Emotional distress in men with life-threatening illness

The association between hope and mortality in homebound elders

OBJECTIVE

Despite high rates of mortality and depression, there is limited knowledge of how depressive symptoms, especially feeling of hopefulness, affect mortality in the homebound elderly.

METHODS

We conducted a secondary analysis of data from a community sample of 1034 adults, age 60 years and older. The Center for Epidemiologic Studies Depression Scale was used to evaluate the mood symptoms and feeling of hopefulness at baseline. The death data were collected within an 8-year follow-up period. Analysis of variance and Chi-square were used to compare the clinical conditions among the groups of individuals who feel hopeful always, sometimes, and rarely. Logistic regression was used to explore the association between the hopefulness about the future and mortality as an outcome.

RESULTS

In the 8-year follow-up period, frequency of feeling hopeful, but not other individual depressive symptoms, was associated with mortality rate. The mortality rate among those who always, sometimes, and rarely felt hopeful were 21.6%, 26.4%, and 35.7%, respectively (P = 0.002). Logistic regression also confirmed that individuals who rarely feel hopeful had higher odds of decease within the 8-year follow-up period than those who always felt hopeful (OR = 1.74, CI = 1.14-2.65) after adjusting for age and medical conditions.

CONCLUSIONS

Baseline hopefulness predicts mortality outcome among the homebound elderly in the community. Identifying individuals who are depressed with hopelessness in the elderly and providing early intervention may improve the mortality rate. Copyright © 2017 John Wiley & Sons, Ltd.

The State–Trait Hopelessness Scale

Hopelessness is predictive in the development of coronary heart disease (CHD) and can persist in patients after a CHD event, adversely affecting recovery. Hopelessness may represent a temporary response (state) or a chronic outlook (trait). Common hopelessness measures fail to differentiate state from trait hopelessness, a potentially important differentiation for treatment. The State–Trait Hopelessness Scale (STHS) was developed and pilot tested with two groups of college students ( n = 39 and 190) and patients with CHD ( n = 44). The instrument was then used with 520 patients, confirming reliability (Cronbach’s α) for the State (.88) and Trait (.91) subscales and concurrent and predictive validity. Separate exploratory factor analyses showed two factors (hopelessness present or hopelessness absent) for the State and Trait subscales, accounting for 58.9% and 57.3% of variance, respectively. These findings support future use of the tool in clinical settings and in intervention studies focused on hopelessness.

The prevalence of hopelessness among adults: disability and other related factors

BACKGROUND

Hopelessness has become an important issue in the fields of health and social care.

OBJECTIVE

This study aims to determine the prevalence of hopelessness and its association with the current health condition, disability, and other socio-demographic characteristics.

METHOD

The cross-sectional study sampled a population of 501 adults in Bolu, Turkey. Questionnaires included the Household Questionnaire, the Health Condition Questionnaire, Beck Hopelessness Scale, and Brief Disability Questionnaire. Data were collected through face-to-face home interviews between September 29 and October 11, 2003.

RESULTS

The prevalence of hopelessness was 30.9%. It was higher among the literate (60.0%) (p < 0.05), males (35.0%) (p > 0.05), and agricultural workers and peasants (50.0%, 41.9%) (p < 0.05). Almost half of the participants were disabled, and 44.6% of the subjects with disabilities were hopeless (p < 0.05). Being without hope was statistically significant with gender, social class, perceived health, and disability (p < 0.05). The risk of hopelessness increased in subjects with perceived bad health, lowered social class, and disability, compared with the reference groups.

CONCLUSIONS

In this study, hopelessness prevalence was high and it was also associated with the current state of health, perceived health, disability, and some socio-demographic variables. It will be important to increase the number of studies related to hopelessness and associated factors for improved mental health services planning at population level.

Putting episodic disability into context: a qualitative study exploring factors that influence disability experienced by adults living with HIV/AIDS

Background

An increasing number of individuals may be living with the health-related consequences of HIV and its associated treatments, a concept we term disability. However, the context in which disability is experienced from the HIV perspective is not well understood. The purpose of this paper is to describe the contextual factors that influence the experiences of disability from the perspective of adults living with HIV.

Methods

We conducted four focus groups and 15 face-to-face interviews with 38 men and women living with HIV. We asked participants to describe their health-related challenges, the physical, social and psychological areas of their life affected, and the impact of these challenges on their overall health. We also conducted two validity check focus groups with seven returning participants. We analyzed data using grounded theory techniques to develop a conceptual framework of disability for adults living with HIV, called the Episodic Disability Framework.

Results

Contextual factors that influenced disability were integral to participants' experiences and emerged as a key component of the framework. Extrinsic contextual factors included social support (support from friends, family, partners, pets and community, support from health care services and personnel, and programme and policy support) and stigma. Intrinsic contextual factors included living strategies (seeking social interaction with others, maintaining a sense of control over life and the illness, "blocking HIV out of the mind", and adopting attitudes and beliefs to help manage living with HIV) and personal attributes (gender and aging). These factors may exacerbate or alleviate dimensions of HIV disability.

Conclusion

This framework is the first to consider the contextual factors that influence experiences of disability from the perspective of adults living with HIV. Extrinsic factors (level of social support and stigma) and intrinsic factors (living strategies and personal attributes) may exacerbate or alleviate episodes of HIV-related disability. These factors offer a broader understanding of the disability experience and may suggest ways to prevent or reduce disability for adults living with HIV.

Putting episodic disability into context: a qualitative study exploring factors that influence disability experienced by adults living with HIV/AIDS

BACKGROUND

An increasing number of individuals may be living with the health-related consequences of HIV and its associated treatments, a concept we term disability. However, the context in which disability is experienced from the HIV perspective is not well understood. The purpose of this paper is to describe the contextual factors that influence the experiences of disability from the perspective of adults living with HIV.

METHODS

We conducted four focus groups and 15 face-to-face interviews with 38 men and women living with HIV. We asked participants to describe their health-related challenges, the physical, social and psychological areas of their life affected, and the impact of these challenges on their overall health. We also conducted two validity check focus groups with seven returning participants. We analyzed data using grounded theory techniques to develop a conceptual framework of disability for adults living with HIV, called the Episodic Disability Framework.

RESULTS

Contextual factors that influenced disability were integral to participants' experiences and emerged as a key component of the framework. Extrinsic contextual factors included social support (support from friends, family, partners, pets and community, support from health care services and personnel, and programme and policy support) and stigma. Intrinsic contextual factors included living strategies (seeking social interaction with others, maintaining a sense of control over life and the illness, "blocking HIV out of the mind", and adopting attitudes and beliefs to help manage living with HIV) and personal attributes (gender and aging). These factors may exacerbate or alleviate dimensions of HIV disability.

CONCLUSION

This framework is the first to consider the contextual factors that influence experiences of disability from the perspective of adults living with HIV. Extrinsic factors (level of social support and stigma) and intrinsic factors (living strategies and personal attributes) may exacerbate or alleviate episodes of HIV-related disability. These factors offer a broader understanding of the disability experience and may suggest ways to prevent or reduce disability for adults living with HIV.

Hopelessness and its effect on cardiac rehabilitation exercise participation following hospitalization for acute coronary syndrome

PURPOSE

Hopelessness has been associated with a higher risk of fatal and nonfatal coronary heart disease, yet very few studies have examined hopelessness after a cardiac event. This investigation examined hopelessness as an independent predictor of participation in a hospital-based cardiac rehabilitation exercise program.

METHODS

A total of 207 patients with acute coronary syndrome were interviewed at 3 and 8 months after hospital discharge. Measures included 1 factor of the Beck Hopelessness Scale, the Center for Epidemiological Studies Depression Scale, the Activity Status Index, the Charlson Comorbidity Index, a sociodemographic variables tool, and a cardiac rehabilitation exercise participation questionnaire.

RESULTS

Random-effects logistic regression analysis revealed that hopelessness persisted over time and was an independent predictor of lower exercise participation. In contrast, depression showed no significant influence on exercise participation.

CONCLUSIONS

Study findings suggest the importance of assessing hopelessness in patients with acute coronary syndrome and identifying approaches to exercise recommendations that directly address hopelessness. Interventions focused on the prevention and treatment of hopelessness symptoms may contribute to improved recovery of patient with acute coronary syndrome.

Hopelessness and depression in the early recovery period after hospitalization for acute coronary syndrome

PURPOSE

Psychosocial factors, such as depression, have been identified as important predictors of morbidity and mortality in individuals with coronary heart disease; however, little research has been done examining hopelessness in this population. This investigation examined the frequency and severity of hopelessness and depression in the early recovery period after hospitalization for acute coronary syndrome (ACS), the relationship between hopelessness and depression, and patient characteristics leading to these 2 variables.

METHODS

A total of 525 post-ACS patients at 5 hospitals in Michigan were interviewed. Measures included the cognitive expectations factor of the Beck Hopelessness Scale and the Center for Epidemiologic Studies-Depression Scale.

RESULTS

Hopelessness symptoms were frequent and moderate to severe in 27% of the sample, whereas depression was frequent and moderate to severe in 36% of subjects. Hopelessness was moderately correlated with depression, yet a number of different patient characteristics were predictive of each. Lower educational level predicted hopelessness, but not depression. Patients who had coronary artery bypass surgery or coronary angioplasty were more hopeless, but not more depressed. Female gender predicted depression, but not hopelessness. Hopelessness and depression had a shared variance of 33%.

CONCLUSIONS

Hopelessness and depression were frequent and moderate to severe in a portion of patients in the early ACS recovery period. An association between hopelessness and depression exists, while different patient characteristics were more strongly associated with each. Longitudinal analysis is needed to examine hopelessness and depression in later phases of the ACS recovery period.

Anxiety and depression of patients with digestive cancer

This study sought to characterize the psychological status of digestive cancer patients, and to investigate the relationship between psychological characteristics and clinical factors. Subjects were 85 inpatients scheduled to undergo surgery for digestive cancer and 26 control patients. The Japanese versions of Hospital Anxiety and Depression Scale (HADS) and Zung's Self Rating Depression Scale (SDS) were administered for all subjects before surgery, before discharge, and 6 months after discharge. Changes in HADS and SDS scores across the three examination days for three groups of subjects (advanced-phase, early phase, and control groups) were compared. The mean scores of anxiety and depression were significantly higher in the advanced-phase group than in the other two groups. Examination day showed a significant effect on depression; depression increased from before surgery to before discharge, and did not return to the preoperative level at 6 months after discharge, but no significant effect on anxiety. As for the relationship between psychological trends and clinical factors, anxiety in the 'middle age' and 'chemotherapy' groups was more severe than in the 'elderly' and 'no chemotherapy' groups. Depression in the 'medical treatment equipment', 'chemotherapy', and 'long-term hospitalization' groups was more severe than in the 'no equipment', 'no chemotherapy', and 'standard-term hospitalization' groups. These results suggest that we should pay careful attention to cancer patients undergoing surgery, especially young patients who are constantly at risk of anxiety, and assess their depression taking into account their disease and treatment conditions, especially after the time when their discharge is determined.

Despair and hopelessness in the context of HIV - a meta-synthesis on qualitative research findings

AIM

The aim of the study was to explore the concepts of despair and hopelessness in the context of human immunodeficiency virus based on previous studies.

BACKGROUND

Some of the consequences of living with human immunodeficiency virus or as a significant other to a person with human immunodeficiency virus include despair and hopelessness.

METHODS

The study is based on five earlier studies describing the dynamics of hope (including despair and hopelessness) in adult persons living with human immunodeficiency virus.

RESULTS

Despair consists of two sub-processes. The downward sub-process of despair refers to stopping and being stuck in a situation, losing grip and sinking into a narrowing existence, focusing on impossibility and losing perspective of the future. Furthermore, the downward orientation means questioning the possibility of hope. The upward sub-process of despair implies fighting against sinking and fighting to rise back up with a glimmer of hope. Hopelessness is the polar opposite of hope and includes sub-processes of helplessly giving up everything (including hope) and living in emptiness in the face of an assumed non-existing future, collapsing mentally, and becoming paralyzed without reason to live.

CONCLUSIONS

The results of this study support the findings of previous studies revealing that despair and hopelessness are possible elements in the life situation of persons living with human immunodeficiency virus and significant others to persons living with human immunodeficiency virus. The results of this study help to define the contents of despair and hopelessness, and help us to distinguish one from the other. The dual-dimensionality of despair has not been pointed out in previous studies and in this way the present study offers new information about the phenomenon of despair.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study offer clinical guidelines on a conceptual level about how to detect these phenomena in persons living with human immunodeficiency virus and their significant others. Furthermore, the findings offer a starting point for interventions used to alleviate despair and hopelessness. Suggestions for suitable interventions are offered. The results of this study underline the clinical relevance of these phenomena in adding new information to the previously documented consequences of despair and hopelessness.

Hopelessness as a Response to Physical Illness

PURPOSE

To analyze hopelessness as a psychological response to physical illness, differentiate hopelessness from depression, and discuss measures of hopelessness.

ORGANIZING FRAMEWORK

Walker and Avant's (1995) concept analysis strategy.

METHOD

A review of the literature from 1983 to 2004 was completed, with a focus on hopelessness theory and measurement.

FINDINGS

Although hopelessness is closely related to depression, distinct characteristics of hopelessness were identified. A continuum of attributes of hopelessness and depression was derived. Hopelessness has been examined in a variety of populations with several different instruments. One established measure was selected for discussion.

CONCLUSIONS

Continued study of hopelessness as a psychological response to physical illness is needed, including the continued differentiation of hopelessness from depression, further analysis of the continuum of hopelessness and depression, and the differentiation of state from trait hopelessness. Research to validate this conceptualization will enhance accuracy of the diagnosis of hopelessness and testing of nursing inteventions.

Desire for hastened death, cancer pain and depression: report of a longitudinal observational study

Desire for hastened death (DHD) is reported in the literature as being common in patients with cancer pain. However, there is currently little evidence to suggest that improvement in pain results in improvement in DHD. Our objectives were to assess 1) the impact of improvements in cancer pain severity and pain's interference with daily functioning and depression on DHD, and 2) the role of factors such as social and spiritual well-being, educational level, and patient age in moderating the impact of pain and depression on DHD. This observational study included patient-rated and clinician-rated scales administered twice at 4-week intervals. We enrolled 131 newly-referred patients to the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center or newly-admitted patients to Calvary Hospital in New York. One hundred and sixteen patients completed the baseline measures and 64 patients completed both baseline and follow-up measures. The main outcome measures included the Brief Pain Inventory (BPI), Beck Depression Inventory (BDI), and the Desire for Hastened Death Scale (DHD). Sixty-six percent of patients had no DHD at baseline and 45% of patients had BDI scores of 14 or greater ('mild' depression). Only 40% of patients with moderate/severe depression were receiving antidepressants. BPI scores improved significantly from baseline to follow-up (6.36 vs. 4.86, P < 0.01). DHD scores increased significantly from baseline to follow-up (0.84 to 1.38, P = 0.03). All other measures including depression were stable. DHD scores were moderately correlated with depression (r = 0.43), low social support (r = 0.38), poor spiritual well-being (r = -0.38), religious well being (r = -0.25), pain interference (r = 0.27), higher educational level (F = 4.50, P = 0.02) and lower physical functioning (KPRS, r = -0.40), but were unrelated to sex, age, race, or marital status. In multivariate regression analyses, baseline DHD (beta = 0.30, P = 0.05) and change in depression (beta=0.36, P = 0.02) were predictive of follow-up DHD. Improvement in pain interference was not predictive of follow-up DHD. The results suggest that improvement in depression moderated the severity of desire for hastened death in a population of patients with cancer pain. Depression was common in this population and was often untreated. Improvements in functional impairment due to pain did not moderate the severity of DHD in a setting of aggressive pain management. Strategies to preemptively screen for depression in the routine assessment of patients with cancer pain may be important to address DHD.

Cognitive reorganization and stigmatization among persons with HIV

BACKGROUND

A diagnosis of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-changing event, where persons must deal with a life-threatening, debilitating disease and its associated stigma and isolation. Studies over the past decade have shown that writing and talking about stressful and traumatic experiences, such as a life-threatening illness, causes emotions surrounding the trauma to change and to become cognitively reorganized. The result is a reduction in inhibition and change in basic cognitive and linguistic processes, which have contributed to meaningful behavioural, psychological, and physical health benefits across a variety of populations.

AIMS

To describe the construction of the Integrated Model of Health Promotion for persons with HIV/AIDS, and present initial empirical support of the model from a feasibility pilot study of women with HIV/AIDS.

APPROACH

The Integrated Model of Health Promotion is described and relevant literature in the field is reviewed. The model is implemented in a feasibility pilot study utilizing the emotional writing disclosure intervention.

RESULTS

Participants in the experimental condition demonstrated a promising pattern of cognitive reorganization, a reduced perception of stigma, and an improvement in mental health scores compared with the control condition.

CONCLUSION

Implications of these findings are discussed within the framework of the Integrated Model of Health Promotion. The model explores health and behavioural benefits associated with emotional writing in individuals with HIV/AIDS. The limited sample size of this pilot study precludes testing for significance. Further studies are required prior to the development of practice guidelines.

Beyond Money: Toward an Economy of Well-Being

Policy decisions at the organizational, corporate, and governmental levels should be more heavily influenced by issues related to well-being-people's evaluations and feelings about their lives. Domestic policy currently focuses heavily on economic outcomes, although economic indicators omit, and even mislead about, much of what society values. We show that economic indicators have many shortcomings, and that measures of well-being point to important conclusions that are not apparent from economic indicators alone. For example, although economic output has risen steeply over the past decades, there has been no rise in life satisfaction during this period, and there has been a substantial increase in depression and distrust. We argue that economic indicators were extremely important in the early stages of economic development, when the fulfillment of basic needs was the main issue. As societies grow wealthy, however, differences in well-being are less frequently due to income, and are more frequently due to factors such as social relationships and enjoyment at work. Important noneconomic predictors of the average levels of well-being of societies include social capital, democratic governance, and human rights. In the workplace, noneconomic factors influence work satisfaction and profitability. It is therefore important that organizations, as well as nations, monitor the well-being of workers, and take steps to improve it. Assessing the well-being of individuals with mental disorders casts light on policy problems that do not emerge from economic indicators. Mental disorders cause widespread suffering, and their impact is growing, especially in relation to the influence of medical disorders, which is declining. Although many studies now show that the suffering due to mental disorders can be alleviated by treatment, a large proportion of persons with mental disorders go untreated. Thus, a policy imperative is to offer treatment to more people with mental disorders, and more assistance to their caregivers. Supportive, positive social relationships are necessary for well-being. There are data suggesting that well-being leads to good social relationships and does not merely follow from them. In addition, experimental evidence indicates that people suffer when they are ostracized from groups or have poor relationships in groups. The fact that strong social relationships are critical to well-being has many policy implications. For instance, corporations should carefully consider relocating employees because doing so can sever friendships and therefore be detrimental to well-being. Desirable outcomes, even economic ones, are often caused by well-being rather than the other way around. People high in well-being later earn higher incomes and perform better at work than people who report low well-being. Happy workers are better organizational citizens, meaning that they help other people at work in various ways. Furthermore, people high in well-being seem to have better social relationships than people low in well-being. For example, they are more likely to get married, stay married, and have rewarding marriages. Finally, well-being is related to health and longevity, although the pathways linking these variables are far from fully understood. Thus, well-being not only is valuable because it feels good, but also is valuable because it has beneficial consequences. This fact makes national and corporate monitoring of well-being imperative. In order to facilitate the use of well-being outcomes in shaping policy, we propose creating a national well-being index that systematically assesses key well-being variables for representative samples of the population. Variables measured should include positive and negative emotions, engagement, purpose and meaning, optimism and trust, and the broad construct of life satisfaction. A major problem with using current findings on well-being to guide policy is that they derive from diverse and incommensurable measures of different concepts, in a haphazard mix of respondents. Thus, current findings provide an interesting sample of policy-related findings, but are not strong enough to serve as the basis of policy. Periodic, systematic assessment of well-being will offer policymakers a much stronger set of findings to use in making policy decisions.

Beyond Money: Toward an Economy of Well-Being

Policy decisions at the organizational, corporate, and governmental levels should be more heavily influenced by issues related to well-being-people's evaluations and feelings about their lives. Domestic policy currently focuses heavily on economic outcomes, although economic indicators omit, and even mislead about, much of what society values. We show that economic indicators have many shortcomings, and that measures of well-being point to important conclusions that are not apparent from economic indicators alone. For example, although economic output has risen steeply over the past decades, there has been no rise in life satisfaction during this period, and there has been a substantial increase in depression and distrust. We argue that economic indicators were extremely important in the early stages of economic development, when the fulfillment of basic needs was the main issue. As societies grow wealthy, however, differences in well-being are less frequently due to income, and are more frequently due to factors such as social relationships and enjoyment at work. Important noneconomic predictors of the average levels of well-being of societies include social capital, democratic governance, and human rights. In the workplace, noneconomic factors influence work satisfaction and profitability. It is therefore important that organizations, as well as nations, monitor the well-being of workers, and take steps to improve it. Assessing the well-being of individuals with mental disorders casts light on policy problems that do not emerge from economic indicators. Mental disorders cause widespread suffering, and their impact is growing, especially in relation to the influence of medical disorders, which is declining. Although many studies now show that the suffering due to mental disorders can be alleviated by treatment, a large proportion of persons with mental disorders go untreated. Thus, a policy imperative is to offer treatment to more people with mental disorders, and more assistance to their caregivers. Supportive, positive social relationships are necessary for well-being. There are data suggesting that well-being leads to good social relationships and does not merely follow from them. In addition, experimental evidence indicates that people suffer when they are ostracized from groups or have poor relationships in groups. The fact that strong social relationships are critical to well-being has many policy implications. For instance, corporations should carefully consider relocating employees because doing so can sever friendships and therefore be detrimental to well-being. Desirable outcomes, even economic ones, are often caused by well-being rather than the other way around. People high in well-being later earn higher incomes and perform better at work than people who report low well-being. Happy workers are better organizational citizens, meaning that they help other people at work in various ways. Furthermore, people high in well-being seem to have better social relationships than people low in well-being. For example, they are more likely to get married, stay married, and have rewarding marriages. Finally, well-being is related to health and longevity, although the pathways linking these variables are far from fully understood. Thus, well-being not only is valuable because it feels good, but also is valuable because it has beneficial consequences. This fact makes national and corporate monitoring of well-being imperative. In order to facilitate the use of well-being outcomes in shaping policy, we propose creating a national well-being index that systematically assesses key well-being variables for representative samples of the population. Variables measured should include positive and negative emotions, engagement, purpose and meaning, optimism and trust, and the broad construct of life satisfaction. A major problem with using current findings on well-being to guide policy is that they derive from diverse and incommensurable measures of different concepts, in a haphazard mix of respondents. Thus, current findings provide an interesting sample of policy-related findings, but are not strong enough to serve as the basis of policy. Periodic, systematic assessment of well-being will offer policymakers a much stronger set of findings to use in making policy decisions.

Stress and coping strategies of patients with cancer. A Korean study

Cancer is a potential life-threatening illness that engenders considerable psychologic distress, requiring persistent coping for the treatment procedures. In this cross-sectional descriptive study stress levels and coping strategies of 257 cancer patients residing in South Korea are addressed. Lazarus and Folkman's theory of stress and coping was used as the theoretical framework. The data were collected from November 1999 to March 2000 by face-to-face interviews. Study participants were primarily male (62.6%) and married (91.4%). Cancer of the gastrointestinal system was the most prevalent type of cancer (31.3%). Women and the patients in the third-stage of cancer showed higher stress but less coping than other groups. Stress was negatively correlated with both problem-focused coping and emotion-focused coping. Korean patients with cancer used emotion-focused coping strategies more than problem-focused coping strategies.

The influence of social support on depressive symptoms in cancer patients: age and gender differences

PURPOSE

The relationship between social support and depressive symptomatology in cancer patients is well established, yet the extent to which patient variables impact this relationship is not well known. The purpose of this study was to examine whether the relationship of social support to the severity of depressive symptoms varies by patient age and gender.

DESCRIPTION OF THE STUDY

A sample of 342 cancer outpatients were administered self-report measures of depressive symptoms, perceived adequacy of social support, satisfaction with family functioning, and the size of their social support network.

RESULTS

There were no significant differences by gender or age in the relationship of the social support variables to depressive symptoms. Although not statistically significant, interesting differences did emerge: a larger social support network was associated with less severe depression for female patients and for younger patients but not for male patients or older patients. For the entire sample, greater perceived adequacy of support and more satisfaction with family functioning were related to less severe depression.

CONCLUSIONS

The findings of the study suggest that interventions to alleviate depressive symptoms in cancer patients may be designed with consideration of demographic characteristics such as age and gender to maximize the beneficial impact on quality of life.

Differential predictors of emotional distress in HIV-infected men and women

Changes in the AIDS epidemic in many areas of the United States require information about the experience of the growing segment of women afflicted. This study compared patterns of emotional distress between men and women with symptomatic HIV and examined potential predictors of different levels of vulnerability. A sample of 126 low socioeconomic men and women seeking care from HIV treatment centers was surveyed using measures of physical and psychological well-being. Women had more HIV symptoms, poorer functioning, and greater disruptions in physical and psychosocial well-being. Physical health status and optimism were primary predictors of emotional distress in both men and women. More than 50% of men and women had scores indicative of clinical anxiety. Approximately 1 out of 10 had clinically relevant scores for depression. Gender differences may provide potentially useful information for tailoring assessment interventions for emotional distress in people infected with HIV.

A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease

Forty-six Chinese patients with symptomatic human immunodeficiency virus (HIV) participated in a comparative study assessing the effectiveness of cognitive-behavioral group therapy (CBT) and peer support/counseling group therapy (PSC) in relation to improving mood and quality of life and decreasing uncertainty in illness as compared to a group receiving routine treatment with no formal psychosocial intervention. The CBT group consisted of 10 subjects, the PSC group of 10 subjects, and the comparison group of 26 subjects. There was a 24% attrition rate. The intervention groups received 12 weekly sessions of therapy over 3 months. Assessment of mood states was carried out before randomization (baseline data), immediately postintervention (3-month time point) and followed-up 3 months later (6-month time point). Assessment of quality of life and uncertainty in illness was carried out before randomization and at the 6-month follow-up time point. Results indicated that the mood of the participants in the CBT group improved in terms of anger, tension-anxiety, depression, confusion, and overall mood. The quality of life in this group was significantly improved compared to the other two groups, as was uncertainty in illness. In the PSC group a worsening of psychologic functioning was observed immediately postintervention, but this picture dramatically improved at the follow-up assessment with improvements of up to 34%. Quality of life also improved over time in this group by almost 5%, but results did not reach statistical significance. This study demonstrated that psychologic interventions could decrease psychologic distress and improve quality of life in symptomatic HIV patients, indicating their use should be incorporated in the management of care of people living with HIV/AIDS.

Telephone support group intervention for persons with hemophilia and HIV/AIDS and family caregivers

The purpose of this pilot project was to test the feasibility of a telephone support group intervention for persons with hemophilia and HIV/AIDS and for their family caregivers. Their support needs were unique because they did not identify with predominant groups of persons with AIDS and were geographically dispersed from peers. The 12 week intervention involved separate telephone support groups for hemophiliacs and for family caregivers. The two groups, comprised of a predetermined maximum of six people, were co-led by a professional and a peer. The support group for family caregivers involved six people and the group for men with hemophilia included five people, including one peer facilitator and one professional facilitator in each group. The telephone support group discussions were taped, transcribed, and analyzed for prevalent themes. The peer and professional facilitators maintained weekly field notes. All participants reported that the telephone groups had a positive impact on meeting their support needs. They believed that they had benefitted from sharing information and that the support groups had decreased their feelings of isolation and loneliness. Participants, however, contended that the intervention should be longer than 12 weeks.

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study

BACKGROUND

Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs' and PLWAs' perspective.

AIM

The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS.

METHODS

The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method.

FINDINGS

The dynamics of hope is a multifaceted and complex combination of 'hope', 'despair' and 'hopelessness'. It comprises balancing between 'believing life to be worth living at the present and in the future', 'losing one's grip and sinking into narrowing existence vs. fighting against sinking' and 'giving up in the face of belief in nonexisting future'. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the 'folding' and 'unfolding' possibilities in everyday life. Factors contributing to the folding possibilities include 'losing', 'fear', 'uncertainty', 'problems in care', 'HIV/AIDS in close ones', 'difficulties in relationships' and 'negative public images and attitudes concerning HIV'. Factors contributing to the unfolding possibilities are 'constructive life experiences', 'wishing not to have HIV while uncertain', 'constructive relationships', 'ability to control one's life', 'finding the meaning of life and zest for life', 'caring', 'noticing one's improved health and the continuance of life', 'increasingly positive attitudes concerning HIV-positive people' and 'protection by law'.

CONCLUSIONS

The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.

Social support as a buffer to the psychological impact of stressful life events in women with breast cancer

BACKGROUND

Three theoretical models by which social support may influence the impact of stressful life events on cancer patients' psychological state were tested: 1) the additive model, in which social support and stressful life events each directly influence cancer patients' adjustment, irrespective of the magnitude of the other; 2) the buffering hypothesis, in which stressful events occurring in the presence of social support should produce less distress than if they occur in its absence; and 3) both additive and buffering models.

METHODS

One hundred seventy-nine patients who had Stage II breast cancer (median age, 56 yrs; 68% disease free), treated a mean of 6.8 years since entry to Cancer and Leukemia Group B (CALGB) 8541, were interviewed by telephone concerning their psychosocial adjustment. The following measures were used: Medical Outcome Study Social Support Survey (MOS-SSS), Life Experience Survey (LES) a measure of stressful life events within the past 12 months, European Organization for Research on the Treatment of Cancer (EORTC QLQ-C30) a measure of quality of life, Mental Health Inventory (MHI), and the Systems of Belief Inventory (SBI) a measure of spiritual and religious involvement.

RESULTS

Hierarchical regression analyses revealed that less than excellent levels of social support (P < 0.01), greater negative impact of LES fateful life events (e.g., death of family member) (P < 0.05), personal illness or injury (P < 0.05), and all other negative life events in the past year (< 4; P < 0.01) were significant predictors of greater MHI psychological distress, in addition to being divorced or separated (P < 0.001), and more recently treated for cancer on CALGB 8541 (P < 0.05). The interaction of LES scores with MOS-SSS or SBI social support, used to test the buffering hypothesis, did not significantly improve the prediction of MHI psychological distress.

CONCLUSIONS

The results supported the additive model, with both stressful life events and social support independently and significantly affecting patients' emotional state. However, the level of social support needed to be very high to reduce the likelihood of severe psychological distress.

Negative and positive influences of social support on depression in patients with head and neck cancer: a prospective study

Patients with head and neck cancer have to cope not only with a life threatening diagnosis, but also with an altered facial appearance and the loss or impairment of important functions as a result of treatment. As a consequence they are prone to psychosocial problems. Social support might influence their ability to adapt to the illness and its treatment. The aim of this prospective study is to examine the influence of different aspects of social support on the depressive symptomatology in head and neck cancer patients treated with surgery and/or radiotherapy. Patients completed a questionnaire relating to available and received support, the extent of the social network, depressive symptoms, and general health complaints before and 6 months after treatment. Received support was found to be associated with more depressive symptomatology at baseline and available support led to less depressive symptomatology. The relationship between social support and depressive symptoms was especially apparent in patients with few general health complaints. Whereas the availability of support seemed to be beneficial regardless of the situation, the effect of received support was equivocal. The provision of support should be tailored to the needs of the individual patient.

Depressive cognitions and psychosocial functioning: a test of Beck's cognitive theory

Depression, the most common mental disorder, is frequently treated with cognitive therapy based on Beck's theory, which suggests that depressive cognitions (negative views of self, world, and future) affect psychosocial functioning. This study tested Beck's theory in depressed inpatients, previously hospitalized and nonhospitalized outpatients, and undiagnosed adults. Multiple regression indicated that negative views of self, world, and future explained a substantial part of psychosocial functioning in all 4 groups. In the 3 depressed groups, views of self and world had a greater impact on psychosocial functioning than did the view of the future, suggesting that interventions to build self-esteem and enhance self-control may be most effective in improving psychosocial functioning of depressed adults.

Stress, health, and depressive symptoms in older adults at three time points over 18 months

This descriptive study is a secondary analysis of data that examined depressive symptoms in a random sample of 429 community-dwelling adults aged 65 years and older. Participants were classified as having consistently high (n = 20). consistently low (n = 327), or fluctuating (n = 82) levels of depressive symptoms, based on scores from the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) at three time points over the course of 18 months. Differences in stress (life events and daily hassles), health (self-assessed health and physical complaints), and biographic variables among the 3 groups were examined. One quarter of the sample reported high depressive symptoms at least once over 18 months. There were significant differences among the 3 symptom groups on each of the stress and health measures and on marital status. The findings support the relationship among stress, health, and depressive symptoms over time. Implications for clinicians and researchers are discussed.