Prevalence of psychiatric disorders in gynecologic outpatients

OBJECTIVE

This study was undertaken to determine the point prevalence of psychiatric disorders in an unselected gynecologic population.

STUDY DESIGN

Participants were 1013 consecutive women attending 2 outpatient gynecology clinics in northern Sweden between November 16 and December 15, 1998. The Primary Care Evaluation of Mental Disorders (PRIME-MD) was used as a diagnostic tool for evaluating mood, anxiety, and eating disorders.

RESULTS

Overall, 897 patients (88.5%) filled in the diagnostic tool's patient questionnaire. Psychiatric disorders were present in 30.5% of the patients. Mood disorders were most common; major depression was prevalent in 10.1% of patients and minor depression was seen in 12.4% of patients. Anxiety disorders were also common and were encountered in 12.1% of patients. Among patients with a diagnosis, only 21.4% had some form of treatment.

CONCLUSIONS

The prevalence of mood and anxiety disorders in an outpatient gynecology clinic is high. The majority of women with a diagnosis based on the diagnostic tool did not have a previous diagnosis and were untreated.

[Measuring patient satisfaction in inpatient gynecology: significant quality improvements]

In the present study a validated questionnaire was used to measure patient satisfaction in a clinic of gynecology in a regional hospital. The goal was to assess problems, to solve them, and to increase patient satisfaction. A 50-item questionnaire was applied to assess satisfaction scores of 60 gynecology patients in 1996, and of 185 patients in 1998/99. The overall degree of patient satisfaction amounted to 74.2 +/- 22.7% increasing two years later to 78.0 +/- 25.8%. This represents a significant improvement and can be considered as success to improve quality. A significant increase of the satisfaction scores was obtained in four domains: 1. Information about the planned intervention, 2. courtesy and willingness to explain the procedures of the anesthesiologists, 3. cleanliness and 4. comfort of room. The present study confirms that validated assessment of patient satisfaction allows to identify problems and to solve them with appropriate corrective measures. This results in an increase of patient satisfaction.

[HIV/AIDS in gynecology. On the treatment readiness of established gynecologists for HIV positive women]

BACKGROUND

Decreasing vertical transmission rates of HIV due to highly active antiretroviral therapy regimens faciliate the choice for childbearing in HIV positive women. Recent trends in epidemiology of HIV show increasing incidence of HIV-related gynecologic diseases. These facts implicate the question about the role of gynecologists in primary care of HIV-infected women and furthermore about the use of health services by HIV-infected women.

MATERIALS AND METHODS

143 of the total of 298 office-based gynecologists practicing in Vienna (41%) completed a questionnaire to assess their knowledge, attitudes, and practice with respect to HIV-infection and AIDS. In addition, personal interviews with 30 HIV-positive women were conducted.

RESULTS

Although about 75% of the gynecologists are willing to care for HIV-positive women in their private practice, only about a third of them already care and 17.9% refuse to care for these patients. More than two thirds of the gynecologists refuse to care for intravenous drug users and patients with manifestations of AIDS. Barriers to care are the fear to be confronted with the psychosocial problems of patients, the fear to need more time to care for these patients and the fear of a lack in knowledge about HIV/AIDS. HIV-positive women are highly satisfied with care, although the majority of the women reported about a lack of confidentiality and therefore did not inform their gynecologist about their HIV-infection.

CONCLUSIONS

The physician-patient relationship of gynecologists and HIV-positive women is characterized by gynecologist's barriers to care on the one hand, on the other hand HIV-positive women report about a lack of confidentiality, which often is associated with a delay in seeking medical care.

DISCUSSION

A strategy to overcome gynecologist's barriers in care for HIV-positive women is medical education. The improvement of the physician-patient relationship will enhance the effects of HIV/STD risk assessment as well as the quality of care.

Quality of life, pain, and psychological well-being in women suffering from gynecological disorders

Most gynecological disorders are not life threatening. They may nevertheless severely affect women's lives. This study was conducted to investigate quality of life (QOL), pain, and psychological well-being in women suffering from such disorders compared with a control group. Women with benign gynecological disorders who are awaiting hysterectomy have a lower score in the health and functioning domain of QOL compared with the control group. More than three of four patients experience pain, mostly pelvic pain. Pain has a clear negative influence on women's QOL, pelvic pain to a greater degree than other types of pain. The patients report the same degree of psychological well-being as the control group. Benign gynecological disorders have a clear negative impact on women's health and functioning, and pain is a major problem for these patients. The more pain, the lower QOL. Their psychological well-being, however, does not seem to be affected.

Who cares? Offering emotion work as a 'gift' in the nursing labour process

Who cares? Offering emotion work as a 'gift' in the nursing labour process The emotional elements of the nursing labour process are being recognized increasingly. Many commentators stress that nurses' 'emotional labour' is hard and productive work and should be valued in the same way as physical or technical labour. However, the term 'emotional labour' fails to conceptualize the many occasions when nurses not only work hard on their emotions in order to present the detached face of a professional carer, but also to offer authentic caring behaviour to patients in their care. Using qualitative data collected from a group of gynaecology nurses in an English National Health Service (NHS) Trust hospital, this paper argues that nursing work is emotionally complex and may be better understood by utilizing a combination of Hochschild's concepts: emotion work as a 'gift' in addition to 'emotional labour'. The gynaecology nurses in this study describe their work as 'emotionful' and therefore it could be said that this particular group of nurses represent a distinct example. Nevertheless, though it is impossible to generalize from limited data, the research presented in this paper does highlight the emotional complexity of the nursing labour process, expands the current conceptual analysis, and offers a path for future research. The examination further emphasizes the need to understand and value the motivations behind nurses' emotion work and their wish to maintain caring as a central value in professional nursing.

Sex, reproduction, and gynecological disease in young adults with a history of juvenile chronic arthritis

OBJECTIVE

To study the effect of chronic disease of childhood on aspects of reproduction in young adults with a history of juvenile chronic arthritis (JCA).

METHODS

Demographic data, clinical features of JCA, previous medical treatment, reproductive events, contraception, wish for children, sexuality, and gynecological disease were evaluated by means of a questionnaire in 126 women and 35 men with JCA and their age matched healthy counterparts.

RESULTS

Median age of patients and controls was 24 years. Median age at menarche was 13 years in female patients and controls. Female patients who shared characteristics of marital status with their healthy counterparts showed a similar attitude to sexual activity, contraception, wish for children, age at first child, and duration of lactation. Fertility was not impaired in JCA, but fecundity was significantly reduced. Also, pregnancy outcome was less successful in women with JCA, shown by a significantly increased rate of miscarriage. When analyzing the occurrence of gynecological disease, a higher proportion of patients had metrorrhagia, pelvic inflammatory disease, and surgery for ovarian cysts. Males with JCA had greater difficulties than both healthy males and female patients in establishing a permanent relationship to the opposite sex.

CONCLUSION

Our study shows that a history of JCA in young men and women can influence several aspects of reproductive behavior and health. Health care providers counseling adolescents with JCA need to be aware of these problems.

[The most frequent nursing diagnoses in a gynecological admission unit]

Our objective was to identify the most frequent nursing diagnoses in a gynecological admission unit. The defining characteristics were surveyed from the data reported in the nursing case history and the patient files of 30 patients. The nursing diagnoses were found according to the revised NANDA Taxionomy I. The five most frequent nursing diagnoses were: risk for infection (30 cases); risk for pain (24 cases); health-seeking behaviors (11 cases); fear (10 cases) and stress incontinence (5 cases).

Distressed women's clinic patients: preferences for mental health treatments and perceived obstacles

Women seen in public gynecology settings are at very high risk of developing psychiatric disorders. Because low-income and ethnic minority women seen in such settings underutilize mental health services, it is important to better understand treatment preferences and obstacles among this high-risk patient population. Public women's clinic patients (N = 105) who reported psychological or emotional distress were asked about their interest in medication, psychotherapy, and psychoeducational classes, as well as perceived obstacles to using these services. The vast majority were interested in receiving some form of mental health treatment, with the most interest shown for individual therapy and general psychoeducational classes about health and stress. Less interest was expressed in group therapy and medication. Women anticipated more instrumental barriers to using services, such as lack of money, transportation, and childcare, than stigma-related barriers, such as fear of embarrassment or rejection. However, Latinas, women with less education, and those with a current mood or anxiety disorder were more likely to anticipate stigma-related barriers to treatment than other women. Implications of these findings for referral and treatment of mental health problems among public women's clinic patients are discussed.

[The healing process following gynecologic laparoscopy: data on the significance of psychological factors]

It is known that patients undergoing laparoscopic surgery can be discharged from hospital sooner and their reconvalescence is achieved faster than after laparotomy. Beside the medical judgement of the healing process it is also important to assess the length of time needed for the patients to feel themselves completely cured and be free of complaints. The data on the subjective judgement of the healing process provided by 335 patients who underwent laparoscopic surgery are analyzed retrospectively here. The aim of the study was to assess how anxiety as a personality trait might influence the healing process and also if there is any connection between anxiety, clinical diagnosis and laparoscopic findings. Anxiety was measured by Spielberger's State-Trait Anxiety Inventory (STAI). The estimated average healing time is 29.8 days (appr. 4 weeks), but patients with diagnostic and/or operative laparoscopy felt themselves free of complaints after 18.9 days (appr. 3 weeks) on the average. The duration of the healing process is independent of the laparoscopic findings and the type of procedure. There is a strong correlation between the anxiety level and the healing process. The average level of anxiety trait was 47.99 +/- 9.50. Anxiety level was the highest in the group of patients operated on for pelvic pain (mean = 51.21). There was no serious organic alteration in the small pelvis in 37% of the cases. One year after the operation 11.3% of the patients did not feel themselves cured and 17.6% had complaints. These data emphasize the role of anxiety and that of psychological factors in the etiopathogenesis and treatment of gynecologic diseases, especially in chronic pelvic pain and infertility or sterility.

Group psychotherapy for women molested in childhood: psychological and somatic symptoms and medical visits

Molested women who completed a series of 16 weekly group psychotherapy sessions conducted by social workers improved substantially regarding various aspects of psychological functioning, including self-image, coping techniques, relationship issues, and mothering. In addition, there was significant improvement in all psychological symptom scales and all global indices of symptomatic distress measured by the SCL-90-R. Furthermore, the improvement was present immediately after therapy and, with the exception of the hostility score, persisted 1 year later. Although the somatization score was reduced, the number of visits for physical symptoms did not change. The patients studied manifested characteristics typical of previously surveyed women with a history of childhood abuse, including a frequent history of major surgery (Drossman et al., 1996; Longstreth & Wolde-Tsadik, 1993; Springs & Friedrich, 1992) and, in some, a previous problem with alcohol (Springs & Friedrich, 1992; Walker et al., 1995) or drugs (Longstreth & Wolde-Tsadik, 1993; Miller & McCluskey-Fawcett, 1993; Springs & Friedrich, 1992). Also, nearly one half of the subjects had irritable bowel syndrome, the prototypical functional bowel disorder (Drossman et al., 1995; Longstreth & Wolde-Tsadik, 1993; Scarinci et al., 1994; Walker et al., 1995). Most of their baseline SCL-90-R scores were > 1 SD above the nonpatient norms. A problem inherent in assessing the long-term benefit of this study and other group psychotherapy studies is the tendency for some patients to continue similar or different forms of therapy after completing the group sessions. More than one half of patients received subsequent therapy that could have influenced their status at 1-year follow-up. However, most of the symptom dimensions and all global indices were similar 1 year posttherapy in the women who did not receive more treatment as compared to results in the women who did. Patients who received additional therapy had higher somatization scores before, immediately after, and 1 year posttherapy; scores in the other group increased 1 year posttherapy. Although the indications for subsequent therapy were not surveyed, there was an association between additional psychological care seeking and somatization. Furthermore, improvement in psychological status reflected by the phobic-anxiety score immediately posttherapy may have contributed to the decision of some patients to seek subsequent therapy. In the group without additional treatment, the loss of some of the initial somatization improvement at 1 year may have contributed to the lack of reduction in medical care visits in the combined groups. We speculate that provision of additional therapy to more patients might have had a long-term effect on somatization and reduced medical visits. We obtained complete psychological data and nearly complete medical-visit data on our patients, and our survey included 1-year follow-up. Our survey did not meet rigorous methodological standards for an outcome study, however. We surveyed only a small number of patients and did not collect similar data on an untreated control group. It was not possible to distinguish health care visits for organic versus functional disorders, but such a distinction may be artificial, because psychological factors may influence health care seeking for "organic" illness. Because our measurements came from a subset of our patients who were willing to complete the survey questionnaires, we do not know how generalizable the findings are. There is increasing awareness among health care professionals that childhood sexual abuse is common and that it may have serious and long-term psychological and medical sequelae. Our data suggest that group psychotherapy by social workers for women victims may have long-lasting psychological and somatic symptom benefits. Reduction in health care usage was not found, and this outcome may require the identification and treatment of patients who need additi

Repairing broken rules: care-seeking narratives for menstrual problems in rural Mali

Narratives play an important role in the organization of therapeutic action in rural Mali. This article provides structural and interpretive analyses of a young, French-speaking Dogon woman's accounts of her efforts to manage her menstrual bleeding and threatened infertility. Through her personal narratives she creates social arenas to recruit support, negotiate changes in her family relationships, and enhance her standing as a member of the community. Beginning with the accounts of her fear and helplessness, the narrator integrates past events into her unfolding present and achieves a meaningful resolution of her problem. Her narratives weave together encounters with family members, friends, and healers to describe a therapeutic itinerary that acquires significance as a transformative experience.

A follow-up study of adolescent girls with early sexual debut in combination with gynecological problems

This research examined the extent to which women's reproductive experiences during adolescence have repercussions in adult life with regard to sexuality, self-image and state of gynecological health. The investigated group comprised 30 females (study group), with a sexual debut at the age of 15 years or younger and documented gynecological ill-health during adolescence. A comparison was made with 30 matched females from the same school classes (control group) without documented gynecological ill-health. At the age of 25-30 a semi-structured interview was conducted with both investigated and control participants. The majority of the women from the study group experienced their adolescent sexual experiences as generally negative. In early adulthood these women had more recurrent and varied gynecological illnesses than their control group counterparts. The study group women more often referred to their appearance as an indicator of their femininity than did the control women (who defined femininity in terms of 'to be in a relationship'). The study group women had a more negative attitude towards their own body than did the control women. Study group women's early sexual experience was also linked to an increase in norm-breaking behavior, lower educational attainment and a younger age of adult responsibilities compared with the control women.

[Gynecologic examination, a role-playing for two]

Although pelvic examination (PE) is a common procedure in gynaecological practice, there is little discussion among gynaecologists about the decision-making process and the possible indications and contraindications. Moreover, examiners need to be aware that their approach and body language during PE will inevitably reflect their attitude toward women. At PE, there is tacit agreement between the examiner and the patient involving a cognitive restructuring of the situation. However, if memories of earlier experiences bearing some resemblance to the PE situation are aroused in the patient, and the emotions connected with them reactivated, she may become overwhelmed by the intensive reactions triggered. In such cases, the examiner needs to be able to recognise what is happening and provide the support the patient needs. Other responsibilities of the examiner at PE include recognising symptoms of post-traumatic stress reactions and vaginismus. In performing a young woman's first PE, the examiner's primary aim should be provide the experience; that PE is a benign procedure, unconnected with pain or distress; as the patient's experience at her first PE will inevitably influence all future examinations. Learning to perform a PE in such a way that it is beneficial to the patient in all these respects is an intricate and challenging task. However, experience with students and gynaecological teaching associates suggests that such skills can be taught and learned. The PE situation is charged with latent salubrious potential, which is usually insufficiently exploited.

The triage-function of a psychosomatic liaison-service for gynecological patients

The psychosomatic psychotherapeutic consultation liaison (CL)-service for gynecological patients at the Vienna University has been evaluated. Research interest focused on success and failure of the initial interview, conceptualized for a specific clientele. The interview has a triage function for treatment planning. By the type of treatment that was applied, patients were divided into three groups: Group A, patients with one single contact with the unit; Group B, patients who were referred to external psychotherapy; Group C, patients who were treated with short-term psychoanalytic psychotherapy as offered by the service unit. The drop-outs figured as Group D. The questionnaires completed by the patients at the first consultation and 6 moths after their final contact with the clinic covered socio-demographic data, ego functions; the motivation for psychotherapy, a complaints list and finally, at the second contact only, an individual retrospective judgement concerning personal consequences of the consultation. Patients needs in CL-services call for quick decisions, which therapeutic measure would be most adequate. An experienced clinician's decision is based on several circumstances: individual feeling of suffering, therapy-motivation and ego-strength, as well as social and demographic facts. Comparing groups with different therapeutic recommendations showed that the psychometric tests discriminated well between these four groups and thus the validity of the clinical recommendation has been confirmed.

[Sexual behavior in married women with chronic gynecologic inflammation]

Using an interview based on a uniform examination pattern comprising 70 items, the authors examined the sex life of 152 women aged 21-40 years, married for at least one year, treated at the time for chronic gynaecological inflammations in Frantiskovy Láznĕ. It was revealed that 55 probands (36.2%) did not report any marked changes in the course of sex life. 58 patients (38.2%) had unpleasant or painful sensations during coitus to which they responded in a rational way: by change or adjustment of the position, care taken by the partner, sometimes by discontinuation of coitus. The third sub-group was formed by 39 probands (25.6%) who were not satisfied with their sex life.