Psychological distress and adjustment to disease in patients before and after radical prostatectomy. Results of a prospective multi-centre study

The aim of this prospective multi-centre study was to evaluate the level of psychological distress (PD) and adjustment to disease in patients who underwent radical prostatectomy. Furthermore, the impact of urinary incontinence and erectile dysfunction on PD was assessed. Anxiety, depression and PD were evaluated using the Hospital Anxiety and Depression Scale in 329 prostate cancer patients before surgery as well as 3, 6 and 12 months after surgery. These results were compared with those of a male German general population reference group. Adjustment to disease was assessed using the Perceived Adjustment to Chronic Illness Scale. Patients reported low levels of PD at all points of assessment similar to population norms of age-matched German men. Persistent PD was seen in about 8% of the patients and 20% had PD at least two of the measurement points. Relevant predictors for PD after surgery were urinary symptoms and baseline PD. Adjustment to disease was highest before surgery and had significantly reduced at 3 and 6 months after surgery. In general, men are resilient to the experience of localised prostate cancer and adjust well psychologically after surgery. However, between 8% and 20% of patients could possibly benefit from mental health support.

[Patient involvement in medical decision making--an overview on patient preferences and impacting factors]

The involvement of patients in medical treatment decisions has been intensively discussed for several years. The present review article is concerned with the patient participation in medical decision making mainly in the field of oncology. Also discussed are methodological aspects of the measurement of patient involvement and the theoretical approach of shared decision -making. The preference to be involved in decisions is expressed from 16-50% of the patients and depends on socio-demographic and disease-related variables. Positive impact of patient participation is observed essentially as short-term effects and for psychosocial outcome criteria. Further research should consider the methodological aspects and focus on dyadic concepts and various dimensions of patient involvement. It is also important to focus on evaluation of the decision and on the possible (long time) effects in terms of recovery, progression of disease, psychosocial consequences and economic impact.

Efficacy of short-term psychodynamic psychotherapy (STPP) with depressed breast cancer patients: results of a randomized controlled multicenter trial

BACKGROUND

There is a lack of trials of psychodynamic treatments of depression in breast cancer patients. The purpose of this trial was to determine the efficacy of short-term psychodynamic psychotherapy (STPP) in non-metastatic breast cancer patients diagnosed with depression, one of the most frequent mental comorbidities of breast cancer.

PATIENTS AND METHODS

In a multicenter prospective trial, 157 breast cancer patients with comorbid depression were randomized to either individual STPP (intervention group, N=78) or 'treatment as usual' (control group, TAU, N=79). As our primary outcome measure, we hypothesized a higher rate of remission defined as no diagnosis of depression (Structured Clinical Interview for DSM-IV) and reduction in depression score by at least 2 points (Hospital Anxiety and Depression Scale, HADS-D) in STPP versus TAU at treatment termination. Secondary outcomes mainly refer to quality of life (QoL).

RESULTS

In the intention to treat (ITT) analysis, 44% of the STPP group achieved highly significantly more remission than TAU (23%). STPP treatment (OR=7.64; P<0.001) was the strongest predictor for remission post-treatment; time was also significant (OR=0.96; P<0.05). A high effect favoring STPP (d=0.82) was observed for the HADS-D score post-treatment (secondary outcome). Regarding further secondary outcomes (QoL), analyses of covariance yielded main effects for group (favoring STPP with an effect size of at least d=0.5) for global QoL, role, emotional and social functioning, pain, treatment side-effects, breast symptoms and upset by hair loss.

CONCLUSIONS

STPP is an effective treatment of a broad range of depressive conditions in breast cancer patients improving depression and functional QoL. Findings are limited by the drop-out rate (∼1/3) and delayed post-treatment assessments. Future trials may consider stepped-care approaches, tailored to patients' needs and requirements in the acute treatment phase.

[Anxiety and depressive symptoms and exposition towards violence in the general older population (between 60 and 84 years) in Germany - results from a cross-sectional study]

BACKGROUND

Depression and anxiety are important public health challenges in the general older population in Germany. Exposition towards violence/abuse in old age has been widely neglected as a risk factor for anxiety and depression among the older population.

METHODS

The ABUEL study (“Abuse of the Elderly in Europe”) is a cross-sectional study of people between 60 and 84 years living in Stuttgart. Anxiety and depression are assessed with the “Hospital Anxiety and Depression Scale” (HADS). We assessed 1) socio-demographic variables and 2) exposition towards violence in the past 12 months as independent variables.

RESULTS

The results indicate that violence exposition in the past 12 months is a risk factor for anxiety (OR: 2.25, 95% CI: 1.32–3.84) and depression (OR: 2.27, 95% CI: 1.27–4.04) among the elderly population in Germany. Anxiety is associated with female gender (OR: 3.18, 95% CI: 1.62–6.25). Anxiety and depression are associated with times of unemployment in the life course.

CONCLUSION

Our data suggest that exposure to violence in old age should be assessed to allow targeted prevention and intervention programmes.

[Patient satisfaction in oncological aftercare--differential results of gender aspects in doctor-patient dyads]

OBJECTIVE

The aim of this study was to explore the role of gender of the physician and gender of the patient in explaining differences in patient satisfaction.

MATERIAL AND METHODS

Overall, 1,130 patients were assigned to one of 4 possible physician-patient sex dyads and were interviewed with a questionnaire about their patient satisfaction.

RESULTS

Female patients in a dyad with a female physician were most satisfied with the overall judgment of practice visit and the inclusion of life situation in comparison to all other dyads. Male patients in a dyad with a male physician were least satisfied.

CONCLUSION

In the future, the specific role of patient-physician dyads has to be considered more in the assessment of subdimensions of patient satisfaction.

Children and Employment - Resource or Stressors after Breast Cancer?

Introduction: Breast cancer patients suffer clinically relevant levels of psychological stress because of their disease. Various factors can affect the level of stress experienced. This study aimed to investigate the relationship between the level of psychological stress and employment and children, including time since diagnosis. Material and Methods: A randomised clinical study was done of 724 breast cancer patients aged between 18 and 65 years; all were in the curative stage of disease and had been diagnosed 0-12 months previously. Patients were investigated for their levels of psychological stress (anxiety and depression) using the Hospital Anxiety and Depression Scale (HADS). The relationship between anxiety and depression and the variables "employment", "parenthood" and "time since diagnosis" were investigated, using univariate and multivariate analysis. Results: Patients with a longer time since diagnosis (4-12 months) were found to have lower levels of anxiety (6.28) compared to patients who had been diagnosed only 0-3 months previously (7.24; p < 0.01). There was no unambiguous relation between parenthood and anxiety. The age of the children was crucial. Even when results were controlled for patient age, the anxiety levels of women with children below the age of 16 years were significantly higher (7.84) compared to patients without children (6.42) or patients whose children were older than 16 years (6.87; p = 0.04). Women who were not employed had significantly higher levels of depression compared to all other participants in the study (p = 0.02). No reciprocal effects were found between investigated variables. Conclusion: We found a differentiated relationship between the variables "time since diagnosis", "employment" and "children" and the level of psychological stress experienced by breast cancer patients. When determining the level of psychological stress in the 1st year after diagnosis, particular attention should be paid to patients who are not employed and patients with children below the age of 16 years.

[Burnout, work disruptions, interpersonal and psychosomatic problems--degree-specific comparison of students at a German university]

In the context of the public debate on psychological strain among students, the prevalence of burnout, procrastination, test anxiety, other work disruptions, interpersonal problems and psychic symptoms were analyzed depending on academic degree. The data of 358 college students (of Leipzig University) were examined. The academic degree had only a marginal effect on burnout- and work disruptions-related variables. In terms of interpersonal problems and psychic symptoms, differences between students were identified, depending on the academic degree. Diploma students reported many complaints, whereas undergraduates aspiring for a State Examination, were comparatively less affected. Knowledge of the population-specific psychological load is useful in order to develop preventive and therapeutic measures.

Patient participation in the medical decision-making process in haemato-oncology--a qualitative study

Cancer patients are showing increased interest in shared decision-making. Patients with haematological illnesses, however, express considerably less desire for shared decision-making as compared with other oncological patient groups. The goal of the current project was to identify the reasons for the lower desire for shared decision-making among patients with haematological illness. We conducted qualitative, semi-structured interviews with 11 haematological patients (39-70 years old) after the beginning of therapy concerning the course and evaluation of medical shared decision-making. The patients were often overwhelmed by the complexity of the illness and the therapy and did not want to assume any responsibility in medical decision-making. They reported a great deal of distress and very traditional paternalistic role expectations with regards to their health care providers, which limited the patients' ability to partake in the decision-making process. In contrast to the socio-cultural support for many other oncological diseases, haematological diseases are not as well supported, e.g. there is a lack of self-help materials, systematic provision of information and support groups for patients, which may be related to a lower empowerment of this patient population. Results show the limits of patient participation in the context of highly complicated medical conditions. In addition to already researched preferences of the physicians and patients for shared decision-making, future research should pay greater attention to the process and other variables relevant to this aspect of the doctor-patient relationship.

[Use of family resources in future need of care. Care preferences and expected willingness of providing care among relatives: a population-based study]

The family is an important resource in elderly care. It is of great interest if persons who might be in need of care in the future would use this resource. Our study assessed wishes and expectations regarding family care in a representative sample of the general population (≥ 45 years, N = 1,445) using questionnaires. Logistic regressions were performed to analyze the potential impact on the willingness to use or provide family care. One quarter of the participants reported experience in family care. In case of own need 62.9% of participants would prefer care provided by relatives and 56.7% would prefer professional care. Participants are more likely to use family care if they report having relatives, are experienced in care of relatives or do not associate old age with being a burden, e.g. report low values in the image of age "being a burden/demanding". Perceived willingness of the relatives to provide care is more likely if there is little regional distance to the relatives, in male participants and if participants talked about future care with their relatives. Besides structural factors, negative images of old age might have a negative influence on the willingness to use family care. Talking about care in old age seems to have a positive impact.

Validation of the Scale for the Assessment of Illness Behavior (SAIB) in a community sample of elderly people

The aim of this study was to evaluate the construct validity of the SAIB in a community sample of elderly people. The SAIB was administered to a large community sample representative of the German population aged 60-85 years (n=1593). The original model was assessed and then refined through confirmatory and exploratory factor analyses. Criterion validity was evaluated by comparing SAIB scores with external criteria in 3 categories: subjective health, chronic illness and health care utilization. The originally suggested five factor structure of the SAIB yielded a comparative fit index (CFI) of 0.70 and the weighted root mean square residual (WRMR) was 3.68. A shortened questionnaire with 13 items and four factors resulted in better model fit (CFI 0.97 and WRMR 1.3). Correlations between subjective health and the new scales ranged from 0.06 to 0.33. Effect sizes (Cohens d) of mean differences in factor scores between those with and without healthcare system contact varied by healthcare type, ranging from 0.05 to 0.94; effect sizes were largest in relation to contact with psychotherapy and alternative medicine practitioners. We propose a shortened version of the SAIB with a different scale structure, which resulted in better model fit with our data. Neither the original nor revised SAIB appeared to discriminate well in terms of health care use, suggesting that the illness behavior as currently conceptualized may not fully explain the increased use of healthcare in the elderly.

Anxiety and depression in sarcoidosis: the influence of age, gender, affected organs, concomitant diseases and dyspnea

BACKGROUND

Heightened degrees of anxiety and depression are often found in patients suffering from sarcoidosis, but the reasons for that are unclear. Furthermore, age and gender differences of anxiety and depression in sarcoidosis have not been reported with reference to normative data.

OBJECTIVES

The aim was to test age and gender differences of anxiety and depression in a large sample, and to examine the influence of affected organs, concomitant diseases and dyspnea.

METHODS

1197 German patients diagnosed with sarcoidosis were examined, using the Hospital Anxiety and Depression Scale (HADS) and the MRC dyspnea scale.

RESULTS

Patients suffering from sarcoidosis were significantly more anxious and depressed than the general population. This effect was especially strong in young age groups. The number of affected organs, the number of concomitant diseases and the degree of dyspnea significantly predicted anxiety and depression scores in univariate analyses. Among the affected organs, muscles, nerves, and bones most significantly contributed to depression. Sleep apnea, restless legs syndrome, and arterial hypertension were associated with anxiety as well as depression. In multivariate analyses including age and gender, however, only dyspnea and the number of concomitant diseases remained predictors of anxiety and depression scores.

CONCLUSIONS

The analysis of mental distress should take into account comparisons with normative values. Young patients deserve special social support. Dyspnea proved to be an important symptom in the prediction of anxiety and depression.

["One cannot just look at the clock" - interviews with family doctors on ambulatory palliative care of tumour patients]

GOAL OF THE STUDY

In the study "possibilities and limits of ambulatory palliative care" there was a survey with family doctors about their own subjective views of ambulatory palliative care. The different parameters of home care, the role of caring relatives as well as burdening and supporting factors for family doctors occupied the focus in these interviews.

METHODS

With the help of the results from 9 qualitative interviews, a questionnaire was compiled and sent by post to all family doctors within 50 km (N=427). For analysis questionnaires were available from N=89 family doctors. Statements about various areas of outpatient palliative work were collected with Likert scales and open questions.

RESULTS

The personal overloads of the care-giving relatives, the inadequate payment and their own time pressures for the family doctors were the main obstacles in home care of palliative patients. On the other hand the family doctors considered as supporting factors for an ambulatory care: a good pain and symptom management, a high satisfaction of the patients and a good teamwork between the caring service and other people taking part in the care.

CONCLUSION

In order to minimise the time overload of family doctors and to focus the psycho-social distress of the caring relatives the expansion of non-medical offers should be supported, e. g., ambulatory hospice services and consultative forms of care by psychologists and religious personnel.

[Care counselling - the client's expectations]

The amendment of legal care consultations in the context of the long-term care insurance law (2008) has broadened recent consulting practice within the action range of the nursing care insurance in Germany. The informational needs and consulting requests of the clients were not investigated so far. Our aim was to examine information needs and consulting requests of those in need of care and their informal carers.The consulting requests of visitors of 2 open citizen events were documented by the use of a semi-structured questionnaire. Content analysis following Mayring (2008) was used for data analysis.158 consulting discussions were documented, from which 177 consulting requests were formed. The consulting requests can be divided in 4 main categories: (1) inquiry about the care system [56/32%], (2) inquiry about individual access to care offers [43/24%], (3) inquiry about regional care suppliers [43/24%], (4) situation- and disease-specific inquiries [35/20%].Inquiries about local suppliers of care and situation- and disease-specific inquiries outweigh the number of inquiries about the care system in general. Furthermore, our results show that the informational needs of those in need of care do not only refer to the scope of care insurance law, but to additional social security codes.

The new rasch-based depression screening (DESC): Evaluation and validation in different patient groups and a large German population sample

Introduction

Comorbid depression in somatic illness is highly prevalent. However, most depression questionnaires show violation of unidimensionality and hypersensitivity of items.

Objectives

The Depression Screening (DESC) is a new self-rating scale for the measurement of depression severity that we developed from a calibrated Rasch-homogeneous item bank (N = 367) to improve short depression assessment in patients beyond psychiatric settings.

Aim

To present data for both parallel forms (10 questions each) of the DESC, and to examine its Rasch model qualities in different patient groups and a representative German general population sample.

Methods

Patient groups with depression, heart disease, neurological or otolaryngological disease (N = 333) were investigated with the DESC accompanied by diagnostic interviews and established depression scales. The demographic sample (N = 2509) was interviewed face to face, too. Adherence to Rasch model assumptions was determined with analysis of model fit, and further measures. Norm values were calculated.

Results

Both DESC versions feature different but highly correlated item sets. Cut-off scores with good sensitivity (0.82, 0.81) and specificity (0.78, 0.77) for the diagnosis of an affective disorder were developed with ROC analyses. No serious Differential Item Functioning in Rasch analyses for both scales was found. In the German validation sample the Rasch dimension “depression” explained 68.5% and 69.3% respectively of the variance. Validity was determined through sufficient intercorrelations with other scales (e.g. BDI, HADS).

Conclusions

Our studies support the good psychometric RASCH qualities of both DESC forms and offer important advancements in depression screening being of use for time-limited clinical and research applications.