Factors affecting quality of life of the Korean aged stroke patients

Among the most prevalent disabling diseases of old age, stroke is the leading chronic condition in Korea. The physical and psychosocial complications of a stroke can result in serious limitations on all aspects of one's life that affect overall quality of life. This study examines the relative importance of and interactions among factors which affect the quality of life of 119 stroke patients aged sixty-five and older in Korea. The model uses family support, personality (specifically hardiness), economic status, and physical functioning as independent variables, and quality of life as a dependent variable. The results of this study suggest that physical functioning and physical care by the family are important factors influencing quality of life of the aged stroke patients. Hardy personality is negatively associated with financial support and physical care by the family. These findings have several implications for policy development, clinical practice, and future research in this area.     

Sexuality and intimacy following radical prostatectomy: Patient and partner perspectives.

Most research on adjustment following radical prostatectomy has focused on limited assessments of urinary and erectile functioning. In this study, the authors provided a more comprehensive assessment of sexuality from 134 radical prostatectomy patients and their partners and determined the extent to which various components of sexuality are associated with psychosocial adjustment. Measures of sexuality and intimacy modestly predicted patients' emotional distress and quality of life (QoL), with body image and dyadic adjustment playing the most important roles after controlling for medical variables, general physical functioning, and optimistic outlook. Urinary incontinence and other sexuality variables were not unique predictors. In contrast, partner ratings of sexual satisfaction played a more important role in predicting their QoL. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline personality traits and disorder: Predicting prospective patient functioning.

Objective: Decisions about the composition of personality assessment in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–V) will be heavily influenced by the clinical utility of candidate constructs. In this study, we addressed 1 aspect of clinical utility by testing the incremental validity of 5-factor model (FFM) personality traits and borderline personality disorder (BPD) symptoms for predicting prospective patient functioning. Method: FFM personality traits and BPD features were correlated with one another and predicted 2-, 4-, 6-, 8-, and 10-year psychosocial functioning scores for 362 patients with personality disorders. Results: Traits and symptom domains related significantly and pervasively to one another and to prospective functioning. FFM extraversion and agreeableness tended to be most incrementally predictive of psychosocial functioning across all intervals; cognitive and impulse action features of BPD features incremented FFM traits in some models. Conclusions: These data suggest that BPD symptoms and personality traits are important long-term indicators of clinical functioning that both overlap with and increment one another in clinical predictions. Results support the integration of personality traits and disorders in DSM–V. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial functioning and depression: Distinguishing among antecedents, concomitants, and consequences.

In this article we attempt to distinguish empirically between psychosocial variables that are concomitants of depression, and variables that may serve as antecedents or sequelae of this disorder. We review studies that investigated the relationship between depression and any of six psychosocial variables after controlling for the effects of concurrent depression. The six variables examined are attributional style, dysfunctional attitudes, personality, social support, marital distress, and coping style. The review suggests that whereas there is little evidence in adults of a cognitive vulnerability to clinical depression, disturbances in interpersonal functioning may be antecedents or sequelae of this disorder. Specifically, marital distress and low social integration appear to be involved in the etiology of depression, and introversion and interpersonal dependency are identified as enduring abnormalities in the functioning of remitted depressives. We attempt to integrate what is known about the relationships among these latter variables, suggests ways in which they may influence the development of depression, and outline specific issues to be addressed in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related quality of life measured by the SF12 in working populations: Associations with psychosocial work characteristics.

This study investigated the contribution of psychosocial work characteristics (decision latitude, job demand, social support at work, and effort-reward imbalance) to health-related quality of life. Data were derived from 2 aircraft manufacturing plants (N = 1,855) at the start of a longitudinal study. Regression analysis showed that work characteristics (1st model) explained 19% of the variance in the mental summary score of the Short Form-12 Health Survey. R2 change for work characteristics decreased to 13%, accounting for demographics, socioeconomic status, body mass index, and medical condition (5th model). Including health behavior and personality factors (full model), R2 change for work characteristics remained significant. Psychosocial work characteristics account for relevant proportions in the subjective perception of mental health beyond a wide array of medical variables and personality factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimistic Personality and Psychosocial Well-Being During Treatment Predict Psychosocial Well-Being Among Long-Term Survivors of Breast Cancer.

In considering well-being among survivors of life-threatening illnesses such as breast cancer, 2 important questions are whether there is continuity between initial adjustment and longer term adjustment and what role personality plays in long-term adjustment. In this research, a sample of 163 early stage breast cancer patients whose psychosocial adjustment was first assessed during the year after surgery completed the same measures 5-13 years after surgery. Initial reports of well-being were relatively strong predictors of follow-up well-being on the same measures. Initial optimism and marital status also predicted follow-up adjustment, even controlling for earlier adjustment, which exerted a substantial unique effect in multivariate analyses. In contrast, initial medical variables played virtually no predictive role. There is substantial continuity of subjective well-being across many years among survivors of breast cancer, rooted partly in personality and social connection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological adjustment to ostomy surgery.

Describes the anatomy and physiology of colostomy, ileostomy, and urostomy surgeries and reviews 16 studies regarding the outcome of these surgeries in terms of patients' health, employment, social activities, sexual functioning, marital relationships, and emotional status. Two studies of factors that influence outcome are also reviewed, and strengths and weaknesses of existing studies are evaluated. Recommendations for further research include grouping patients by diagnosis rather than by type of surgery; more precise labeling of surgical procedures; avoidance of positive bias in sampling by selecting patients from physician and hospital records, rather than from the members of mutual help groups; and use of longitudinal studies to investigate personality and situational variables that influence the process of psychosocial adjustment to ostomy. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical correlates of anhedonia and perceptual aberration in first-episode patients with schizophrenia and affective disorder.

Examined the association between scales measuring physical anhedonia, social anhedonia, and perceptual aberration and premorbid functioning, clinical state, and current level of adjustment in 91 psychotic Ss. The patients were examined at the onset of their 1st psychotic episode and again 18 mo later. For patients with schizophrenia, anhedonia was significantly related to premorbid functioning. No association was found between the scales and clinical state or level of adjustment at intake or follow-up. In affective disorder patients, no correlation was found between premorbid functioning (a stable characteristic) and scale scores, but moderately large correlations emerged between the scales and clinical state and level of adjustment at both assessment times. These results suggest that schizophrenic and affective disorder patients endorse items on these scales for different reasons. The authors hypothesize that for patients with schizophrenia the scales assess enduring personality characteristics, whereas for the affective disordered patients they assess clinical condition at the time of testing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social adjustment and the course of affective illness: a one-year controlled longitudinal study involving bipolar and unipolar outpatients

The association between social adjustment and recurrent affective episodes was examined in 27 recovered bipolar patients and 24 recovered unipolar patients who had been receiving maintenance treatment for at least 1 year. Social adjustment variables and psychiatric status were assessed by bimonthly interviews over the 1-year period using the Social Adjustment Scale (SAS) and the Research Diagnostic Criteria (RDC). Variations in the social adjustment scores were analyzed in the 2 months preceding the onset of a recurrent affective episode. Furthermore, social adjustment variables at entry into the study were assessed to investigate whether there was any association between these and the potential timing of a recurrent episode. Results revealed no significant deterioration in social adjustment during the 2 months preceding a recurrent affective episode. However, it was demonstrated that there was a relationship between a patient's overall social adjustment score at entry into the study and the onset of recurrent affective episodes, independent of any residual depressive symptomatology. Specifically, impaired work adjustment in bipolar and unipolar patients was associated with recurrent episodes. Impaired social and leisure activities adjustment in bipolar patients was also associated with recurrent episodes, and impaired marital adjustment in unipolar patients was associated with recurrent episodes. These results suggest that social maladjustment could be a risk factor for both unipolar and bipolar recurrent affective episodes and that impairment in specific areas of social functioning could be used to predict outcome.     

Do neurocognitive ability and personality traits account for different aspects of psychosocial outcome after traumatic brain injury?

Objective: To examine the contributions of demographic, injury, cognitive, and personality characteristics to psychosocial outcome 8 years after traumatic brain injury (TBI). Design: Multiple regression analyses were used to estimate the variance explained by putative "predictors" of psychosocial outcome. Participants: Thirty-nine TBI survivors and 39 family member informants. On the basis of Glasgow Coma Scale scores and Accident Injury Severity (head) ratings, the patients' brain injuries ranged from mild to critical in severity. Main Outcome Measures: One self-report measure combined putative markers of social role engagement, such as marital status and earned income. Another, based on informant ratings using the Katz Adjustment Scale, was conceptualized as reflecting behavioral adjustment. Results: Whereas cognitive functioning explained significant unique variation in social role engagement, it did not account for variance in behavioral adjustment. Conversely, whereas 3 personality trait ratings explained significant incremental variance in behavioral stability, only 1 did the same with respect to social role engagement. Conclusions: Social role engagement and behavioral adjustment appear to represent 2 related but distinguishable aspects of TBI outcome that are associated with different patient characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of disaster support work

Limited available evidence suggests that disaster support work may have negative effects. This study attempts to examine the impact of disaster-related stress on helpers offering psychological support to victims of two major disasters, and to identify potential moderating factors. Sixty-seven social workers were surveyed, measures being taken of psychological symptomatology and wellbeing, personality variables, social support, life events, and various aspects of disaster support work. Comparison with normative data suggested that subjects were experiencing significant levels of stress. Two major sources of disaster-related stress were identified: role-related difficulties and contact with clients' distress. Approximately one third of the variance in helper response could be explained by variables reflecting coping style, prior life events and the aforementioned aspects of disaster support work. Follow-up data at 12 months demonstrated persisting high levels of stress.     

A multimethod, multi-informant, and multidimensional perspective on psychosocial adjustment in preadolescents with spina bifida.

This study examined the psychosocial adjustment of preadolescents with spina bifida in relation to a comparison sample of able-bodied preadolescents (8- and 9-year-olds; n = 68 in each sample). The study also examined the potential clinical utility of a narrowband multimethod, multi-informant, and multidimensional perspective on the assessment of psychosocial functioning in children and adolescents with pediatric conditions. Findings revealed that children with spina bifida tended to be socially immature and passive, less likely to have social contacts outside of school, more dependent on adults for guidance, less competent scholastically, less physically active, less likely to make independent decisions, and more likely to exhibit attention and concentration difficulties. No group differences were found for externalizing symptoms, affective functioning, or global self-worth, suggesting resilience in these domains for the spina bifida sample. Findings also suggest that low socioeconomic status and the presence of a physical disability may be additive risk factors for certain psychosocial adjustment difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial and physical correlates of survival and recurrence in patients with head and neck carcinoma: results of a 6-year longitudinal study

BACKGROUND: Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions. To the authors' knowledge, to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients. The current study focused on the complex interactions among psychosocial, medical, behavioral, and demographic variables as they relate to prognosis in these patients. METHODS: A total of 133 consecutive head and neck carcinoma patients were included in a prospective study at pretreatment. In addition to clinical variables, psychosocial and physical functioning was assessed by means of a self-report questionnaire. RESULTS: During the observation period 57 patients died whereas 76 were still alive at 6 years after treatment. Results of the multivariate survival analysis indicated that patients without head and neck metastasis had a better prognosis than patients with positive cervical lymph nodes. Pretreatment smoking showed a negative correlation with overall survival. Patients who were more physically self-efficacious (i.e., higher perceived physical abilities) were more likely to survive and less likely to develop a recurrence. In addition, patients who expressed intense psychosocial complaints prior to treatment had a better prognosis than had those who did not express such negative feelings. CONCLUSIONS: The current findings linking physical self-efficacy and prognosis are promising, but clinical trials are necessary to examine the direct and indirect mediational pathways of the variables that underlie physical efficacy and influence survival and recurrence. Also, the negative correlation between pretreatment smoking and survival suggests a need for increased efforts to address smoking in newly diagnosed patients.     

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)     

Major life events, hassles, and adaptation in adolescence: Confounding in the conceptualization and measurement of life stress and adjustment revisited.

Prior work has suggested that methodological and conceptual confounding may play a role in the associations obtained between stressful life events, social resources, and adaptive outcome. Of particular concern in our work were (a) the source and method of assessment; (b) conceptual overlap between life stress and resource items and symptoms of disorder; and (c) induced response bias through the instructional sets of stress measures. A second goal was to extend our understanding of the life stress–adjustment linkage in groups for whom little data of this type exist. By using multitrait-multimethod procedures we found that both distal major life events and proximal daily stressors had important degrees of unique and shared variance with adaptive functioning, whereas the effects for social support were inconclusive. Further, the importance of considering possible sources of potential confounding in producing quite different levels of association between life stress and adaptation was underscored by the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term posttreatment functioning among patients with unipolar depression: An integrative model.

This study tested an integrative structural equation model of posttreatment functioning among 16 depressed patients followed for an average of 9 years after the end of an episode of treatment. The model examined (a) the link between life change and psychosocial resource change and (b) the role of resource change in mediating the relationship between life change and change in depression. An increase in the preponderance of negative over positive life events was associated with a decline in resources and an increase in depressive symptoms. A decline in resources was associated with an increase in depressive symptoms. The association between changes in events and depressive symptoms was completely mediated through resource change. These findings indicate that life stressors contribute to posttreatment depression through an erosion of personal and social resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial characteristics of inner-city children with asthma: a description of the NCICAS psychosocial protocol. National Cooperative Inner-City Asthma Study

Previous research has demonstrated a significant reciprocal relationship between psychosocial factors and asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated both asthma-specific and non-specific psychosocial variables, including asthma knowledge beliefs and management behavior, caregiver and child adjustment, life stress, and social support. This article presents these psychosocial characteristics in 1,528 4-9-year-old asthmatic urban children and their caretakers. Caretakers demonstrated considerable asthma knowledge, averaging 84% correct responses on the Asthma Information Quiz. However, respondents provided less than one helpful response for each hypothetical problem situation involving asthma care, and most respondents had more than one undesirable response, indicating a potentially dangerous or maladaptive action. Both adults and children reported multiple caretakers responsible for asthma management (adult report: average 3.4, including the child); in addition, children rated their responsibility for self-care significantly higher than did adults. Scores on the Child Behavior Checklist indicated increased problems compared to normative samples (57.3 vs. 50, respectively), and 35% of children met the criteria for problems of clinical severity. On the Brief Symptom Inventory, adults reported elevated levels of psychological distress (56.02 vs norm of 50); 50% of caretakers had symptoms of clinical severity. Caretakers also experienced an average of 8.13 undesirable life events in the 12 months preceding the baseline interview. These findings suggest that limited asthma problem-solving skills, multiple asthma managers, child and adult adjustment problems, and high levels of life stress are significant concerns for this group and may place the inner-city children in this study population at increased risk for problems related to adherence to asthma management regimens and for asthma morbidity.     

Multimethod investigation of interpersonal functioning in borderline personality disorder.

Even though interpersonal functioning is of great clinical importance for patients with borderline personality disorder (BPD), the comparative validity of different assessment methods for interpersonal dysfunction has not yet been tested. This study examined multiple methods of assessing interpersonal functioning, including self- and other-reports, clinical ratings, electronic diaries, and social cognitions in three groups of psychiatric patients (N = 138): patients with (1) BPD, (2) another personality disorder, and (3) Axis I psychopathology only. Using dominance analysis, we examined the predictive validity of each method in detecting changes in symptom distress and social functioning 6 months later. Across multiple methods, the BPD group often reported higher interpersonal dysfunction scores compared with other groups. Predictive validity results demonstrated that self-report and electronic diary ratings were the most important predictors of distress and social functioning. Our findings suggest that self-report scores and electronic diary ratings have high clinical utility, because these methods appear most sensitive to change. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychosocial factors predicting employee sickness absence during economic decline

Psychosocial factors such as work characteristics, life events, social support, and personality were examined as predictors of the change in medically certified sickness absence observed during a period of severe economic decline. Longitudinal data, derived from self-reports and register-based information relating to 763 local government employees, were collected at 3 points during a 5-year period: before the economic decline, during the nadir of that decline, and immediately after the nadir. After the effects of prior absence and demographic and lifestyle variables had been partialed out, the results of multiple Poisson regression analyses showed that work characteristics play a major role in forthcoming sickness absences. Negative life events and the personality trait sense of coherence (in women) also predicted forthcoming absence rate. Social support did not relate to absences either in men or in women.     

Parent Functioning in Families of Preadolescents With Spina Bifida: Longitudinal Implications for Child Adjustment.

The purpose of this study was to test a strength-of-association model regarding possible longitudinal and bidirectional associations between parent functioning and child adjustment in families of children with spina bifida (n = 68) and families of able-bodied children (n = 68). Parent functioning was assessed across 3 domains: parenting stress, individual psychosocial adjustment, and marital satisfaction. Child adjustment was indexed by teacher-reported internalizing and externalizing symptoms, self-reported depressive symptoms, and observed adaptive behavior. Findings revealed that all 3 parent functioning variables predicted child adjustment outcomes, and that such results were particularly strong for externalizing symptoms. Associations between parent functioning and child adjustment tended to be in the direction of parent to child and were similar across both groups. These findings have implications for potential interventions targeted at helping families manage the transition into early adolescence in families of children with spina bifida as well as families of healthy children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)