Depression among acute spinal cord injury patients: A study utilizing the Zung Self-Rating Depression Scale.

Administered the Self-Rating Depression Scale (SRDS) an average of 63 days post-injury to 58 acute spinal cord injury (SCI) patients (aged 18–55 yrs) and 51 age-matched healthy controls (CTLs). Mean SRDS scores were 37.1 for CTLs and 49.0 for SCI Ss. Several factors, including age, yrs of education, level of injury (paraplegic vs quadriplegic), etiology of injury (violent vs nonviolent), presence of acute closed head injury, or recent history of alcohol or substance abuse, had no association with SRDS scores. Since undiagnosed and untreated depression may compromise an SCI patient's adaptation to injury and motivation during rehabilitation, abnormally elevated SRDS scores may help to determine which patients might require more focused psychological assessment and treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical decision making among cancer patients.

The purpose of this study is to assess the decisional processes used by patients undergoing cancer treatment. Results demonstrated that patients used 4 discrete strategies to make medical decisions: information seeking, information processing, advice following, and ruminating. Patients' decisional style predicted their scores on measures of coping. Patients who used the cognitively effortful information-seeking and information-processing decisional strategies reported using more coping strategies and more of the strategies that prior research has shown to be more effective for coping with life-threatening illness than did patients who used the advice-following decisional strategy (all ps?     

Compliance with chemotherapy among breast cancer patients.

Explored the extent of and reasons for noncompliance with intravenously administered chemotherapy among 78 female breast cancer patients (aged 29–78 yrs). Overall, chemotherapy compliance was high (92%). The few cases of noncompliance were indirect. In particular, 2 Ss rejected chemotherapy outright, and 2 alcoholic Ss used alcohol to avoid chemotherapy. The high rate of chemotherapy compliance was judged to be due to its perceived centrality to recovery from cancer, the medical nature of its administration, the ease with which noncompliance could be detected, and Ss' spontaneous use of successful coping techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among chronic pain patients: Cognitive-behavioral analysis and effect on rehabilitation outcome.

This study addressed two issues concerning the theoretical and clinical relevance of depression to chronic pain: (a) whether reliable differences among depressed, mildly depressed, and nondepressed chronic pain patients could be identified and (b) whether depression influenced participation in or outcome following a rehabilitation program. To address the first issue, four theoretical constructs were measured by multiple scales. Multivariate analyses of each construct revealed significant differences between the three groups on instrumental activities and coping skills, with more depressed individuals reporting lower levels of functioning and less support. An analysis of the second issue revealed that depressed pain patients showed a greater tendency to drop out of treatment. Outcome did not vary with depression among treatment completers. The results reveal the need to consider a cognitive-behavioral model of depression secondary to chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk of cancer among patients with cutaneous basal cell carcinoma

A population-based cohort of 37,674 patients diagnosed during the period 1978-1991 and registered in the Danish Cancer Registry with basal cell carcinoma of the skin (BCC) were followed for the occurrence of new malignancies. BCC patients experienced significantly increased cancer incidence rates compared with the general Danish population. The elevated cancer risk was not restricted to new cutaneous malignancies. Cancers at various sites, including lip, salivary glands, larynx, lung, breast, kidney and non-Hodgkin lymphoma occurred in significant excess. Patients diagnosed with BCC before the age of 60 years were at higher risk of developing new malignancies than patients diagnosed with BCC at an older age. This age association pertained particularly to breast cancer, testicular cancer and non-Hodgkin lymphoma.     

Promoting smoking cessation among cancer patients: a behavioral model

The smoking cessation clinical practice guideline recently published by the Agency for Health Care Policy and Research (AHCPR) summarizes current knowledge on smoking cessation treatments. Among its recommendations, the guideline encourages physicians to motivate patients who indicate that they are not yet ready to quit smoking. Because medical training typically emphasizes pharmacologic rather than behavioral treatment, we believe that physicians caring for cancer patients may benefit from more extensive instruction in motivating patients to quit smoking. This article describes how a contemporary theoretical approach, the transtheoretical model of change, can be used to promote behavioral change. Multiple studies, primarily in the field of smoking cessation, provide strong empiric support for use of this model in clinical practice. The model consists of five stages of smoking cessation that describe different levels of readiness to quit: precontemplation, contemplation, preparation, action, and maintenance. A diagnostic tool is presented, and specific smoking cessation counseling strategies are suggested for each stage of change. Implications for the use of the model by physicians who counsel and treat smokers are discussed.     

Differences in crisis reactions among cancer and surgery patients.

To investigate the psychological reactions caused by traumatic events, 31 female cancer patients were compared to 15 female surgery patients and 15 healthy females at each of 5 test periods. Instruments included the State–Trait Anxiety Inventory, Halpern Crisis Scale, and Rotter's Internal–External Locus of Control Scale. Cancer and surgery patients reported more crisis than healthy Ss. However, cancer patients also reported a strong sense of helplessness, while surgery patients and healthy Ss did not. Discriminant analyses for each test period were able to assign 73–82% of the Ss to their correct groups on the basis of differences in test scores. Results suggest that surgery and cancer are different types of crises, characterized by distinctly different psychological reactions. Contrary to theory, the crises under study did not appear to be resolved within 6–8 wks after onset. In fact, crisis was not resolved within the 15-wk duration of the experiment. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of quality of life among pediatric patients with cancer.

Historical foundations of quality of life (QL) assessment, including those in adult oncology, are reviewed in the context of the current need for a developmental measure for clinical pediatric research. QL measures that can be applied to the assessment of children with cancer and other chronic and life-threatening diseases are urgently needed. Use of valid QL scales would facilitate the evaluation of patient status over time as well as the comparison of results of patients with different diagnoses, treatment histories, and outcomes of therapy. The attributes of an effective QL measure, based on clinical experience in pediatric oncology settings, include simplicity and brevity as well as conventional psychometric properties. Psychologists, in collaboration with their pediatric oncologist colleagues, are encouraged to develop new QL assessment methods. Suggestions are given for studies necessary to accomplish this goal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and immune function among spouses of cancer patients.

This study investigated whether social support was related to immune function among spouses of cancer patients. Effects of depression and negative life events were examined as potential mediators. Results showed evidence of greater immunocompetence on 2 of 3 dynamic measures: natural killer cytotoxicity and proliferation response to phytohemaglutinin among spouses who reported high levels of social support. All six components of social support assessed by the Social Provisions Scale (C. E. Cutrona and D. W. Russell, 1987) were strongly related to these indices of immune function. No evidence was found for mediation by either life events or depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sero-prevalence of herpes simplex virus type-2 among cancer cervix patients

Serum samples were collected from 140 cancer cervix patients aged between 25-60 years and also from 20 age matched, married, healthy women to serve as controls. These sera were tested for HSV-2 antibodies by ELISA test and HBsAg by RPHA test. HSV-2 antibodies were detected in 92 (65-71%) and HBsAg in 25 (17.8%) cancer cervix patients. Sera from control group were negative for HSV-2 antibodies and HBsAg.     

Validation of the Geriatric Depression Scale--Short Form among inpatients

Little is known about the diagnostic validity of the 15-item Geriatric Depression Scale-Short Form (GDS-SF), especially when compared to the original 30-item version (Geriatric Depression Scale-Long Form; GDS-LF). This study compared the GDS-SF and GDS-LF with a sample of depressed, demented, and thought-disordered inpatients. The GDS-SF and GDS-LF were found to be highly correlated (r = .89) and to have similar high sensitivity rates. The specificity rates for both forms were similar, but lower than desirable. Overall, the GDS-SF was found to be an adequate substitute for the GDS-LF.     

Depression among elderly Chinese immigrants: an exploratory study

Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.     

Depression of young and elderly patients

OBJECTIVE: To compare the presentation and outcome of depression between young and elderly patients. DESIGN: The clinical presentation, treatment and outcome of 47 young patients (21 to 64 years) were compared with 58 elderly (65 years and older) patients admitted to a general hospital psychiatric ward for the treatment of depressive disorders (based on ICD-10). SUBJECTS: There was no significant difference between the sexes in each age group. The majority of the elderly were either widowed (36%) or married (53%) while 45% of the young were single and 51% married. Seventy per cent of the elderly had retired while 64% of the young were in full-time employment. Most patients lived with their families (87% young and 96% elderly). All but one elderly suffered at least one physical disorder with two-thirds having two or more physical disorders; this contrasts greatly to young patients who were physically healthier (p < 0.001). RESULTS: In clinical presentation and symptomatology, the young patients had significantly more suicide ideation (p < 0.003) and psychomotor retardation (p < 0.001) but there was no difference in suicidal attempt, delusion, hallucination or agitation. More young patients (36%) had a past psychiatric illness (often depressive disorders) than elderly patients (8%) (p < 0.001), more elderly patients (88%) were treated with antidepressants than the young patients (62%) (p < 0.002). At one year follow-up, more elderly patients (46%) recovered compared with the young patients (23%) (p < 0.05). CONCLUSION: There were some differences in the symptomatology of depression between young and elderly patients, but the prognosis was better for elderly patients.     

Use of the Zung Self-Rating Depression Scale in cancer patients: feasibility as a screening tool

The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.     

Protective buffering and emotional desynchrony among spousal caregivers of cancer patients.

Objective: To examine protective buffering and emotional desynchrony among spousal caregivers of cancer survivors. Design: Repeated measures; 42 caregivers engaged in 2 videotaped, oral emotional expression exercises: 1 in the presence of their patient and 1 in the absence of their patient. Main Outcome Measures: Felt emotion (self-report) and expressed emotion (lexical expression or words uttered and coder-derived facial expression). Other measures assessed mental and physical health, dyadic satisfaction, and dispositional emotional inhibition. Results: Protective buffering differed by communicative channel (lexical vs. facial). Caregivers' facial expressions were more positive when the patient was present versus absent. In contrast, the valence of caregivers' words did not differ per patient presence. Facial protective buffering was unrelated to health and dyadic outcomes. Lexical protective buffering was inversely related to both caregiver and patient marital satisfaction. Dispositional emotional inhibition was inversely related to caregiver mental health and marital satisfaction. Desynchrony occurred when the patient was present but was counter to prediction; felt emotion was more positive than expressed emotion. Conclusion: Results provide behavioral evidence of facial protective buffering. To the extent that lexical buffering occurs, it poses a dyadic risk, and chronic inhibition poses both psychological and dyadic risks. Future research is needed to refine the operational definition of desynchrony and to examine the biopsychosocial sequelae of buffering. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among the head-injured and non-head-injured: a discriminant analysis

Neuropsychologists often use traditional psychological tests to assess depression following a head injury; but the assumption that depression with a head injury resembles that in an uninjured person is suspect. The current study attempts to examine the cognitive manifestations of depression with and without a coexisting head-injury. Advanced statistical methods are used to assess whether or not the two depressions 'look alike' with respect to the neuropsychological sequelae of the disorders. A total of 1182 people were entered into one of two discriminant function analyses (DFA) for depression. Each person was a member of one of the following groups: (a) depressed, (b) non-depressed, (c) head-injured, or (d) head-injured and depressed. Two functions were performed for depression, one on the population of head-injured people and one on the population of uninjured people. Cross-validations were performed for each population and across populations in order to assess the utility of each population's function for the opposite group. This comparison allows the researcher to indirectly compare depression in the two populations. Both functions were successfully applied to either population when MMPI variables were included in the analyses. However, when only cognitive variables were included the function performed on the non-head-injured population did not correctly classify head-injured people as depressed or non-depressed. One explanation for this is that the range of cognitive scores in head-injured people is so great that it allows for a less accurate but more generalizable function. Suggestions for future research are discussed.     

An investigation into the causes of absconding among black African breast cancer patients

OBJECTIVE: To discuss the complexities facing the researcher in attempting to determine reasons for the high rate of absconding from biomedical treatments by black African women diagnosed with breast cancer. DESIGN: Qualitative study based on in-depth interviews and participant observations of the informants, to ascertain attitudes, beliefs and practices of black African breast cancer patients with regard to the choice of healer. PARTICIPANTS: 10 black breast cancer patients, 4 African indigenous healers, 4 black lay persons, and 8 Groote Schuur Hospital members. SETTING: Radiation Oncology Department, Groote Schuur Hospital, Cape Town. RESULTS: The study revealed that various determinants affect black women's decision to abscond from biomedical breast cancer treatments. These determinants were based on social and cultural peculiarities. However, these findings did not explain the difference in absconding rates between black cervical (30%) and breast cancer (80%) patients. Although the two patient groups shared social, economic, and cultural backgrounds, their decisions with regard to biomedical treatments of cancer were remarkably different. CONCLUSIONS: The methods chosen for the research project provided a framework for a qualitative study of one ethnic group of breast cancer patients. However, the research framework failed to allow comparisons between breast and cervical cancer patients from the same ethnic backgrounds. Therefore, although the research findings revealed determinants affecting black breast cancer treatments, they do not explain the discrepancy between absconding rates of black cervical and breast cancer patients.     

The relationships among nursing diagnoses in discharge planning for patients with lung cancer

An explanatory study was designed to investigate whether nursing diagnoses present at discharge from the hospital accurately describe the complexity of care required in the community. A sample of 196 patients with lung cancer referred to community agencies at discharge was described by types of nursing diagnoses; types of agencies needed and services required; and by age, gender, race, economic status, and hospital length of stay. Using multiple logistic regression, a model for home care referral resulted in four significant predictor diagnoses: altered nutrition: less than body requirements, bathing/hygiene self-care deficit, high risk for infection, and high risk for injury. The model for hospice referral resulted in four significant predictor diagnoses: anticipatory grieving, impaired skin integrity, high risk for impaired skin integrity, and pain. The data suggest that the nursing diagnoses described the discharge planning needs, which predicted the type of agency referral needed.     

Negative affect and barriers to exercise among early stage breast cancer patients.

Objective: To assess the relative frequency of and barriers to exercise among women with breast cancer while controlling for cancer-relevant and demographic factors. Design: The present study employed concurrent samples, correlational research design. Main Outcome Measures: Exercise frequency and its association with negative affect and barriers to exercise, independent of cancer treatment, among women (N = 176) with Stage I or II breast cancer who were 3, 6, and 12 months postsurgery. Results: After accounting for cancer-relevant and control variables, degree of negative affect and frequency of perceived barriers were significantly inversely associated with exercise. Conclusion: These findings suggest that attention to both emotional factors and psychosocial barriers to exercise may be warranted to further understand exercise among women with early stage breast cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prolonged disease-free survival by maintenance chemotherapy among patients with recurrent platinum-sensitive ovarian cancer

The aim of this prospective, randomized and double-blind study was to assess the effects of a high dose of the analgesic tramadol administered at the conclusion of surgery on extubation time, sedation, and post-anaesthetic shivering. Forty adult patients, ASA physical status I or II, underwent laparoscopic surgery of about 1 h duration and received a standardized anaesthesia that was maintained with isoflurane in O2/N2O. Tramadol 3 mg kg-1 (n = 20) was administered intravenously at the beginning of wound closure, and was compared with saline (n = 20). Post-anaesthetic shivering did not occur in any patient who received tramadol, whereas it occurred in 60% of the control group (P < 0.001). There were no adverse effects on time to extubation and sedation, and discharge-ready time was shorter in the tramadol group (P < 0.05 compared with control). Pain scores in the post-anaesthesia care unit (PACU) were statistically not different between the two groups, but significantly more supplemental medication was administered in the control group to treat shivering and/or pain. In conclusion, administration of a high dose of tramadol at the end of surgery prevents post-anaesthetic shivering without prolongation of extubation time, and shortens the PACU/discharge-ready time.