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Garcia ACM, Maia LO, Reed PG. Exploring Psychedelics for Alleviating Existential and Spiritual Suffering in People With Serious Illnesses: Links to the Theory of Self-Transcendence. J Holist Nurs 2024:8980101241257836. [PMID: 38809663 DOI: 10.1177/08980101241257836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.
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Affiliation(s)
| | - Lucas Oliveira Maia
- Federal University of Alfenas University of Campinas Federal University of Rio Grande do Norte
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2
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Ramm M, Jedamzik J, Lenz P, Jürgens L, Heuft G, Conrad R. Older adults coping with critical life events - results of the revised demoralization scale in a representative sample of older adulthood. Front Psychiatry 2024; 15:1389021. [PMID: 38800056 PMCID: PMC11116776 DOI: 10.3389/fpsyt.2024.1389021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background High suicide rates in older adults are a relevant public health concern. Social isolation or widowhood as well as physical decline play a crucial role for suicidality in older adulthood. Previous evidence suggested that demoralization is an important risk factor for suicide. Whether demoralization is a relevant phenomenon in older adulthood which possibly could account for high suicide rates remains unclear. Methods Demoralization Scale II (DS-II) scores assessed in a survey of the German general population were investigated with respect to older adults (aged ≥ 65 years). DS-II scores were compared between older (≥ 65 years) and younger (< 65 years) adulthood and between young-old (65-74y), middle-old (75-84y), and old-old (85+y) individuals. We tested the impact of sociodemographic factors on DS-II scores within older adults. Results The sample comprised N = 545 adults ≥ 65 years and N = 1922 adults < 65 years. DS-II scores increased in older compared to younger adults (F(1,2465) = 6.1; p = 0.013; d = 0.09) and further from young-old to old-old (Mdiff = 2.7; 95% CI 0.45, 5.46; p = 0.034). One-fourth of individuals ≥ 65 years and almost half of old-old individuals reported DS-II scores above the cut-off > 5. Living with a partner protected from demoralization in old-old individuals. Discussion This study provides first evidence for an increased rate of demoralization in very old adults, in particular women, which is partly related to partnership status. We suggest that demoralization is considered as a crucial entity in older adulthood which can be missed by standard psychological screenings.
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Affiliation(s)
- Markus Ramm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Johanna Jedamzik
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Philipp Lenz
- West German Cancer Center, University Hospital Münster, Münster, Germany
- Institute of Palliative Care, University Hospital Münster, Münster, Germany
| | - Lara Jürgens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Gereon Heuft
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany
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Gnall KE, Sacco SJ, Park CL, Mazure CM, Hoff RA. Life meaning and mental health in post-9/11 veterans: the mediating role of perceived stress. ANXIETY, STRESS, AND COPING 2023; 36:743-756. [PMID: 36542555 DOI: 10.1080/10615806.2022.2154341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Post-9/11 veterans frequently experience diminished mental health following military service. Life meaning is related to better mental health in veterans, yet its mechanism of action is unknown. A meaning-making model suggests that life meaning can reduce perceived stress, thus enhancing mental health. The present study tested this meaning-making model by predicting multiple dimensions of mental health (i.e., symptoms of posttraumatic stress disorder, anxiety, insomnia, and depression, and mental health quality of life) from life meaning as mediated by perceived stress. DESIGN AND METHODS The present study was a secondary analysis of a 12-month observational study of 367 post-9/11 veterans. Participants completed demographic and health surveys at baseline, 6-month, and 12-month follow-ups. A multivariate mediation model was created predicting changes in dimensions of mental health from 6 months to 12 months. RESULTS Higher life meaning at baseline predicted changes in all dimensions of mental health between 6 and 12 months, an effect mediated by changes in perceived stress between baseline and 6 months. CONCLUSIONS Across dimensions of mental health, the meaning-making model was supported. Understanding post-9/11 veteran mental health from this theoretical perspective may help better tailor healthcare efforts and enhance veteran health overall.
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Affiliation(s)
- Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Shane J Sacco
- Department of Statistics, University of Connecticut, Storrs, CT, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at YaleYale School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, CT, USA
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Wang S, Zhu Y, Wang Z, Zheng M, Li X, Zhang Y, Wan H. Efficacy of meaning-centered group psychotherapy in Chinese patients with cancer: A randomized controlled trial. Palliat Support Care 2023; 21:773-781. [PMID: 37558651 DOI: 10.1017/s1478951523000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVES Meaninglessness is one of the most common psychological problems in cancer patients, which can lead to anxiety, depression and psychological distress, and diminished quality of life. Recent evidence indicates that meaning-centered group psychotherapy (MCGP) effectively enhances the meaning in life among cancer patients. This study aimed to evaluate the impact of MCGP on the meaning in life, post-traumatic growth, psychological distress, and fear of recurrence among Chinese cancer patients with a favorable prognosis. METHODS Sixty-six cancer patients were randomly assigned to either the MCGP group (n = 33) or the control group (n = 33). Participants in the MCGP group underwent a 4-week, 8-session MCGP, while those in the control group received usual care. Meaning in life, post-traumatic growth, psychological distress, and fear of recurrence were assessed at both baseline and postintervention to evaluate the impact of the intervention. The intervention outcomes were analyzed using paired t-tests or analysis of covariance, as appropriate. RESULTS Patients in the MCGP group demonstrated significant improvements in meaning in life, post-traumatic growth, and fear of recurrence from baseline to postintervention. In comparison to the control group, the MCGP group displayed positive effects on meaning in life and post-traumatic growth following the intervention. However, no significant effects were observed in terms of psychological distress and fear of recurrence. SIGNIFICANCE OF RESULTS Our research offers evidence supporting the effectiveness of MCGP in enhancing meaning in life and post-traumatic growth among Chinese cancer patients with a favorable prognosis.
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Affiliation(s)
- Shuman Wang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Yu Zhu
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Ziying Wang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Mimi Zheng
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Xiaoru Li
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Yu Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
| | - Hongwei Wan
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai Proton Heavy Ion Hospital, Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai Proton Heavy Ion Hospital, Shanghai, China
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Bovero A, Pesce S, Botto R, Tesio V, Ghiggia A. Self-Transcendence: Association with Spirituality in an Italian Sample of Terminal Cancer Patients. Behav Sci (Basel) 2023; 13:559. [PMID: 37504006 PMCID: PMC10376349 DOI: 10.3390/bs13070559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023] Open
Abstract
Terminally ill cancer patients often experience demoralization and loss of dignity, which undermines their spiritual wellbeing, which could, however, be supported by the presence of other factors such as self-transcendence and religious coping strategies. To assess self-transcendence and religious coping strategies and how they influence spirituality, we studied 141 end-stage cancer patients (64.3% male; mean age 68.6 ± 14.6) with a Karnofsky Performance Status ≤ 50 and a life expectancy ≤ 4 months using the Self-Transcendence Scale, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-Sp-12), the Brief Religious COPE, and the Patient Dignity Inventory. To understand the effects of these variables on spirituality, hierarchical multiple regression was performed on FACIT-Sp-12. The final model predicted 67% of the variance in spiritual wellbeing. Demoralization was the strongest influencing factor (β = -0.727, p < 0.001), followed by self-transcendence (β = 0.256, p < 0.001), and positive religious coping (β = 0.148, p < 0.05). This study suggests that self-transcendence and positive religious coping may be protective factors for spirituality in terminal cancer patients. These factors should be considered in treatment to promote spiritual wellbeing and improve patients' quality of life at the end of life.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
| | - Sara Pesce
- Clinical Psychology Unit, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
| | - Rossana Botto
- Clinical Psychology Unit, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
- Department of Neuroscience, University of Turin, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126 Turin, Italy
| | - Valentina Tesio
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Ada Ghiggia
- Department of Life Sciences, University of Trieste, Via Edoardo Weiss 21, 34128 Trieste, Italy
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Woźniewicz A, Cosci F. Clinical utility of demoralization: A systematic review of the literature. Clin Psychol Rev 2023; 99:102227. [PMID: 36462221 DOI: 10.1016/j.cpr.2022.102227] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/28/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Demoralization is a complex clinical phenomenon which has raised a growing interest in clinical and research realms. The present systematic review of the literature aimed at (1) updating on demoralization prevalence in different populations, (2) identifying the instruments more largely used to assess demoralization, and (3) verifying whether new tools of assessment have been proposed. PubMed and Web of Science were searched from inception to April 2022. Search terms were: demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA guidelines were followed. GRADE rating system was used. A total of 188 papers were included. Demoralization appeared to be a distinctive psychological state common in medical, psychiatric, and non-clinical settings, thus not limited to life-threatening diseases. Diagnostic Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS) are the most commonly used tools to assess it. DCPR allow to diagnose demoralization as a manifestation of dealing with chronic stress. DS captures dimensionally a psychological distress related to end of life. Demoralization is associated with clinical features encompassing allostatic overload, quality of life, wellbeing/euthymia. Implications on health outcomes and treatment are discussed. Demoralization warrants careful consideration in clinical contexts through valid assessment procedures. DCPR are recommended to diagnose it, DS can be helpful to capture clinical details.
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Affiliation(s)
- Agnieszka Woźniewicz
- Department of Geriatrics, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Jurija Gagarina 11, 87-100 Toruń, Poland
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, via di San salvi n. 12, Florence, Italy; Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 6200, MD, Maastricht, The Netherlands.
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Klussman K, Nichols AL, Langer J. Mental health in the United States during the COVID-19 pandemic: A longitudinal examination of the ameliorating effect of meaning salience. CURRENT PSYCHOLOGY 2023; 42:1915-1922. [PMID: 33727777 PMCID: PMC7952503 DOI: 10.1007/s12144-021-01538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/04/2022]
Abstract
During the COVID-19 pandemic, various restrictions forced people around the world to socially isolate. People were asked to stay at home and were largely unable to do many of the activities that they derived meaning from. Since meaning is often related to mental health, these restrictions were likely to decrease mental health. The current study aimed to examine these effects and additionally benefit individuals' mental health by making their meaning salient. Specifically, the goal of the research was to design an intervention that could counter the potential negative effects of social distancing. We recruited a total of 96 U.S.A. residents (M age = 34.45, 92.7% Female) and assigned them to either the control group or to a meaning salience intervention. That is, participants either focused on the meaning of their daily activities (n = 45) or did not participate in any study-related activities during the week (n = 51). They completed various measures of mental health before and after this experimental period. Results suggested that the control group reported significantly greater anxiety, depression, and stress at the end of the week. In contrast, the experimental group reported less anxiety and trended toward less depression and stress at the end of that same week. In all, results suggest that simply focusing on one's daily activities and the meaning found in them protected people from the otherwise detrimental effects of the restrictions. This provides a promising and simple intervention that may assist both individuals and practitioners aiming to improve mental health, especially in challenging times.
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ÜLBE S, DİRİK G. Kanser Tanısı almış Kişilere Uygulanan Anlam Temelli Müdahale Programları: Sistematik bir Derleme. KLINIK PSIKOLOJI DERGISI 2022. [DOI: 10.57127/kpd.26024438m0000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Son yıllarda kanser tanısı almış kişilerin yalnızca yaşadıkları olumsuz psikolojik semptomları azaltmayı değil, aynı zamanda kişilerin yaşamdaki anlam kaynaklarını ve değerleri ile temasa geçerek yaşamlarını zenginleştirmeyi amaçlayan çeşitli anlam temelli müdahale geliştirilmiştir. Mevcut çalışmanın amacı kanser tanısı alan kişilerde doğrudan yaşamda anlam ve amaç duygularını geliştirmeye odaklanan müdahalelerin özelliklerini ve sonuçlarını sistematik olarak incelemektir. Bu kapsamda PsychINFO, MEDLINE, CINAHL Complete, PubMed, Scopus ve Web of Science olmak üzere toplamda altı elektronik veri tabanı kullanılarak sistematik bir literatür taraması yapılmıştır. 2000-2022 yılları arasında yapılan tarama sonucunda kanser tanısı almış kişiler için doğrudan anlam yaratmaya ve yaşamda anlam duygusuna odaklanan 14 farklı müdahale programını içeren 20 çalışmaya ulaşılmıştır. Derlemede yer alan araştırmaların örneklemini çoğunlukla kadın, orta yaş ve üzeri olan ve ileri evre kanser tanısı alan kişiler oluşturmuştur. Meme ve akciğer kanseri bu derlemedeki araştırmalarda en çok yer alan kanser türüdür. Derlemeye dâhil edilen çalışmaların çoğunluğunun kuramsal olarak Frankl’ın çalışmalarından etkilendiği ve psikoterapide varoluşsal yaklaşımı benimsedikleri görülmektedir. Anlam odaklı müdahale programlarının etkileri değerlendirildiğinde ise yapılan müdahalelerin anlam duygusunu, yaşam kalitesini ve spiritüel iyi oluş düzeylerini iyileştirmede büyük oranda etkili olduğu görülmektedir. Ayrıca anksiyete, depresyon, duygusal sıkıntı, iyimserlik ve umutsuzluk düzeyleri üzerinde görece olumlu etkileri olduğu düşünülmektedir. Bu kapsamda anlam odaklı müdahalelerinin kanser tanısı almış kişilerin hem anlam ve varoluşla ilgili sorularını hem de duygusal sıkıntılarını ele almada umut verici bir yaklaşım olduğu görülmektedir. Diğer taraftan anlam odaklı müdahalelere ilişkin daha kapsamlı çıkarımlar yapabilmek için daha titiz bir araştırma metodolojisi kullanan yeni çalışmalara ihtiyaç vardır.
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Almeida M, Ramos C, Maciel L, Basto-Pereira M, Leal I. Meaning in life, meaning-making and posttraumatic growth in cancer patients: Systematic review and meta-analysis. Front Psychol 2022; 13:995981. [PMID: 36570997 PMCID: PMC9784472 DOI: 10.3389/fpsyg.2022.995981] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction The purpose of this systematic review and meta-analysis is to assess the association between meaning in life (MiL), meaning-making and posttraumatic growth (PTG) in the context of cancer. Methods A systematic search was conducted in eighteen electronic databases. The screening and selection process followed the PRISMA guidelines. For the purpose of the meta-analysis, the correlation coefficients between meaning in life and posttraumatic growth were extracted from the included studies. The effect size (r) was calculated using the restricted maximum-likelihood estimator, a random-effects model. Heterogeneity was assessed through the Q statistic, I2 index and forest plot, while publication bias was analyzed with the use of the funnel plot and Egger's test. Results 889 records were considered according to the inclusion criteria. A total of nine articles, published between 2006 and 2021, were included in the systematic review. More than half were published in the last five years. The sample was mostly diagnosed with breast cancer. The meta-analysis included five articles (N = 844) and the results indicate a significant moderate correlation between meaning in life and posttraumatic growth (r = 0.43, 95% IC [0.36, 0.50]). Discussion In conclusion, there is a clear association between meaning in life and posttraumatic growth in cancer patients. Future research should explore this relationship further, in order to better assist and guide meaning centered interventions that can potentiate a positive adjustment and possibly growth from the cancer experience.
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Affiliation(s)
- Margarida Almeida
- Ispa – Instituto Universitário, Lisbon, Portugal,*Correspondence: Margarida Almeida,
| | - Catarina Ramos
- LabPSI – Laboratório de Psicologia Egas Moniz, Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Caparica, Portugal
| | - Laura Maciel
- WJCR – William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| | - Miguel Basto-Pereira
- WJCR – William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
| | - Isabel Leal
- WJCR – William James Center for Research, Ispa – Instituto Universitário, Lisbon, Portugal
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Zhang JM, Zhang MR, Yang CH, Li Y. The meaning of life according to patients with advanced lung cancer: a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2028348. [PMID: 35103558 PMCID: PMC8925916 DOI: 10.1080/17482631.2022.2028348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose This qualitative study explores the meaning of life and end-of-life coping strategies among patients in China with advanced lung cancer. Methods We conducted in-depth interviews with 21 hospitalized patients with advanced lung cancer and analysed the data using the 7-step Colaizzi method. Results The analysis revealed themes in patients’ experiences and feelings about living with a terminal illness. These include: 1) The core of the meaning of life is “self-iteration,” which includes self-recognition and cherishing life; 2) The existence form of the meaning of life is “yu-wei,” including self-reliance and altruism; 3) The meaning of life is embodied in three levels: the past, present, and future. The past includes gratitude, guilt and remorse, and avoidance; the present includes using the support system, positive response, independence, and integrity; the future includes accompanying relatives, preparing for death, living a high quality of life, and worrying. Conclusion Meaning of life is a multidimensional and diverse concept among patients with advanced lung cancer. Medical care providers and family members can provide targeted professional guidance and psychological support according to patients’ characteristics to help them discover their meaning of life, improve their quality of life, and achieve a positive end-of-life perspective.
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Affiliation(s)
- Jin Mei Zhang
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.,Department of Respiratory Medicine, Hongkou Branch of Changhai Hospital, Naval Medical University, Shanghai, China
| | - Mei Rong Zhang
- Department of Nursing, Shanghai Yangpu District Mental Health Centre, Shanghai, China
| | - Chun Hong Yang
- Department of Pediatrics, The First Affiliated Hospital of China Medical University, Liaoning, China
| | - Yumei Li
- Department of Nursing, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
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Vaganian L, Boecker M, Bussmann S, Kusch M, Labouvie H, Margraf J, Gerlach AL, Cwik JC. Psychometric evaluation of the Positive Mental Health (PMH) scale using item response theory. BMC Psychiatry 2022; 22:512. [PMID: 35902823 PMCID: PMC9334023 DOI: 10.1186/s12888-022-04162-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The investigation of patient-reported outcomes and psycho-oncological interventions mainly focuses on psychological distress or psychopathology. However, the recognition of the equal importance of positive mental health (PMH) has increased lately. The PMH-scale is a brief questionnaire allowing to assess well-being in individuals in the general population and in patients. Previous studies evaluated the psychometric properties of the PMH-scale using classical test theory (CTT). This study is the first to investigate the PMH-scale in patients with cancer using item analysis according to the Rasch model. METHODS In total, N = 357 cancer patients participated in the study. A Rasch analysis of the PMH-scale was conducted including testing of unidimensionality, local independence, homogeneity and differential item functioning (DIF) with regard to age, gender, type of cancer, the presence of metastases, psycho-oncological support, and duration of disease. Additionally, the ordering of the item thresholds as well as the targeting of the scale were investigated. RESULTS After excluding one misfitting item and accounting for local dependence by forming superitems, a satisfactory overall fit to the Rasch model was established (χ2 = 30.34, p = 0.21). The new PMH-8 scale proved to be unidimensional, and homogeneity of the scale could be inferred. All items showed ordered thresholds, there was no further item misfit. DIF was found for age, but as the impact of DIF was not substantial, no adjustment related to the age-DIF had to be made. The Person Separation Index (PSI = 0.89) was excellent, indicating excellent discriminatory power between different levels of positive mental health. Overall, the targeting of the PMH-8 was good for the majority of the present sample. However, at both ends of the scale item thresholds are missing as indicated by a slight floor effect (1.4%) and a considerable ceiling effect (9.8%). CONCLUSIONS Overall, the results of the analysis according to the Rasch model support the use of the revised PMH-scale in a psycho-oncological context.
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Affiliation(s)
- Lusine Vaganian
- Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Pohligstr. 1, 50969, Cologne, Germany.
| | - Maren Boecker
- grid.412301.50000 0000 8653 1507Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Aachen, Germany ,grid.412301.50000 0000 8653 1507Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, University Hospital of RWTH Aachen, Aachen, Germany
| | - Sonja Bussmann
- grid.6190.e0000 0000 8580 3777Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Pohligstr. 1, 50969 Cologne, Germany
| | - Michael Kusch
- grid.411097.a0000 0000 8852 305XDepartment I of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany
| | - Hildegard Labouvie
- grid.411097.a0000 0000 8852 305XDepartment I of Internal Medicine, Section: Clinical Psycho-Oncology, Working Group Psycho-Oncological Health Services Research, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Margraf
- grid.5570.70000 0004 0490 981XMental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alexander L. Gerlach
- grid.6190.e0000 0000 8580 3777Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Pohligstr. 1, 50969 Cologne, Germany
| | - Jan C. Cwik
- grid.6190.e0000 0000 8580 3777Department of Clinical Psychology and Psychotherapy, Faculty of Human Sciences, University of Cologne, Pohligstr. 1, 50969 Cologne, Germany
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Carreno DF, Eisenbeck N. Existential Insights in Cancer: Meaning in Life Adaptability. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:461. [PMID: 35454300 PMCID: PMC9029503 DOI: 10.3390/medicina58040461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
Previous research demonstrated that the cancer diagnosis and treatment evoke existential concerns, especially ones related to meaning in life and meaning-making processes. The cancer experience is a vital challenge that often entails changes in what is personally important in life. Firstly, this paper collects evidence supporting that meaning adaptability, the way people adapt their meaning in life to the cancer experience, is a central element in the mental health of cancer patients. Various theories that could account for this meaning adaptability are introduced. Secondly, the paper provides a compilation of studies showing how people change what is significant in their lives within the course of cancer. Finally, the paper presents the available psychological therapies directed to facilitate meaning adaptability in this population. Meaning-centered interventions have been demonstrated to be effective in alleviating the suffering related to the cancer experience and promoting personal growth.
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Affiliation(s)
- David F. Carreno
- Department of Psychology, University of Almería, 04120 Almeria, Spain;
| | - Nikolett Eisenbeck
- Department of Personality, Evaluation and Psychological Treatment, University of Seville, 14004 Seville, Spain
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Stracke C, Lemmen C, Rhiem K, Schmutzler R, Kautz-Freimuth S, Stock S. "You Always Have It in the Back of Your Mind"-Feelings, Coping, and Support Needs of Women with Pathogenic Variants in Moderate-Risk Genes for Hereditary Breast Cancer Attending Genetic Counseling in Germany: A Qualitative Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063525. [PMID: 35329227 PMCID: PMC8951351 DOI: 10.3390/ijerph19063525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
Hereditary breast cancer accounts for approximately 30% of newly diagnosed breast cancer (BC) cases. Pathogenic variants in moderate-risk BC genes (MBCG) differ from those in high-risk genes in terms of associated cancer risks, affected organs, and available preventive options. Little is known about how MBCG pathogenic variant carriers who have attended post-test genetic counseling perceive their situation, how they cope with their situation, and which support needs they might have. Problem-centered, guided, individual interviews were conducted with twelve women carrying pathogenic variants in MBCG. The interview analysis was based on Mayring’s qualitative content analysis. The women were between 29 and 59 years old and carried pathogenic variants in the risk genes CHEK2 (n = 8), ATM (n = 1), or PALB2 (n = 3). Women reported a wide range of feelings, both positive (relief, calmness) and negative (overwhelm, fear, grief, guilt). All women applied strategies of emotion-focused coping to deal with this lifelong situation. Appraisal and evaluation of the affected mother’s coping might influence the patient’s own behavior and coping style. These results could be used during and after post-test genetic counseling to provide more needs-oriented counseling, and to help women in adjusting to and coping with being a pathogenic variant carrier.
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Affiliation(s)
- Claudia Stracke
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (S.K.-F.); (S.S.)
- Correspondence:
| | - Clarissa Lemmen
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (S.K.-F.); (S.S.)
| | - Kerstin Rhiem
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.R.); (R.S.)
| | - Rita Schmutzler
- Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (K.R.); (R.S.)
| | - Sibylle Kautz-Freimuth
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (S.K.-F.); (S.S.)
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany; (C.L.); (S.K.-F.); (S.S.)
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Dursun P, Alyagut P, Yılmaz I. Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD). CURRENT PSYCHOLOGY 2022; 41:3299-3317. [PMID: 35035188 PMCID: PMC8742667 DOI: 10.1007/s12144-021-02695-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/03/2022]
Abstract
Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.
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Affiliation(s)
- Pinar Dursun
- Department of Psychology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Pinar Alyagut
- Department of Philosophy, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Itır Yılmaz
- Antalya Manavgat State Hospital Department of Psychiatry, Antalya, Turkey
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15
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Koranyi S, Hinz A, Hufeld JM, Hartung TJ, Quintero Garzón L, Fendel U, Letsch A, Rose M, Esser P, Mehnert-Theuerkauf A. Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer. Front Psychol 2021; 12:789793. [PMID: 34899543 PMCID: PMC8652041 DOI: 10.3389/fpsyg.2021.789793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale-II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer. Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach's Alpha (α). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatment-related variables were examined with ANOVAs. Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with α = 0.93 for the DS-II total scale, α = 0.90 for the Meaning and Purpose subscale, and α = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60). Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.
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Affiliation(s)
- Susan Koranyi
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Julia M. Hufeld
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Tim J. Hartung
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leonhard Quintero Garzón
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Uta Fendel
- Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anne Letsch
- Department of Hematology and Oncology, Campus Benjamin Franklin, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Amherst, MA, United States
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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16
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Racine S, Miller A, Mehak A, Trolio V. Examining risk and protective factors for psychological health during the COVID-19 pandemic. ANXIETY STRESS AND COPING 2021; 35:124-140. [PMID: 34314272 DOI: 10.1080/10615806.2021.1958789] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has profoundly impacted people's lives, with significant mental health consequences emerging. In addition to sociodemographic and COVID-19 specific factors, psychological risk and protective mechanisms likely influence individual differences in mental health during the COVID-19 pandemic. We examined associations between a broad set of risk and protective factors with depression, anxiety, alcohol problems, and eating pathology, and investigated interactions between objective stress due to COVID-19 and risk/protective variables in predicting psychopathology. METHODS Participants were 877 adults (73.7% female) recruited via internet sources from around the globe, but primarily residing in North America (87.4%). RESULTS Structural equation modelling revealed that certain risk and protective factors (e.g., loneliness, mindfulness) were broadly related to psychopathology, whereas others showed unique relations with specific symptoms (e.g., greater repetitive thinking and anxiety; low meaning and purpose and depression). COVID-19 objective stress interacted with risk factors, but not protective factors, to predict greater anxiety symptoms, but not other forms of psychopathology. CONCLUSIONS Findings contribute to our understanding of psychological mechanisms underlying individual differences in psychopathology in the context of a global stressor. Strategies that reduce loneliness and increase mindfulness will likely impact the greatest number of mental health symptoms.
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Affiliation(s)
- Sarah Racine
- Department of Psychology, McGill University, Montréal, Canada
| | - Alexia Miller
- Department of Psychology, McGill University, Montréal, Canada
| | - Adrienne Mehak
- Department of Psychology, McGill University, Montréal, Canada
| | - Vittoria Trolio
- Department of Psychology, McGill University, Montréal, Canada
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Klussman K, Nichols AL, Langer J. Meaning gained versus meaning lost: The effects of meaning salience on anxiety and depression during the coronavirus pandemic. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:834-842. [PMID: 34137028 DOI: 10.1002/ijop.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/18/2021] [Indexed: 11/09/2022]
Abstract
People who have meaningful lives generally experience less anxiety and depression. Meaning salience, or the awareness of the meaning in one's life, is believed to partially explain this relationship. However, in times of isolation, what might be most salient to people are the meaningful aspects of their lives that have disappeared. This study seeks to understand how making gained versus lost meaning salient affects anxiety and depression. Participants either wrote for 5 minutes about how their life gained meaning (n = 29) or lost meaning (n = 30) due to the coronavirus restrictions, or about music (i.e., the control condition; n = 32). Those who wrote about gained meaning experienced less momentary anxiety than those who wrote about lost meaning. In addition, meaning salience moderated the relationship between meaning and both anxiety and depression. Those who wrote about gained meaning appeared to exhibit a positive relationship between meaning in life (MIL) and both anxiety and depression, while those who wrote about lost meaning exhibited negative relationships. In all, this suggests that meaning salience is not always positive and that researchers and practitioners should consider how making positive meaning salient may be more beneficial than a general focus on MIL.
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18
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van den Brekel L, van der Baan FH, Zweers D, Koldenhof JJ, Vos JBH, de Graeff A, Witteveen PO, Teunissen SCCM. Predicting Anxiety in Hospitalized Cancer Patients. J Pain Symptom Manage 2020; 60:522-530.e1. [PMID: 32305577 DOI: 10.1016/j.jpainsymman.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/23/2022]
Abstract
CONTEXT Anxiety in patients with cancer is highly prevalent; yet it remains underestimated and inadequately assessed. Little is known about predictors for anxiety in hospitalized patients with cancer. Insight in predictors should improve recognition and enable a targeted approach. OBJECTIVES To determine the prevalence of anxiety and predictors for anxiety in hospitalized patients with cancer at different stages of disease. METHODS A cross-sectional analysis of patients with cancer admitted to the Utrecht University Medical Center in 2015-2018 was conducted. The Utrecht Symptom Diary, an adapted Dutch version of the Edmonton Symptom Assessment System, was used to assess symptom burden on a numeric rating scale (0 = no symptom and 10 = worst possible symptom). Scores ≥4 were considered clinically relevant. All patients completed the Utrecht Symptom Diary as part of routine care. The first questionnaire after admission was selected. Using multivariable linear regression, the predictive value of potential predictors on anxiety was analyzed. RESULTS In total, 2144 patients were included, of which 22% reported clinically relevant anxiety. The prevalence of anxiety was highest (36%) in patients receiving symptom-directed palliation only. In the total group, female gender, younger age, depressed mood, sleeping problems, dyspnea, and cancer of the head and neck were predictive of anxiety. Throughout all stages of disease, depressed mood was consistently the strongest predictor. CONCLUSION We found a high prevalence of anxiety in hospitalized patients with cancer. It is recommended to explore anxiety in hospitalized patients with cancer, in particular when they experience depressed mood. Structural use of a symptom diary during hospitalization facilitates the recognition of anxiety and concurrent symptoms.
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Affiliation(s)
- Lieke van den Brekel
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands.
| | - Frederieke H van der Baan
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands
| | - Danielle Zweers
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - José J Koldenhof
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - J Bernard H Vos
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Petronella O Witteveen
- Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Saskia C C M Teunissen
- Department of General Practice, Center of Expertise Palliative Care-Utrecht, Julius Center for Healthcare Sciences and Primary Care, University of Utrecht, Utrecht, The Netherlands; Department of Medical Oncology, Cancer Center University Medical Center-Utrecht, University of Utrecht, Utrecht, The Netherlands
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Bernard M, Berchtold A, Strasser F, Gamondi C, Borasio GD. Meaning in life and quality of life: palliative care patients versus the general population. BMJ Support Palliat Care 2020:bmjspcare-2020-002211. [PMID: 32631960 DOI: 10.1136/bmjspcare-2020-002211] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Meaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL). METHODS A cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a single-item visual analogue scale (0-10). Sociodemographic variables were controlled for in the analyses. RESULTS 206 patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both populations even if the difference was significant (patients 81.9 vs general population 87, p<0.001). Patients were more likely to cite 'family' (OR=1.78), 'social relations' (OR=1.9), 'spirituality and religion' (OR=3.93), 'social commitment' (OR=1.94) and 'growth' (OR=2.07), and less likely to cite 'finances' (OR=0.15) and 'health' (OR=0.21) as MIL-relevant areas. The SMILE scores and MIL areas explained 21.8% of the QOL variance for the patients and 15.1% for the representative sample. CONCLUSIONS Our data emphasise the importance of MIL as a contributor to QOL in both populations. It highlights the importance of the life areas contributing to MIL, especially social interactions for both populations, and spirituality and areas related to growth in palliative care patients.
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Affiliation(s)
- Mathieu Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - André Berchtold
- Institute of Social Sciences & NCCR LIVES, University of Lausanne, Lausanne, Switzerland
| | - Florian Strasser
- Department of Internal Medicine and Palliative Care Center, Clinical Medical Oncology & Hematology, Cantonal Hospital, St. Gallen, Switzerland
| | - Claudia Gamondi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Palliative Care Clinic, Oncology Institute of Southern switzerland, Palliative Care Departement, Bellinzona, Ticino, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Meaning-Centered Interventions for Patients With Advanced or Terminal Cancer: A Meta-analysis. Cancer Nurs 2020; 42:332-340. [PMID: 30024439 DOI: 10.1097/ncc.0000000000000628] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients with advanced or terminal cancer undergoing hospice or palliative care, spiritual care based on meaning-centered intervention (MCI) has become an essential form of support. OBJECTIVE The aim of this study was to characterize MCI systematically and the effectiveness of hospice and palliative care for patients with advanced or terminal cancer. METHODS MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean electronic databases were searched from inception to May 2017. The RevMan 5.3 program of the Cochrane Library was used for data analysis. RESULTS A meta-analysis was conducted of 10 controlled trials (6 randomized and 4 nonrandomized) featuring 623 patients with cancer. Meaning-centered interventions were compared with usual care control groups or other psychosocial interventions. The weighted average effect sizes across studies were -0.96 (P < .001, I = 7%) for meaning in life, -0.37 (P = .002, I = 0%) for spiritual well-being, -0.48 (P < .001, I = 0%) for quality of life, -0.28 (P = .02, I = 0%) for anxiety, and -0.31 (P = .02, I = 17%) for physical symptoms. CONCLUSION Spiritual care based on MCI may help to improve the physical, psychosocial, and spiritual well-being of patients with advanced or terminal cancer. IMPLICATION FOR PRACTICE Meaning-centered interventions could be a valuable way to enhance quality of life at the end stage for patients with advanced or terminal cancer.
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21
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Almeida VM, Carvalho C, Pereira MG. The contribution of purpose in life to psychological morbidity and quality of life in chronic pain patients. PSYCHOL HEALTH MED 2019; 25:160-170. [PMID: 31522538 DOI: 10.1080/13548506.2019.1665189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic pain is a cause of morbidity, interference with daily functioning, decreased health and quality of life. Purpose in life acts as a protective factor and mitigates these consequences. This cross-sectional study aimed to determine whether purpose in life contributed to psychological morbidity and quality of life in patients with chronic pain by controlling psychological variables related to health (pain severity and interference, pain perceptions, pain catastrophizing and coping). The sample included 103 patients diagnosed with chronic pain. Results showed that purpose in life independently contributed to psychological morbidity and to mental quality of life, but not to physical quality of life, after controlling for pain-related variables. Results showed the relevance of purpose in life to identify patients at risk of developing psychological morbidity and decreased quality of life, suggestting the need to intervene in chronic pain, specifically on purpose in life, to prevent psychological morbidity and promote quality of life, in this population.
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Affiliation(s)
| | - Cátia Carvalho
- School of Psychology, University of Minho, Braga, Portugal
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22
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Kuk A, Guszkowska M. Changes and Predictors of the Sense of Meaning in Life in Polish University Students Participating in Psychological Workshops Communication-Forgiveness-Love. JOURNAL OF RELIGION AND HEALTH 2019; 58:1095-1106. [PMID: 29705828 PMCID: PMC6606651 DOI: 10.1007/s10943-018-0631-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of this study was to determine changes in the sense of meaning in life of university students who participated in psychological workshops "Communication-Forgiveness-Love". The study evaluated 33 university students from first-cycle and second-cycle studies in physical education in the Józef Piłsudski University of Physical Education in Warsaw. The Reker's Life Attitude Profile-Revised Questionnaire, Social Competencies Questionnaire (KKS) by Matczak, Emotional Intelligence Questionnaire (INTE) by Schutte et al. and the Goldberg's General Health Questionnaire GHQ-28 were used. The study found that psychological workshops can be effective in instilling the sense of meaning in life in university students, especially those from first-cycle studies. The workshops can produce more benefits to students with worse mental status and with lower social competencies.
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Affiliation(s)
- Anna Kuk
- The Faculty of Physical Education, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968, Warsaw, Poland.
| | - Monika Guszkowska
- The Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Marymocka 34, 00-968, Warsaw, Poland
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Park CL, Pustejovsky JE, Trevino K, Sherman AC, Esposito C, Berendsen M, Salsman JM. Effects of psychosocial interventions on meaning and purpose in adults with cancer: A systematic review and meta-analysis. Cancer 2019; 125:2383-2393. [PMID: 31034600 PMCID: PMC6602826 DOI: 10.1002/cncr.32078] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 01/18/2019] [Accepted: 02/28/2019] [Indexed: 12/25/2022]
Abstract
Meaning and purpose in life are associated with the mental and physical health of patients with cancer and survivors and also constitute highly valued outcomes in themselves. Because meaning and purpose are often threatened by a cancer diagnosis and treatment, interventions have been developed to promote meaning and purpose. The present meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on meaning/purpose in adults with cancer and tested potential moderators of intervention effects. Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which meaning or purpose was an outcome. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, rater pairs extracted and evaluated data for quality. Findings were synthesized across studies with standard meta-analytic methods, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis. Twenty-nine RCTs were identified, and they encompassed 82 treatment effects among 2305 patients/survivors. Psychosocial interventions were associated with significant improvements in meaning/purpose (g = 0.37; 95% CI, 0.22-0.52; P < .0001). Interventions designed to enhance meaning/purpose (g = 0.42; 95% CI, 0.24-0.60) demonstrated significantly higher effect sizes than those targeting other primary outcomes (g = 0.18; 95% CI, 0.09-0.27; P = .009). Few other intervention, clinical, or demographic characteristics tested were significant moderators. In conclusion, the results suggest that psychosocial interventions are associated with small to medium effects in enhancing meaning/purpose among patients with cancer, and the benefits are comparable to those of interventions designed to reduce depression, pain, and fatigue in patients with cancer. Methodological concerns include small samples and ambiguity regarding allocation concealment. Future research should focus on explicitly meaning-centered interventions and identify optimal treatment or survivorship phases for implementation.
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Affiliation(s)
| | - James E Pustejovsky
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas
| | | | - Allen C Sherman
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Mark Berendsen
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John M Salsman
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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Hou WK, Liang L, Lau KM, Hall M. Savouring and psychological well‐being in family dyads coping with cancer: An actor–partner interdependence model. Eur J Cancer Care (Engl) 2019; 28:e13047. [DOI: 10.1111/ecc.13047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/01/2019] [Accepted: 03/25/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Wai Kai Hou
- Laboratory of Psychology and Ecology of Stress (LoPES) The Education University of Hong Kong Hong Kong City Hong Kong
- Department of Psychology The Education University of Hong Kong Hong Kong Hong Kong
- Centre for Psychosocial Health The Education University of Hong Kong Hong Kong Hong Kong
| | - Li Liang
- Laboratory of Psychology and Ecology of Stress (LoPES) The Education University of Hong Kong Hong Kong City Hong Kong
- Department of Psychology The Education University of Hong Kong Hong Kong Hong Kong
- Centre for Psychosocial Health The Education University of Hong Kong Hong Kong Hong Kong
| | - Kam Man Lau
- Laboratory of Psychology and Ecology of Stress (LoPES) The Education University of Hong Kong Hong Kong City Hong Kong
| | - Mila Hall
- Teachers College Columbia University New York New York
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25
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Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients. Support Care Cancer 2019; 27:4317-4325. [DOI: 10.1007/s00520-019-04744-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/08/2019] [Indexed: 10/27/2022]
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26
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Philipp R, Mehnert A, Lo C, Müller V, Reck M, Vehling S. Characterizing death acceptance among patients with cancer. Psychooncology 2019; 28:854-862. [PMID: 30762269 DOI: 10.1002/pon.5030] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/26/2019] [Accepted: 02/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Death acceptance may indicate positive adaptation in cancer patients. Little is known about what characterizes patients with different levels of death acceptance or its impact on psychological distress. We aimed to broaden the understanding of death acceptance by exploring associated demographic, medical, and psychological characteristics. METHODS At baseline, we studied 307 mixed cancer patients attending the University Cancer Center Hamburg and a specialized lung cancer center (age M = 59.6, 69% female, 69% advanced cancer). At 1-year follow-up, 153 patients participated. We assessed death acceptance using the validated Life Attitude Profile-Revised. Patients further completed the Memorial Symptom Assessment Scale, the Demoralization Scale, the Patient Health Questionnaire, and the Generalized Anxiety Disorder Questionnaire. Statistical analyses included multinomial and hierarchical regression analyses. RESULTS At baseline, mean death acceptance was 4.33 (standard deviation [SD] = 1.3, range 1-7). There was no change to follow-up (P = 0.26). When all variables were entered simultaneously, patients who experienced high death acceptance were more likely to be older (odds ratio [OR] = 1.04; 95% confidence interval [CI], 1.01-1.07), male (OR = 3.59; 95% CI, 1.35-9.56), widowed (OR = 3.24; 95% CI, 1.01-10.41), and diagnosed with stage IV (OR = 2.44; 95% CI, 1.27-4.71). They were less likely to be diagnosed with lung cancer (OR = 0.20; 95% CI, 0.07-0.58), and their death acceptance was lower with every month since diagnosis (OR = 0.99; 95% CI, 0.98-0.99). High death acceptance predicted lower demoralization and anxiety at follow-up but not depression. CONCLUSIONS High death acceptance was adaptive. It predicted lower existential distress and anxiety after 1 year. Advanced cancer did not preclude death acceptance, supporting the exploration of death-related concerns in psychosocial interventions.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig
| | - Chris Lo
- Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Ontario.,Department of Psychiatry, University of Toronto, Toronto, Ontario.,Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario.,Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Volkmar Müller
- Department of Gynecology, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), German Center for Lung Research, LungenClinic Grosshansdorf, Grosshansdorf
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg
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Positive mental health among cancer survivors: overlap in psychological well-being, personal meaning, and posttraumatic growth. Support Care Cancer 2018; 27:443-450. [PMID: 29959577 PMCID: PMC6326009 DOI: 10.1007/s00520-018-4325-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/18/2018] [Indexed: 01/23/2023]
Abstract
Purpose Positive mental health involves theoretical constructs like psychological well-being, personal meaning, and posttraumatic growth. This study aims to provide empirical insight into possible overlap between these constructs in cancer survivors. Methods Within the context of a randomized controlled trial, 170 cancer survivors completed the patient-reported outcome measures (PROMs) Ryff’s Scales of Psychological Well-Being (SPWB), Personal Meaning Profile (PMP), and Posttraumatic Growth Inventory (PTGI). Exploratory factor analysis (EFA) on the subscales of these PROMs, as well as structural equation modeling (SEM), was used to explore overlap in these three constructs. Results The EFA resulted in a three-factor solution with an insufficient model fit. SEM led to a model with a high estimated correlation (0.87) between SPWB and PMP and lower estimated correlations with PTGI (respectively 0.38 and 0.47). Furthermore, the estimated correlation between the subscales relation with God (PMP) and spiritual change (PTGI) was high (0.92). This model had adequate fit indices (χ2(93) = 144, p = .001, RMSEA = 0.059, CFI = 0.965, TLI = 0.955, SRMR = 0.061). Conclusions The constructs psychological well-being and personal meaning overlap to a large extent in cancer survivors. Posttraumatic growth can be seen as a separate construct, as well as religiosity. These findings facilitate researchers to select the appropriate PROM(s) when testing the effect of a psychosocial intervention on positive mental health in cancer survivors. Relevance An increasing number of psychosocial intervention trials for cancer survivors use positive mental health outcomes. These constructs are often multifaceted and overlapping. Knowledge of this overlap is important in designing trials, in order to avoid the pitfalls of multiple testing and finding artificially strengthened associations. Netherlands Trial Register NTR3571 Electronic supplementary material The online version of this article (10.1007/s00520-018-4325-8) contains supplementary material, which is available to authorized users.
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28
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Abstract
Depression is common but under-diagnosed in cancer survivors. This study characterized depressive symptoms over one year in cancer survivors and examined disease-related and psychosocial predictors of depression severity. Participants (n = 122; Mage 65.33, SD = 9.17, 98.4% male) with head and neck, esophageal, gastric, or colorectal cancers were recruited through tumor registries at two regional Veterans Administration Medical Centers. Self-report measures assessing depressive symptoms (PHQ-9), combat-related PTSD symptoms (PC-PTSD), and health-related quality of life (PROMIS) were administered at six, twelve, and eighteen months after diagnosis. Symptoms consistent with major depression were endorsed by approximately one-quarter of the sample at six (24%), twelve (22%), and eighteen (26%) months post diagnosis, with 12% of participants reporting consistently significant depressive symptoms. In multivariate modeling, significant predictors of depression at eighteen months included prior depressive symptoms (β = .446, p < 0.001) and current pain interference (β = .231, p = .003). The present findings suggest that major depression is common and persistent one year following cancer diagnosis. Attention to pain management and routine monitoring of mood symptoms is critical to reducing risk of depression in cancer survivors.
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Affiliation(s)
- Patricia M Bamonti
- a Department of Psychiatry , VA Boston Healthcare System and Harvard Medical School , Boston , USA
| | - Jennifer Moye
- a Department of Psychiatry , VA Boston Healthcare System and Harvard Medical School , Boston , USA
| | - Aanand D Naik
- b Health Services Research and Development , Michael E. DeBakey VAMC , Houston , TX , USA.,c Department of Medicine , Baylor College of Medicine , Houston , USA
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29
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Loeffler S, Poehlmann K, Hornemann B. Finding meaning in suffering?-Meaning making and psychological adjustment over the course of a breast cancer disease. Eur J Cancer Care (Engl) 2018; 27:e12841. [DOI: 10.1111/ecc.12841] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2018] [Indexed: 01/07/2023]
Affiliation(s)
- S. Loeffler
- University Hospital Carl Gustav Carus; Dresden Germany
| | - K. Poehlmann
- Akademie für Allgemeine Psychotherapie (aap) private GmbH; Dresden Germany
| | - B. Hornemann
- University Hospital Carl Gustav Carus; University Cancer Center; Dresden Germany
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30
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Existential distress and meaning-focused interventions in cancer survivorship. Curr Opin Support Palliat Care 2018; 12:46-51. [DOI: 10.1097/spc.0000000000000324] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Bernard M, Hayek AS, Spring G, Borasio GD, Diawara F. Interventions psychologiques centrées sur la spiritualité : revue de la question. PSYCHO-ONCOLOGIE 2017. [DOI: 10.1007/s11839-017-0641-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Bernard M, Strasser F, Gamondi C, Braunschweig G, Forster M, Kaspers-Elekes K, Walther Veri S, Borasio GD. Relationship Between Spirituality, Meaning in Life, Psychological Distress, Wish for Hastened Death, and Their Influence on Quality of Life in Palliative Care Patients. J Pain Symptom Manage 2017; 54:514-522. [PMID: 28716616 DOI: 10.1016/j.jpainsymman.2017.07.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 06/28/2017] [Accepted: 07/07/2017] [Indexed: 11/25/2022]
Abstract
CONTEXT Spiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic nature underlying these components is essential for the development of interventions tailored to the palliative context. OBJECTIVES The aims were to explore 1) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients and 2) the extent to which these nonphysical determinants influence QOL. METHODS A cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS), and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single-item visual analogue scale (0-10). RESULTS Two hundred and six patients completed the protocol (51.5% female; mean age = 67.5 years). The results indicated a significant negative relationship between FACIT-Sp/SMILE and HADS total scores (P = 0.000). The best model for QOL explained 32.8% of the variance (P = 0.000) and included the FACIT-Sp, SMILE, and SAHD total scores, the IIR "private religiosity" score, as well as the HADS "depression" score. CONCLUSION Both spiritual well-being and meaning in life appear to be potential protective factors against psychological distress at the end of life. Since nonphysical determinants play a major role in shaping QOL at the end of life, there is a need for the development of meaning-oriented and spiritual care interventions tailored to the fragility of palliative patients.
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Affiliation(s)
- Mathieu Bernard
- Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - Florian Strasser
- Oncological Palliative Medicine, Clinic Oncology/Hematology, Department of Internal Medicine, Cantonal Hospital, St. Gallen, Switzerland; University Bern, Bern, Switzerland
| | - Claudia Gamondi
- Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Palliative Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Giliane Braunschweig
- Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Karin Kaspers-Elekes
- Palliative Center, Cantonal Hospital, St. Gallen, Switzerland; Palliative Care Clinic, Cantonal Hospital, Münsterlingen, Switzerland
| | - Silvia Walther Veri
- Palliative Care Clinic, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Gian Domenico Borasio
- Palliative and Supportive Care Service, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Guerrero-Torrelles M, Monforte-Royo C, Rodríguez-Prat A, Porta-Sales J, Balaguer A. Understanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis. Palliat Med 2017; 31:798-813. [PMID: 28498025 DOI: 10.1177/0269216316685235] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. AIMS To identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes. DESIGN Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project. DATA SOURCES The CINAHL, PsycINFO, PubMed and Web of Science databases were searched. RESULTS A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Five articles described randomized controlled trials, two were qualitative studies, two were commentaries or reflections, and there was one pre-post evaluation, one exploratory study and one description of a model of care. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. CONCLUSION This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.
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Affiliation(s)
- Mariona Guerrero-Torrelles
- 1 Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- 1 Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Josep Porta-Sales
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.,4 Palliative Care Service, Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Balaguer
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Abstract
BACKGROUND Demoralization frequently occurs in hospice, cancer, and critically ill patients. Severe demoralization can lead to suicidal ideation, making this issue of great import to healthcare providers. OBJECTIVE The aim of this study is to inform nursing professionals of the risk factors of demoralization in cancer patients via investigating its relationship with cancer patients' demographic data and disease characteristics. METHODS This is a cross-sectional descriptive study using a structured questionnaire including assessments of demographic data and disease characteristics, as well as the Demoralization Scale Mandarin version. Univariate logistic regression was used to explore the relations between demoralization and these other variables. RESULTS The mean (SD) Demoralization Scale Mandarin version score was 30.08 (13.68) (range, 0-73). Demoralization was significantly related to age (r = 0.1, P = .050), marital status (r = 0.11, P = .034), education (r = 0.17, P < .001), monthly income (r = 0.22, P < .001), disease status (r = 0.10, P = .050), and treatment type (r = 0.12, P = .014). CONCLUSIONS This study demonstrates the factors influencing demoralization among cancer patients. Future studies might expand to include patients with other chronic or critical illnesses or disadvantaged groups to better understand the prevalence of demoralization. This would help draw more attention from clinical healthcare providers, healthcare institutions, and other healthcare authorities to demoralization. IMPLICATIONS OR PRACTICE The results provide reference data for nursing professionals about the care of cancer patients.
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Affiliation(s)
- Yu-Chi Li
- Author Affiliations: Department of Nursing (Mrs Li) and Department of Medical Research (Dr Ho), Chi-Mei Medical Center, Tainan; and College of Nursing, Kaohsiung Medical University, Taiwan (Mrs Li and Dr Wang)
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35
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Vehling S, Kissane DW, Lo C, Glaesmer H, Hartung TJ, Rodin G, Mehnert A. The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer 2017; 123:3394-3401. [PMID: 28472548 DOI: 10.1002/cncr.30749] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/15/2017] [Accepted: 04/03/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness. METHODS In a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression. RESULTS Clinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7%; 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1-3.5). CONCLUSIONS Clinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population. Cancer 2017;123:3394-401. © 2017 American Cancer Society.
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Affiliation(s)
- Sigrun Vehling
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David W Kissane
- Department of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Christopher Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Guelph-Humber, Toronto, Ontario, Canada
| | - Heide Glaesmer
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Tim J Hartung
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anja Mehnert
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
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Grassi L, Costantini A, Kissane D, Brunetti S, Caruso R, Piazza G, Marchetti P, Sabato S, Nanni MG. The factor structure and use of the Demoralization Scale (DS-IT) in Italian cancer patients. Psychooncology 2017; 26:1965-1971. [DOI: 10.1002/pon.4413] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit; Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital; Ferrara Italy
| | - Anna Costantini
- Psychoncology Unit, Sant'Andrea Hospital Sapienza; University of Rome; Rome Italy
| | - David Kissane
- Department of Psychiatry; Monash University and Szalmuk Family Research Unit at Cabrini Health; Clayton Victoria Australia
| | - Serena Brunetti
- Psychoncology Unit, Sant'Andrea Hospital Sapienza; University of Rome; Rome Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit; Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital; Ferrara Italy
| | - Giulia Piazza
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
| | - Paolo Marchetti
- Medical Oncology; La Sapienza University of Rome and IDI-IRCCS; Rome Italy
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
- University Hospital Psychiatry Unit; Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital; Ferrara Italy
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37
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Guerra MP, Lencastre L, Silva E, Teixeira PM. Meaning in life in medical settings: A new measure correlating with psychological variables in disease. COGENT PSYCHOLOGY 2017. [DOI: 10.1080/23311908.2017.1286747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Marina Prista Guerra
- Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Leonor Lencastre
- Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Eunice Silva
- Portuguese Institute of Oncology Francisco Gentil, Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Pedro M. Teixeira
- Faculty of Psychology and Educational Sciences, University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
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38
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Xia HZ, Gao L, Wang Y, Song H, Shi BX. Development of the Chinese version of Meaning in Life Scale for cancer patients and psychometric evaluation. J Clin Nurs 2017; 26:3298-3304. [PMID: 27878884 DOI: 10.1111/jocn.13675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To develop a Meaning in Life Scale for cancer patients in Chinese version and to test the validity and reliability. BACKGROUND Meaning in life is a protective factor of psychological well-being and is negatively related to depression and demoralisation among cancer patients. The existing scales measuring meaning in life are mostly designed in English and there is no scale designed for Chinese cancer patients based on Chinese cultural background. DESIGN Process of instrument development and psychometric evaluation were used. METHODS Items were generated from literature review and a focus group interview. Delphi technique was used to test the content validity. Item analysis and exploratory factor analysis were performed with data from 251 cancer patients. The internal consistency of the scale was tested by Cronbach's alpha. RESULTS A 25-item Meaning in Life Scale in Chinese version with five domains was developed. The five factors explained 62·686% of the variance. The Cronbach's alpha for the total scale was 0·897. CONCLUSIONS The Meaning in Life Scale in Chinese version has acceptable internal consistency reliability and good content validity and acceptable construct validity. The content of the scale reflected the attitudes of cancer patients towards meaning in life based on Chinese cultural background. RELEVANCE TO CLINICAL PRACTICE The Chinese version of Meaning in Life Scale for Cancer Patients appears to be a new scale to assess meaning in life among Chinese cancer patients exactly and the concept of meaning in life presented in this scale provides new ideas of meaning intervention in routine clinical practice.
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Affiliation(s)
- Hao-Zhi Xia
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Lei Gao
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Yang Wang
- Department of Breast, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hui Song
- Department of Breast, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Bao-Xin Shi
- School of Nursing, Tianjin Medical University, Tianjin, China
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Abstract
BACKGROUND Breast cancer is the most common cancer among women worldwide, and spiritual fulfillment such as experiencing meaning in life plays an important role in coping with the disease. OBJECTIVE The objectives of this study were to explore and understand Chinese breast cancer survivors' perspective on meaning in life. METHODS This study used Grounded Theory; 23 participants were recruited using convenience sampling, purposive sampling, and theoretical sampling. Semistructured interviews were conducted, and the data were analyzed using open coding, axial coding, and selective coding. RESULTS A core category emerged as "satisfaction with my life" to explain Chinese breast cancer survivors' perspective of meaning in life, and 4 subcategories described the core category including (1) living a healthy and peaceful life, (2) having a good relationship with others, (3) achieving purpose in life, and (4) fulfilling responsibility. CONCLUSION Chinese breast cancer survivors value physical health as well as spiritual fulfillment. The experience of adapting to life with cancer, having a good relationship with others, pursuing life goals, and fulfilling responsibility consists of a satisfying life, which makes life more meaningful. IMPLICATIONS FOR PRACTICE Health providers should pay more attention to survivors' experience of meaning in life and help them enhance meaning in life and improve their quality of life through building good relationship with others, achieving purpose in life, and fulfilling responsibility for family and society.
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Hartung TJ, Brähler E, Faller H, Härter M, Hinz A, Johansen C, Keller M, Koch U, Schulz H, Weis J, Mehnert A. The risk of being depressed is significantly higher in cancer patients than in the general population: Prevalence and severity of depressive symptoms across major cancer types. Eur J Cancer 2016; 72:46-53. [PMID: 28024266 DOI: 10.1016/j.ejca.2016.11.017] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is a common co-morbidity of cancer that has a detrimental effect on quality of life, treatment adherence and potentially survival. We conducted an epidemiological multi-center study including a population-based random comparison sample and estimated the prevalence of depressive symptoms by cancer site, thereby identifying cancer patients with the highest prevalence of depression. PATIENTS AND METHODS We included 4020 adult cancer inpatients and outpatients from five distinct regions across Germany in a proportional stratified random sample based on the nationwide cancer incidence and a comparison group consisting of 5018 participants. Both groups reported depressive symptoms by filling in the Patient Health Questionnaire (PHQ-9). In multivariate analyses adjusted for age and sex, we calculated the odds of being depressed. RESULTS Out of 5818 eligible patients, 69% participated (51% women, mean age = 58 years). We estimated that one in four cancer patients (24%) is depressed (PHQ-9 ≥ 10). The odds of being depressed among cancer patients were more than five times higher than in the general population (OR, 5.4; 95% CI, 4.6-6.2). Patients with pancreatic (M = 8.0, SD = 5.0), thyroid (M = 7.8, SD = 6.3) and brain tumours (M = 7.6, SD = 4.9) showed the highest prevalence, whereas patients with prostate cancer (M = 4.3, SD = 3.8) and malignant melanoma (M = 5.3, SD = 4.3) had the lowest levels of depressive symptoms. CONCLUSION Our results help clinicians identify cancer patients in need of psychosocial support when navigating in the growing survivor population.
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Affiliation(s)
- T J Hartung
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.
| | - E Brähler
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany; Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany
| | - H Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - M Härter
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Hinz
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
| | - C Johansen
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany; Oncology Clinic, 5073 Rigshospitalet, University of Copenhagen, Denmark; Unit of Survivorship, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - M Keller
- Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - U Koch
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Deanery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Schulz
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Weis
- Department of Psychooncology, UKF Reha gGmbh University Clinic Center Freiburg, Freiburg, Germany
| | - A Mehnert
- Department of Medical Psychology and Medical Sociology, Section of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany
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Komisar J, McFarland DC. Is empathy associated with a self-ascribed sense of meaning among resident physicians working with patients nearing the end of life on a hematology-oncology ward? Psychooncology 2016; 26:1403-1406. [PMID: 27648813 DOI: 10.1002/pon.4282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/21/2016] [Accepted: 09/15/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jonathan Komisar
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel C McFarland
- Department of Medicine, Memorial Sloan Kettering Cancer Center, West Harrison, New York, USA
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Bernard M, Braunschweig G, Fegg MJ, Borasio GD. Meaning in life and perceived quality of life in Switzerland: results of a representative survey in the German, French and Italian regions. Health Qual Life Outcomes 2015; 13:160. [PMID: 26416234 PMCID: PMC4587717 DOI: 10.1186/s12955-015-0353-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/15/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The concept of meaning in life (MIL) has become a central one in recent years, particularly in psycho-oncology and palliative care. The Schedule for Meaning in Life Evaluation (SMILE) has been developed to allow individuals to choose the life areas that they consider to be important for their own MIL. This approach relates to the "World Health Organisation" definition of quality of life (QOL) as an individual's perception of his own position. The aims of this study were (i) to assess MIL in a representative sample of the Swiss population according to the three linguistic regions and (ii) to evaluate whether MIL constitutes a significant determinant of the perceived QOL. METHODS A telephone survey of the Swiss population, performed by a professional survey company, was conducted between November and December 2013. The interview included the SMILE, perceived QOL (0-10) and health status (1-5), and various sociodemographic variables. In the SMILE, an index of weighting (IOW, 20-100), an index of satisfaction (IOS, 0-100), and a total SMILE index (IOWS, 0-100) are calculated from the areas mentioned by the participants as providing MIL. RESULTS Among the 6671 telephonic contacts realized, 1015 (15%) participants completed the survey: 405 French, 400 German and 210 Italian participants. "Family" (80.2%), "occupation/work" (51%), and "social relations" (43.3%) were the most cited MIL-relevant categories. Italian participants listed "health" more frequently than German and French participants (50.4% vs 31.5% and 24.8% respectively, χ(2) = 12.229, p = .002). Age, gender, education, employment, and marital status significantly influenced either the MIL scores or the MIL-relevant categories. Linear regression analyses indicate that 24.3% of the QOL variance (p = .000) is explained by health status (B = .609, IC = .490-.728, p = .000), MIL (B = .034, IC = .028-.041, p = .000) and socioeconomic status (F = 11.01, p = .000). CONCLUSION The major finding of our analysis highlights the positive and significant influence of MIL on the perceived QOL in a representative sample of a general, multilingual and multicultural population. This result indicates that the existential dimension is not only determinant for QOL in some critical life events, as shown e.g. in psycho-oncology and palliative care, but also in everyday life.
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Affiliation(s)
- Mathieu Bernard
- Palliative Care Service, CHUV, University of Lausanne, Lausanne, Switzerland.
| | | | - Martin Johannes Fegg
- Department of Palliative Medicine, Ludwig-Maximilians University, Munich, Germany
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Tang PL, Wang HH, Chou FH. A Systematic Review and Meta-Analysis of Demoralization and Depression in Patients With Cancer. PSYCHOSOMATICS 2015; 56:634-43. [PMID: 26411374 DOI: 10.1016/j.psym.2015.06.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. Depression and demoralization syndrome in patients with cancer are closely related to suicidal behavior. OBJECTIVE The purpose of this study was to explore the factors affecting demoralization of patients with cancer from a depression perspective, to assist with distinguishing patient emotions and provide appropriate intervention as early as possible, thereby enabling patients to receive proper care. METHODS A systematic review and meta-analysis was employed in this study. The databases included Cumulative Index for Nursing and Allied Health Literature, Cochrane, PubMed/ MEDLINE, PsycINFO, and Centre for European Policy Studies, and reference lists of articles. Experts in this field also were contacted. Based on inclusion criteria, 2 investigators selected the research and reviewed each study's quality according to the Newcastle-Ottawa Scale. Five correlational studies with 32 subjects were identified. RESULTS The countries of studies included Australia, Germany, Taiwan, and the United States. There was a statistically significant difference in depression between patients with cancer in the high-demoralization group and those of the low-demoralization group (odds ratio = 9.65, 95% CI: 6.99-13.33, Z = 15.002, p < 0.0001). Four studies regarded demoralization and depression as distinguishable. CONCLUSIONS The demoralization of patients with cancer was highly correlated with depression. Therefore, the suicide risk of demoralized patients without depression must also be assessed to prevent patients with high suicide risk from being neglected. If medical staff can perceive patient's demoralization issues earlier, they can more effectively prevent patients' depression from occurring, which benefits suicide prevention.
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Affiliation(s)
- Pei-Ling Tang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC
| | - Hsiu-Hung Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC
| | - Fan-Hao Chou
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC.
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Damásio BF, Koller SH. How Search for Meaning Interacts with Complex Categories of Meaning in Life and Subjective Well-Being? THE SPANISH JOURNAL OF PSYCHOLOGY 2015; 18:E4. [PMID: 26054413 DOI: 10.1017/sjp.2015.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study sought to assess how the search for meaning interacts with crisis of meaning and with different categories of meaning in life (meaningfulness, crisis of meaning, existential indifference, and existential conflict). Furthermore, the moderation role of search for meaning between the relation of categories of meaning and subjective well-being (SWB) was also evaluated. Participants included 3,034 subjects (63.9% women) ranging in age from 18 to 91 (M = 33.90; SD = 15.01) years old from 22 Brazilian states. Zero-order correlations and a factorial MANOVA were implemented. Positive low correlations were found for search for meaning and crisis of meaning (r = .258; p < .001). Search for meaning presented a small-effect size moderation effect on the relation of the different categories of meaning with subjective happiness, F(6, 3008) = 2.698, p < .05; η2 = .004, but not for satisfaction with life, F(6, 3008) = .935, p = .47; η2 = .002. The differences on the levels of subjective happiness of those inserted in existential indifferent and conflicting categories differ depending on the levels of search for meaning. Further directions for future studies are proposed.
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Abstract
BACKGROUND Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope. METHODS We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word 'demoralization' in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected. RESULTS Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes. CONCLUSIONS Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.
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Affiliation(s)
- L Tecuta
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - E Tomba
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - S Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
| | - G A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology,University of Bologna,Bologna,Italy
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Robinson S, Kissane DW, Brooker J, Burney S. A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research. J Pain Symptom Manage 2015; 49:595-610. [PMID: 25131888 DOI: 10.1016/j.jpainsymman.2014.07.008] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/16/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
CONTEXT Demoralization can be understood as a condition that results from existential conflict. It presents with symptoms of hopelessness and helplessness caused by a loss of purpose and meaning in life. It is a significant mental health concern given there can be an associated desire for hastened death. OBJECTIVES The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with progressive disease or cancer, including prevalence rates; the relationships between demoralization and sociodemographic, disease- and treatment-related, and psychological factors; and the psychometric properties of demoralization measures. METHODS A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with nine electronic bibliographic databases, resulting in 25 studies (33 articles) with a total of 4545 participants reviewed. Full articles underwent methodological quality assessment, and correlational information was synthesized according to the strength of evidence. RESULTS The findings suggest that demoralization is prevalent in patients with progressive disease or cancer and clinically significant in 13%-18%. A range of factors were consistently associated with demoralization: poorly controlled physical symptoms, inadequately treated depression and anxiety, reduced social functioning, unemployment, and single status. The Demoralization Scale has demonstrated good psychometric properties across five studies. CONCLUSION Overall, this systematic review was limited by the extent of variability in the characteristics of studies. Patients who are single, isolated or jobless, have poorly controlled physical symptoms, or have inadequately treated anxiety and depressive disorders are at increased risk for demoralization. Clinical recognition of demoralization can trigger more focused interventions.
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Affiliation(s)
- Sophie Robinson
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Cabrini Monash Psycho-oncology, Cabrini Health, Melbourne, Victoria, Australia
| | - David W Kissane
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Cabrini Monash Psycho-oncology, Cabrini Health, Melbourne, Victoria, Australia.
| | - Joanne Brooker
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; Cabrini Monash Psycho-oncology, Cabrini Health, Melbourne, Victoria, Australia
| | - Susan Burney
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; Cabrini Monash Psycho-oncology, Cabrini Health, Melbourne, Victoria, Australia
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Grassi L, Caruso R, Sabato S, Massarenti S, Nanni MG, The UniFe Psychiatry Working Group Coauthors. Psychosocial screening and assessment in oncology and palliative care settings. Front Psychol 2015; 5:1485. [PMID: 25709584 PMCID: PMC4285729 DOI: 10.3389/fpsyg.2014.01485] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 12/02/2014] [Indexed: 11/28/2022] Open
Abstract
Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this, the many different variables, such as the factors affecting individual vulnerability (e.g., life events, chronic stress and allostatic load, well-being, and health attitudes) and the psychosocial correlates of medical disease (e.g., psychiatric disturbances, psychological symptoms, illness behavior, and quality of life) which are possibly implicated not only in “classical” psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools [e.g., and specific psychosocially oriented interview (e.g., the Diagnostic Criteria for Psychosomatic Research)] represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.
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Affiliation(s)
- Luigi Grassi
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy ; University Hospital Psychiatric Unit, Program of Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Drugs Abuse, S. Anna University Hospital and Health Authority Ferrara Italy
| | - Rosangela Caruso
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy
| | - Silvana Sabato
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy
| | - Sara Massarenti
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy
| | - Maria G Nanni
- Clinical Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara Ferrara, Italy ; University Hospital Psychiatric Unit, Program of Psycho-Oncology and Psychiatry in Palliative Care Integrated Department of Mental Health and Drugs Abuse, S. Anna University Hospital and Health Authority Ferrara Italy
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Kudla D, Kujur J, Tigga S, Tirkey P, Rai P, Fegg MJ. Meaning in life experience at the end of life: validation of the Hindi version of the Schedule for Meaning in Life Evaluation and a cross-cultural comparison between Indian and German palliative care patients. J Pain Symptom Manage 2015; 49:79-88. [PMID: 24937164 DOI: 10.1016/j.jpainsymman.2014.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/28/2014] [Accepted: 05/16/2014] [Indexed: 12/12/2022]
Abstract
CONTEXT The experience of Meaning in Life (MiL) is a major protective factor against feelings of hopelessness and wishes for hastened death in palliative care (PC) patients. However, most instruments for MiL assessment have been developed only in Western countries so far. Little is known about MiL experience in Asian PC patients. OBJECTIVES This study aimed to provide a Hindi version of the Schedule for Meaning in Life Evaluation (SMiLE), test its feasibility and validity in Indian PC patients, and compare the results with previous studies in Germany. METHODS Indian PC patients in a hospice for the destitute were eligible to participate in this cross-sectional study. In the SMiLE instrument, respondents individually listed MiL-giving areas before rating their satisfaction with and importance of these areas. Overall indices of satisfaction (IoS, range 0-100), weighting (IoW, range 0-100), and weighted satisfaction (IoWS, range 0-100) were calculated. RESULTS A Hindi forward-backward translation of the SMiLE was made. Two hundred fifty-eight Indian PC patients took part in the study (response rate 93.5%). Convergent validity of the SMiLE was found with the World Health Organization Quality of Life-Brief version (r = 0.17; P = 0.008) and the Idler Index of Religiosity (public religiousness: r = 0.25, P < 0.001 and private religiousness: r = 0.29, P < 0.001). Indian PC patients' IoW was 65.8 ± 22.1, IoS 68.6 ± 17.4, and IoWS 70.2 ± 17.0. In multivariate analyses of covariance, they differed significantly from German PC patients only in IoW (IoW: 84.8 ± 11.5, P < 0.001; IoS: 70.2 ± 19.7; IoWS: 72.0 ± 19.4). Compared with Germans, Indians more often listed spirituality (P < 0.001) and social commitment (P < 0.001) and less often social relations (P = 0.008). CONCLUSION Preliminary results indicate good feasibility and validity of the Hindi version of the SMiLE. MiL experience also seems to be a coping resource for Indian PC patients.
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Affiliation(s)
- Dorothea Kudla
- Department of Palliative Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Julius Kujur
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Sumanti Tigga
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Prakash Tirkey
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Punita Rai
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Martin Johannes Fegg
- Department of Palliative Medicine, Ludwig-Maximilians-University, Munich, Germany.
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A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer. Support Care Cancer 2014; 22:3165-74. [PMID: 24935648 PMCID: PMC4218975 DOI: 10.1007/s00520-014-2290-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 05/15/2014] [Indexed: 11/02/2022]
Abstract
PURPOSE This study aims to study the effects of depression and demoralization on suicidal ideation and to determine the feasibility of the Distress Thermometer as a screening tool for patients with cancer who experience depression and demoralization, and thus to establish a model screening process for suicide prevention. METHODS Purposive sampling was used to invite inpatients and outpatients with lung cancer, leukemia, and lymphoma. Two hundred participants completed the questionnaire, which included the Distress Thermometer (DT), Patient Health Questionnaire-9 (PHQ-9), Demoralization Scale-Mandarin Version (DS-MV), and Beck Scale for Suicide Ideation. All data obtained were analyzed using SPSS 18.0 and SAS 9.3. RESULTS Tobit regression analysis showed that demoralization influenced suicidal ideation more than depression did (t = 2.84, p < 0.01). When PHQ-9 ≥ 10 and DS-MV ≥42 were used as criteria for the DT, receiver operating characteristic analysis revealed that the AUC values were 0.77-0.79, with optimal cutoff points for both of DT ≥5; sensitivity 76.9 and 80.6 %, respectively; and specificity of 73.9 and 72.2 %, respectively. CONCLUSIONS Demoralization had more influence on suicidal ideation than depression did. Therefore, attention should be paid to highly demoralized patients with cancer or high demoralization comorbid with depression for the purposes of suicide evaluation and prevention. The DT scale (with a cutoff of ≥5 points) has discriminative ability as a screening tool for demoralization or depression and can also be used in clinical settings for the preliminary screening of patients with cancer and high suicide risk.
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Acceptance and valued living as critical appraisal and coping strengths for caregivers dealing with terminal illness and bereavement. Palliat Support Care 2014; 13:359-68. [PMID: 24784235 DOI: 10.1017/s1478951514000431] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Informal caregivers of palliative care patients play an essential role in the coordination of care for patients during their final phases of life. However, undertaking a caregiving role can have enduring psychological consequences for caregivers and interfere with functioning. Studies have investigated a variety of factors associated with individual differences in caregiver psychosocial outcomes, but little is known about their relative impact, and there is a need for guiding models to support research in this area. METHOD A review of the literature was conducted on factors influencing the psychological distress and grief of caregivers. Drawing from acceptance and commitment therapy (ACT) and Stroebe and colleagues' integrative risk factor framework, we developed a process model to describe individual differences in caregiver psychological distress and grief. RESULTS The model presents caregiver psychological distress and grief as functions of death attitudes and communication about death and dying, mediated by acceptance and valued living from an ACT perspective. An outline of the empirical and theoretical underpinnings for each component in the model is provided. SIGNIFICANT OF RESULTS: The presented model is an inherently strengths-based model that is concordant with acceptance- and values- (ACT) based interventions to facilitate coping in caregivers.
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