolescents with autism.

Research on families of individuals with autism has tended to focus on child-driven effects utilizing models of stress and coping. The current study used a family systems perspective to examine whether family level adaptability promoted beneficial outcomes for mothers and their adolescents with autism over time. Participants were 149 families of children diagnosed with autism who were between the ages of 10 and 22 years during the 3-year period examined. Mothers reported on family adaptability, the mother–child relationship, their own depressive symptoms, and the behavior problems of their children at Wave 1, and these factors were used to predict maternal depression and child behavior problems 3 years later. Family level adaptability predicted change in both maternal depression and child behavior problems over the study period, above and beyond the contribution of the dyadic mother–child relationship. These associations did not appear to depend upon the intellectual disability status of the individual with autism. Implications for autism, parent mental health, family systems theory, and intervention with this population are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Caregiving Representations of Mothers of Behaviorally Inhibited and Uninhibited Preschool Children.

This study examined differences in the caregiving representations of mothers of 3- to 4-year-old behaviorally inhibited and uninhibited children with secure or insecure attachments. Mothers of inhibited children perceived their children as more vulnerable than did mothers of uninhibited children, and they acknowledged difficulties associated with their children's inhibited temperament. However, mothers of insecure inhibited children were less likely than mothers of secure inhibited children to validate their children's emotional experiences and to be aware of their children's internal states and perspectives, and they showed higher levels of boundary violation and defense against negative affect. Implications of the more problematic caregiving representations of mothers of insecure inhibited children for parent-child relationships are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological reactions at the onset of insulin-dependent diabetes mellitus in children and later adjustment and metabolic control

The initial psychological reactions at the onset of insulin-dependent diabetes mellitus (IDDM) in a population-based sample of 76 children were studied with staff observations and a self-report questionnaire for children 12 years of age and more. Younger children reacted with more anger and less distress than the older children. High initial self-reported distress was associated with poorer subjective psychological IDDM adjustment at a follow-up 10 months later for the older children. The children's initial reactions as well as later adjustment were intimately associated with maternal initial reactions in the total group. The metabolic control, estimated as the mean level of the major fraction of glycosylated haemoglobin (Hb AIc) during the first 2 years, was poorer in the adolescent group. Initial anxiety over injections and protest but low general distress in mothers and children were associated with better metabolic control.