Independent and mediated contributions of personality, coping, social support, and depressive symptoms to physical functioning outcome among patients in cardiac rehabilitation

Childhood psychological maltreatment and adolescent depressive symptoms: Exploring the role of social anxiety and maladaptive emotion regulation strategies

BACKGROUND

Despite emerging evidence for the effect of childhood psychological maltreatment on adolescent depressive symptoms, the underlying processes for this effect are largely under-investigated. This study examined a conceptual framework for the effect of childhood psychological maltreatment on adolescent depressive symptoms through social anxiety disorder (SAD) and maladaptive emotion regulation strategies.

METHODS

The participants were 1649 Chinese middle school students (751 girls and 898 boys) with a mean age of 16.29 ± 1.04 years old. A moderation-mediation model hypothesized that childhood psychological maltreatment predicts adolescent depressive symptoms, with SAD as a mediator and maladaptive emotion regulation strategies as a moderator.

RESULTS

Childhood psychological maltreatment significantly positively predicted adolescent depressive symptoms, while SAD mediated the relation. Maladaptive emotion regulation strategies moderated the pathways from psychological maltreatment to depressive symptoms (but not from psychological maltreatment to SAD) and from SAD to adolescent depressive symptoms.

LIMITATIONS

Subjective measures, and the cross-sectional design are the main limitations.

CONCLUSIONS

SAD plays a mediating role in the relation between childhood psychological maltreatment and depressive symptoms. Maladaptive emotion regulation strategies exacerbate the relation between childhood psychological maltreatment and depressive symptoms, as well as the relation between SAD and depressive symptoms. These results highlight the importance of addressing social anxiety in reducing adolescent depressive symptoms by improving their cognitive emotion regulation strategies.

Impact of Social Support on Cardiovascular Risk Prediction Models: A Systematic Review

Cardiovascular diseases (CVD) stand as the primary causes of both mortality and morbidity on a global scale. Social factors such as low social support can increase the risk of developing heart diseases and have shown poor prognosis in cardiac patients. Resources such as PubMed and Google Scholar were searched using a boolean algorithm for articles published between 2003 and 2023. Eligible articles showed an association between social support and cardiovascular risks. A systematic review was conducted using the guidance published in the Cochrane Prognosis Method Group and the PRISMA checklist, for reviews of selected articles. A total of five studies were included in our final analysis. Overall, we found that participants with low social support developed cardiovascular events, and providing a good support system can decrease the risk of readmission in patients with a history of CVD. We also found that integrating social determinants in the cardiovascular risk prediction model showed improvement in accessing the risk. Population with good social support showed low mortality and decreased rate of readmission. There are various prediction models, but the social determinants are not primarily included while calculating the algorithms. Although it has been proven in multiple studies that including the social determinants of health (SDOH) improves the accuracy of cardiovascular risk prediction models. Hence, the inclusion of SDOH should be highly encouraged.

The specific psychosocial modulator factors of emotional adjustment in infertile individuals compared to fertile people

Certain psychological and social factors modulate emotional adjustment in infertility. The aims of this study were: analyse whether there are sex and group differences (infertile vs. fertile) in emotional adjustment, and personality, dispositional optimism, coping strategies, personal and interpersonal resources; observe the modulating role of these psychosocial variables in the emotional adjustment of infertile individuals compared to fertile ones; and determine if the modulator variables associated with emotional adjustment are specific to infertile people. Method: A cross-sectional study design was used with a sample of 139 heterosexual Spanish participants (84 infertile, 55 fertile). For the data analysis we performed correlations, multiple regression analysis, MANOVAS and ANOVAS. Results: The multivariate and univariate analyses showed that the infertile group exhibited greater emotional maladjustment, more personal resources, lesser degree of confrontive coping, social support seeking, positive reappraisal, and lower marital satisfaction than the fertile group. In addition, women (infertile and fertile) sought more social support seeking and the infertile ones made more use of self-controlling strategies. Multiple regression analyses showed that for all subjects the emotional adjustment was modulated by dispositional optimism and escape/avoidance. For infertile participants, the remaining significant modulating factors were personal resources and marital satisfaction, whereas, for the fertile group, they were openness and interpersonal resources. Conclusion: Infertile women and men showed no differences in emotional maladjustment, but levels were higher than in the fertile group. We found differences between infertile and fertile subjects in terms of modulating variables of emotional adjustment. For infertile participants, the development of personal resources and increased marital satisfaction are particularly important.

Examining Intra- and Inter-Personal Health Effects of Optimism and Pessimism: The Role of Subjective Well-Being in Romantic Couples

Recent meta-analytic research suggests that the absence of pessimism could be a stronger predictor of physical health than the presence of optimism (Scheier et al., 2021a). The present study examined the role of subjective well-being in the effects of optimism and pessimism on physical health in romantic couples. It was hypothesized that pessimism would be more strongly associated with both well-being and health than optimism, intra- and inter-personally. Subjective well-being was also expected to explain variance in the associations between optimism, pessimism, and health. A baseline sample of 153 opposite-sex couples completed various measures of subjective well-being (e.g., life satisfaction, positive and negative affect, and depressive symptoms) and physical health (e.g., subjective health, sleep efficiency, physical symptoms, cold symptoms, and chronic illness). Results of actor-partner interdependence models showed that the absence of pessimism, but not the presence of optimism, was associated with better physical health at baseline and over time. Pessimism was also a stronger predictor than optimism of baseline levels in some indicators of subjective well-being. These effects were obtained intra- and inter-personally. Finally, subjective well-being explained variance in some of the effects of pessimism on levels of physical health. Implications for theory, research, and practice are discussed.

Social Support as a Mediator of the Personality-Physical Functioning Relationship in a National Sample of African Americans: A Two-Wave Longitudinal Study

The present study investigates whether social support mediates the relationship between personality traits and physical functioning among African Americans over 2.5 years. Data were collected from a national probability sample of African American adults (analytic sample N = 312). Telephone surveys included measures of the five-factor model personality traits, social support, and physical functioning. Personality traits were assessed at Time 1 (T1), and social support and physical functioning were assessed 2.5 years later at Time 2 (T2). Physical functioning was assessed using the SF-12 at T2. Results indicated that T2 social support mediated the relationship between T1 personality traits and T2 physical functioning for the traits of conscientiousness, extraversion, agreeableness, and neuroticism, but not for openness to experience. This information may be useful to healthcare providers and community members in developing strategies targeting personality traits in cultivating social support for health promotion.

Psychological Impact of the COVID-19 Pandemic on Licensed Full-Time Practicing Nurses Undertaking Part-Time Studies in Higher Education: A Cross-Sectional Study

Frontline nurses face an unpreceded situation with the coronavirus disease (COVID-19) pandemic, and many report suffering from physical and psychological stress. This online, cross-sectional survey used questionnaires, such as the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire (PHQ-2), the Connor-Davidson Resilience Scale, stress-related questions, and Brief Coping Orientation to Problems Experienced (Brief-COPE), to determine the psychological impact of COVID-19 on licensed full-time practicing nurses undertaking part-time studies in higher education. Recruitment commenced from August to September 2020; 385 students were approached, and 124 completed the survey (response rate: 32%). Most of the respondents were frontline nurses working in public sectors (89.5%), 29% of whom reported symptoms of depression, and 61.3% reported mild to severe levels of anxiety. The GAD-7 was significantly associated with the resilience score (β = -0.188; p = 0.008) and exhaustion (β = 0.612; p < 0.001). The PHQ-2 was significantly associated with 'anxiety about infection' (β = 0.071; p = 0.048). A lower anxiety level was significantly associated with a higher resilience level and a lower level of exhaustion, and a lower depression level was significantly associated with a lower anxiety about infection. Nursing programs incorporating resilience building may mitigate psychological distress of the study population.

Cardiac Rehabilitation: A Bibliometric Review From 2001 to 2020

Cardiovascular disease (CVD) is a serious threat to global public health due to its high prevalence and disability rate. Meanwhile, cardiac rehabilitation (CR) has attracted increasing attention for its positive effects on the cardiovascular system. There is overwhelming evidence that CR for patients with CVD is effective in reducing cardiovascular morbidity and mortality. To learn more about the development of CR, 5,567 papers about CR and related research were retrieved in the Web of Science Core Collection from 2001 to 2020. Then, these publications were scientometrically analyzed based on CiteSpace in terms of spatiotemporal distribution, author distribution, subject categories, topic distribution, and references. The results can be elaborated from three aspects. Firstly, the number of annual publications related to CR has increased year by year in general over the past two decades. Secondly, a co-occurrence analysis of the output countries and authors shows that a few developed countries such as the United States, Canada, and the UK are the most active in carrying out CR and where regional academic communities represented by Sherry Grace and Ross Arena were formed. Thirdly, an analysis of the subject categories and topic distribution of the papers reveals that CR is a typical interdiscipline with a wide range of disciplines involved, including clinical medicine, basic medicine, public health management, and sports science. The research topics cover the participants and implementers, components, and the objectives and requirements of CR. The current research hotspots are the three core modalities of CR, namely patient education, exercise training and mental support, as well as mobile health (mHealth) dependent on computer science. In conclusion, this work has provided some useful information for acquiring knowledge about CR, including identifying potential collaborators for researchers interested in CR, and discovering research trends and hot topics in CR, which can offer some guidance for more extensive and in-depth CR-related studies in the future.

Integrating community participation in the transition of older adults from hospital to home: a scoping review

INTRODUCTION

Benefits of community participation and physical activity for the health and wellbeing of older adults are well documented. This review aims to answer the question; "How is community participation considered for older adults in the transition from hospital to home?"

MATERIALS AND METHODS

This scoping review searched key databases using subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria were adults aged ≥60 years, transitioning from hospital to home, reporting on community participation, inclusive of leisure activities, social activities, and physical activity.

RESULTS

Of 2206 initial unique articles, 19 met inclusion criteria. Articles covered a range of diagnoses, most frequently stroke, hip replacement, or fracture. Numerous measures of community participation were reported, identifying "low" and "reduced" community participation in ten studies. Measures of physical activity, health-related quality of life, sleep quality, and loneliness were variable. Five studies reported interventions and four reported improved components of community participation. Numerous barriers to community participation were identified, with recommendations for future transition care services considered.

CONCLUSION

There are considerable barriers to promoting community participation in transition care services for older people. Older adults need information to prepare for returning home from hospital and to regain valued leisure and social activities for health-related quality of life.IMPLICATIONS FOR REHABILITATIONCommunity participation is an important component of healthy ageing which health professionals should consider beyond discharge.Levels of mobility and endurance should be considered in terms of facilitating community participation for older adults.Transition care services should provide adequate information to prepare individuals expectations of returning home following hospital stay, whilst attempting to maintain valued leisure and social activities.

A longitudinal examination of social support as a mediator of the personality-health relationship in a national sample of African Americans

The present study investigates whether social support mediates the relationship between personality traits and health among African Americans over a five-year period, filling a gap in the literature on longitudinal tests of the personality-health association. Data were collected from a national probability sample of African American adults (N = 200). Personality was assessed at Time 1 (T1), social support was assessed 2.5 years later (T2), and physical functioning was examined 5 years (T3) after T1. Telephone surveys included measures of the Five Factor Model personality traits (T1), social support (T2), and physical functioning (T3). Results suggested that relationships between the T1 personality traits and T3 physical functioning were not mediated by T2 social support. Secondary analyses found that among all T1 personality traits, higher openness and lower neuroticism uniquely predicted higher T2 social support. Further, among T1 personality traits, higher conscientiousness uniquely predicted better T3 physical functioning. This information may be useful to healthcare providers and community members in developing prevention and intervention strategies for African Americans.

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.

Depression, Anxiety, Perceived Stress, and Their Changes Predict Greater Decline in Physical Health Functioning over 12 Months Among Patients with Coronary Heart Disease

BACKGROUND

Although the deleterious impact of psychological distress on patients with coronary heart disease (CHD) is recognized, few studies have examined the influence of change in psychological distress on health outcomes over time. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted the decline in physical functioning in CHD patients over 12 months. In addition, perceived social support was examined as a buffer of psychological distress or a direct predictor of physical functioning.

METHODS

Participants were 255 CHD patients with a mean age of 63 (SD = 8.65) years, including 208 men and 47 women. Psychological distress and physical functioning were assessed at baseline, 6 months and 12 months. Hierarchical regression analyses were conducted to examine the influences of psychological factors on physical functioning over 12 months. All models were adjusted for baseline physical functioning, age, gender, marital status, education, BMI, and length of participation at a wellness center.

RESULTS

For each psychological distress variable (depression, anxiety, or perceived stress), both the baseline (βs = - 0.19 to - 0.32, ps = 0.008 to < 0.001) and its respective change over time (βs = - 0.17 to - 0.38, ps = 0.020 to < 0.001) independently and significantly predicted greater decline in physical functioning at 6 and 12 months, after adjusting for covariates. Perceived social support predicted greater improvement in physical functioning at 12 months (β = 0.13, p = 0.050), but it did not buffer impact of psychological distress.

CONCLUSIONS

Findings underscore the importance of monitoring various forms of psychological distress continuously over time for CHD patients.

Explaining the Relationship Between Personality and Health in a National Sample of African Americans: The Mediating Role of Social Support

Though associations between personality and health have been previously observed, less is known about why such relationships exist. The present study examines whether social support mediated the relationship between personality traits and health among African Americans. We hypothesized that social support would help explain the relationship between each of the five-factor model traits and physical functioning. Data were collected from a national probability sample of 803 African American adults using a telephone survey including measures of the five-factor model personality traits, social support, and physical functioning. Results of mediational analyses suggested that higher openness to experience, conscientiousness, extraversion, and agreeableness, and lower neuroticism predicted higher social support. Higher openness, conscientiousness, extraversion, and lower neuroticism, but not agreeableness, predicted higher physical functioning. The relationships between physical functioning and personality traits were at least partially mediated by social support. This study reinforces the importance of identifying the mechanisms underlying the personality-health relationship. This information may be useful to community members and health care providers in developing prevention and treatment strategies for African Americans.

Why and when social support predicts older adults' pain-related disability: a longitudinal study

Pain-related social support has been shown to be directly associated with pain-related disability, depending on whether it promotes functional autonomy or dependence. However, previous studies mostly relied on cross-sectional methods, precluding conclusions on the temporal relationship between pain-related social support and disability. Also, research on the behavioral and psychological processes that account for such a relationship is scarce. Therefore, this study aimed at investigating the following longitudinally: (1) direct effects of social support for functional autonomy/dependence on pain-related disability, (2) mediating role of physical functioning, pain-related self-efficacy, and fear, and (3) whether pain duration and pain intensity moderate such mediating processes. A total of 168 older adults (Mage = 78.3; SDage = 8.7) participated in a 3-month prospective design, with 3 moments of measurement, with a 6-week lag between them. Participants completed the Formal Social Support for Autonomy and Dependence in Pain Inventory, the Brief Pain Inventory, the 36-SF Health Survey, behavioral tasks from the Senior Fitness Test, the Pain Self-Efficacy Questionnaire, and the Tampa Scale for Kinesiophobia. Moderated mediation analyses showed that formal social support for functional dependence (T1) predicted an increase in pain-related disability (T3), that was mediated by self-reported physical functioning (T2) and by pain-related self-efficacy (T2) at short to moderate pain duration and at low to moderate pain intensity, but not at higher levels. Findings emphasized that social support for functional dependence is a risk factor for pain-related disability and uncovered the "why" and "when" of this relationship. Implications for the design of social support interventions aiming at promoting older adults' healthy aging despite chronic pain are drawn.

Ethnic differences in response to directive vs. non-directive brief intervention for subsyndromal depression

OBJECTIVE

Analog research suggests that directive interventions might increase treatment engagement for non-symptomatic Asian American (AA) students; however, no studies have assessed whether directiveness improves therapy processes or clinical outcomes for AAs with mental health symptoms. This study tested the comparative efficacy of brief directive vs. non-directive intervention for AAs and European Americans (EAs) with subsyndromal depression.

METHOD

Participants were randomly assigned directive, non-directive, or cultural values interview conditions, and assessed three times over six months. Directive and non-directive treatment involved meeting with a therapist for a single, 20-minute session to receive psychoeducation and personalized feedback on depressive symptoms and coping strategies. Cultural values participants also met with a therapist.

RESULTS

Although results were mixed for the overall sample, directive treatment was generally superior to non-directive treatment and cultural values at addressing depressive symptoms, coping behavior, and working alliance. Ethnicity did moderate treatment effects for some outcomes, but in an unexpected manner. At six-month follow-up, the directive intervention was more effective than cultural values at reducing depressive symptoms for AAs; however, the cultural values condition was more effective than the non-directive intervention at reducing depressive symptoms for EAs.

CONCLUSION

Mixed evidence was found for directiveness as an Asian-specific treatment enhancement. Clinical or methodological significance of this article: This article adds to a complicated body of research and clinical work aiming to inform best practices for ethnic minorities. We found some evidence that a directive therapeutic style may be a "culturally invariant" clinical technique that could be beneficial to Asian American and European American populations alike. Yet, other findings suggest that directiveness might be uniquely advantageous for Asian Americans, particularly for long-term improvement of depressive symptoms.

Biopsychosocial predictors of coping strategies of patients postmyocardial infarction

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event.

Patient and partner dispositional optimism as a long-term predictor of illness representations in autoimmune diseases

We examined whether the dispositional optimism of patients suffering from an autoimmune disease as well as of their partners can predict, at a dyadic level, their representations of illness consequences, and personal and treatment control, assessed 1 year later. Patient optimism predicted several patient and partner illness representations. Partner optimism was unrelated to own or patient illness representations. Results highlight the strong long-term predictive power of patient optimism and underline the importance of the interpersonal function of personality traits. At the same time, study findings indicate that the dyadic effects of optimism are complex and probably conditional on several factors.

Is dispositional optimism or dispositional pessimism predictive of ideal cardiovascular health? The Young Finns Study

OBJECTIVE

We examined the independent association between dispositional optimism compared to dispositional pessimism and ideal cardiovascular health (defined by the American Heart Association).

DESIGN

A prospective design with a study sample of 1113 participants aged 24-39 years from the longitudinal Young Finns Study.

MAIN OUTCOME MEASURES

Ideal cardiovascular health (comprised of seven ideal cardiovascular health metrics) was measured in 2001. The ideal cardiovascular health metrics were reassessed in 2007.

RESULTS

Low pessimism rather than high optimism was a better predictor of ideal cardiovascular health in 2007. When examining the association between optimism and pessimism and the seven ideal cardiovascular health metrics in 2007 (BMI, diet, physical activity, smoking status, blood pressure, total cholesterol and plasma glucose), low pessimism predicted non-smoking status, ideal physical activity and eating a healthy diet, while high optimism was associated with eating a healthy diet.

CONCLUSION

Our findings suggest that low pessimism rather than high optimism is associated with ideal cardiovascular health, especially with health behaviours such as not smoking, being physically active and eating a healthy diet. Socio-economic status was the potential mediating or confounding factor. Future studies should examine the differential meaning of the optimism/pessimism concepts to further clarify their relation to health outcomes.

Quality of life among parents of children with epilepsy: A preliminary research study

PURPOSE

The current preliminary study was based on the principles of positive psychology orientation when examining the multidimensional construct of quality of life (QOL): the physical functioning, psychological functioning, functional state, and social functioning among parents of children with epilepsy. We assessed the contribution of loneliness and personal resources, namely optimism and flexibility, to parents' QOL.

METHOD

The study was conducted at a multidisciplinary center for epilepsy in a central hospital in Israel. Forty-eight parents agreed to participate in a preliminary research study and completed a battery of self-report questionnaires.

RESULTS

Significant negative correlations were found between flexibility and the scores on the four components of QOL (higher scores on the QOL scales indicated lower QOL). Optimism was not found to be associated with the scores on QOL. High levels of loneliness were found to be associated with higher scores on the four components of parents' QOL. Among sociodemographic variables, only the economic situation (due to illness) was linked negatively to the scores on QOL components. Flexibility and economic situation were the significant variables that accounted for the explained variance of total QOL.

CONCLUSION

The results of this study highlight the importance of flexibility in effectively managing the stressors that might be associated with childhood epilepsy. These results suggest that psychosocial intervention providing coping strategies for the family might improve QOL. Moreover, a parent's economic situation seems to be an essential part of the psychosocial assessment, and assurance of the optimal utilization of financial rights and facilities may improve their QOL.

The patient's experience of early discharge following total hip replacement

BACKGROUND

Strategies within the public health system to curtail costs, increase efficiency and service utilisation have resulted in reduced hospital stays following elective orthopaedic procedures. Although there are advantages that support the concept of early discharge from hospital, very little is known about how patients manage the transition from hospital to home.

AIM

The aim of this qualitative study was to describe the post-discharge experience of elderly patients following primary total hip replacement (THR).

METHODS

Ten patients, six women and four men, provided descriptions of their experience. Data were collected by face-to-face interviews and the analysis process was based on Giorgi's phenomenological scientific methodology (Giorgi, 1994, 1997, 2000).

RESULTS

The analysis of the data resulted in four themes, namely; an inadequate assessment of suitable adaptive aids and personal needs; personal frustration; coping with the physical and mobility and limited social interaction.

CONCLUSION

Findings from this study demonstrated a need to review the discharge process and implement strategies to prepare patients for the stressors that the participants in this study encountered as a result of their early discharge.

Elderly patients' heart-related conditions: Disclosing health information differs by target

Americans are living longer, and many are managing at least one chronic illness. Having people with whom to disclose health information is a salient component of managing a chronic health condition, such as heart disease. The purpose of this study is to explore differences in elderly patients' health disclosures by target (i.e. disclosing to a partner vs. another person). Elderly patients (>age 60) with a diagnosed heart-related condition (n = 273) completed a survey regarding sharing information about their health condition. Results indicated significant differences between the two groups in perceived support; breadth, depth, and frequency of disclosures; and disclosure of psychological/emotional symptoms, physical symptoms, and talk about heart-healthy behaviors. No significant differences were found between the two groups for relationship quality and efficacy. Patients who reported sharing information with a partner reported significantly more health information disclosures compared to patients who reported sharing information with another person.

A Dyadic Approach

The purpose of the present study was to apply Berg and Upchurch’s developmental-conceptual model toward a better understanding of how couples cope with chronic illness. Specifically, a model was hypothesized in which proximal factors (relational quality), dyadic appraisal (illness interference), and dyadic coping (partner support) influence adjustment (health condition management). The study was cross-sectional and included 308 dyads in which one partner has a chronic health condition. The actor partner interdependence model shows how congruence and noncongruence in relational quality, dyadic appraisal, and dyadic coping influence dyadic adjustment.

Are people healthier if their partners are more optimistic? The dyadic effect of optimism on health among older adults

OBJECTIVE

Optimism has been linked with an array of positive health outcomes at the individual level. However, researchers have not examined how a spouse's optimism might impact an individual's health. We hypothesized that being optimistic (and having an optimistic spouse) would both be associated with better health.

METHODS

Participants were 3940 adults (1970 couples) from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. Participants were tracked for four years and outcomes included: physical functioning, self-rated health, and number of chronic illnesses. We analyzed the dyadic data using the actor-partner interdependence model.

RESULTS

After controlling for several psychological and demographic factors, a person's own optimism and their spouse's optimism predicted better self-rated health and physical functioning (bs = .08-.25, ps<.01). More optimistic people also reported better physical functioning (b = -.11, p<.01) and fewer chronic illnesses (b=-.01, p<.05) over time. Further, having an optimistic spouse uniquely predicted better physical functioning (b = -.09, p<.01) and fewer chronic illnesses (b = -.01, p<.05) over time. The strength of the relationship between optimism and health did not diminish over time.

CONCLUSIONS

Being optimistic and having an optimistic spouse were both associated with better health. Examining partner effects is important because such analyses reveal the unique role that spouses play in promoting health. These findings may have important implications for future health interventions.

Patient perspectives on the Hula Empowering Lifestyle Adaptation Study: benefits of dancing hula for cardiac rehabilitation

BACKGROUND

The Hula Empowering Lifestyle Adaption Study, funded by the National Institute on Minority Health and Health Disparities, was a 5-year research trial evaluating the impact of the traditional Native Hawaiian dance form, hula, as an exercise modality for cardiac rehabilitation, compared with usual care, on individuals recently hospitalized for a cardiac event or who had recently undergone coronary artery bypass surgery.

METHOD AND RESULTS

Seeking to learn what physical, mental, spiritual, and social effects the intervention may have had for participants, we interviewed 20 of a total of 35 patients who were enrolled in the dance arm of the study. Classical thematic triangulation analysis was used. Participants recognized that hula's coordination of body, mind, and spirit as a group activity deepened their appreciation of and connections to Hawaiian culture. This was true for those who were Native Hawaiian, connecting to their own cultural heritage, as well as for non-Native Hawaiians, who found that it improved their appreciation of the surrounding cultural traditions of the host culture where they now live.

CONCLUSIONS

Not only was hula a safe activity that improved functional capacity, participants also regarded its significant sociocultural aspects-even for participants who are not Native Hawaiian -as enhancing its value and meaningfulness. Learning the words of well-known Hawaiian songs provided additional long-term cues that encouraged "ownership" of the therapy and acted as practical reminders of the importance of exercise and lifestyle moderation while also offering new spiritual connections to the surrounding social environment.

Social support, depression, and heart disease: a ten year literature review

BACKGROUND

Coronary heart disease is the major cause of morbidity and mortality in the world. Psychosocial factors such as depression and low social support are established risk factors for poor prognosis in patients with heart disease. However, little is known about the hypothetical relationship pattern between them.

PURPOSE

The purposes of this narrative review are (1) to appraise the 2002-2012 empirical evidence about the multivariate relationship between depression, social support and health outcomes in patients with heart disease; (2) to evaluate the methodological quality of included studies.

METHOD

PubMed and PsychINFO were searched for quantitative studies assessing the multiple effects of low social support and depression on prognosis outcomes in patients with heart disease. The following search terms were used: social relation(*), cardiac disease, support quality, relationship, and relational support.

RESULTS

Five studies (three prospective cohort studies, one case-control study, and one randomization controlled trial) were selected and coded according to the types of support (social and marital). The majority of findings suggests that low social support/being unmarried and depression are independent risk factors for poor cardiac prognosis. However, all analyzed studies have some limitations. The majority of them did not focus on the quality of marital or social relationships, but assessed only the presence of marital status or social relationship. Moreover, some of them present methodological limitations.

CONCLUSION

Depressive symptoms and the absence of social or marital support are significant risk factors for poor prognosis in cardiac patients and some evidence supports their independence in predicting adverse outcomes. Cardiac rehabilitation and prevention programs should thus include not only the assessment and treatment of depression but also a specific component on the family and social contexts of patients.

Emotional distress, alexithymia, and coping as predictors of cardiac rehabilitation outcomes and attendance

PURPOSE

The purpose of this study was to examine emotional distress, alexithymia, and coping styles as predictors of cardiac rehabilitation (CR) outcomes and attendance.

METHODS

Participants included 56 patients in an outpatient CR program (65% male, 59% white, M = 61.1 years) who completed self-report measures of emotional distress (ie, depressive and anxiety symptoms), alexithymia, and coping styles (ie, approach and avoidance coping). CR outcomes recorded at entry and completion of the program included blood cholesterol, oxygen uptake ((Equation is included in full-text article.)VO(2max)), knowledge about cardiac disease, and self-reported lipid consumption. Attendance was also recorded as a measure of adherence.

RESULTS

Significant improvements were observed in oxygen uptake, high-density lipoprotein levels, disease knowledge, and self-reported lipid consumption. Older age was associated with less distress, and anxiety and higher education were associated with better attendance. Higher alexithymia (ie, greater difficulty processing emotion) was associated with increased low-density lipoprotein cholesterol, and alexithymia predicted increased self-reported lipid consumption in the context of higher approach coping.

CONCLUSIONS

CR is associated with physical and quality-of-life benefits, as well as increased knowledge about cardiac disease management. However, coping strategies that are generally beneficial (approach coping) may be associated with negative health behavior among individuals who have difficulty processing emotion. Anxiety and lower education were associated with poorer attendance, perhaps indicating the need for intervention to prevent dropout.

Association of the sense of coherence with physical and psychosocial health in the rehabilitation of osteoarthritis of the hip and knee: a prospective cohort study

Background

According to Antonovsky’s salutogenic concept, a strong sense of coherence is associated with physical and psychological health. The goal of this study was to analyze the association of Antonovsky’s sense of coherence with physical and psychosocial health components in patients with hip and knee osteoarthritis before and after in- and outpatient rehabilitation.

Methods

Prospective cohort study with 335 patients, 136 (41%) with hip and 199 (59%) with knee osteoarthritis. The outcome was measured by Short Form-36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Sense of Coherence (SOC-13). Baseline scores of the SF-36 and WOMAC scales and the observed effect sizes after rehabilitation were correlated with the baseline SOC-13. These correlations of the SF-36 scales were compared to the Factor Score Coefficients for the Mental Component Summary of SF-36, which quantify the factor load on the psychosocial dimension. Predictive impact of the baseline SOC-13 for the SF-36 and WOMAC scales (baseline scores and effect sizes) was then determined by multivariate linear regression controlled for possible confounders.

Results

At baseline, the SOC-13 correlated with the WOMAC scores between r = 0.18 (stiffness) and r = 0.25 (pain) and with the SF-36 scores between r = 0.10 (physical functioning) and r = 0.53 (mental health). The correlation of these SF-36 correlation coefficients to the Factor Score Coefficient of the SF-36 Mental Component Summary was r = 0.95. The correlations for the effect sizes (baseline → discharge) with the baseline SOC-13 global score were all negative and varied between r = 0.00 (physical functioning) and r = −0.19 (social functioning). In the multivariate linear regression model, the explained variance of the SF-36 scores by the baseline SOC-13 increased continuously from physical to psychosocial health dimensions (from 12.9% to 29.8%). This gradient was consistently observed for both the baseline scores and the effect sizes. The results of the WOMAC were consistent with the physical health scales of SF-36.

Conclusions

The sense of coherence was associated with psychosocial health dimensions but hardly with physical health. The higher the load of a scale on the psychosocial dimension the higher was its correlation to the sense of coherence. This is in contrast to the idea of Antonovsky who predicted high associations with both mental and physical health.

Literacy, cognitive function, and health: results of the LitCog study

BACKGROUND

Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities.

OBJECTIVE

To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status.

DESIGN

Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring 'fluid' abilities necessary to learn and apply new information, and 'crystallized' abilities such as background knowledge.

SETTING

An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois.

PATIENTS

Eight hundred and eighty-two English-speaking adults ages 55 to 74.

MEASUREMENTS

Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving.

RESULTS

Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r=0.57 to 0.77, all p<0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: β= -28.9, 95 % Confidence Interval (CI) -31.4 to -26.4, p; with cognitive abilities: β= -8.5, 95 % CI -10.9 to -6.0).

LIMITATIONS

Cross-sectional analyses, English-speaking, older adults only.

CONCLUSIONS

The most common measures used in health literacy studies are detecting individual differences in cognitive abilities, which may predict one's capacity to engage in self-care and achieve desirable health outcomes. Future interventions should respond to all of the cognitive demands patients face in managing health, beyond reading and numeracy.

Beyond initial disclosure: the role of prognosis and symptom uncertainty in patterns of disclosure in relationships

This study is framed in Greene's (2009) health disclosure decision-making model (DD-MM) and explores the role of prognosis and symptom uncertainty in patterns of disclosure in a close relationship. Toward this end, an uncertainty and disclosure model is hypothesized in which prognosis and symptom uncertainty and relational quality are expected to predict perceived partner support, communication efficacy, and the depth, breadth, and frequency of disclosure to a partner about a chronic health condition. Patients with diagnosed heart-related conditions visiting a private medical office were recruited to complete anonymous surveys. Results indicated that (1) the key mechanisms identified in the DD-MM are associated with the depth, breadth, and frequency of disclosure to a partner about a health condition, and (2) uncertainty plays a prominent role in people's communication with their partner about the heart-related condition. The findings and implications of the study are discussed.

Adults surviving lung cancer two or more years: A systematic review

BACKGROUND

Lung cancer has had a low survival rate throughout the years. Some studies have shown that psychological variables such as hardiness and resiliency may play a role in the meaningfulness of survival among lung cancer patients.

OBJECTIVE

The objective of this systematic review was to synthesize the best available evidence on the experiences of surviving lung cancer (including psychological/affective well-being dimensions such as resiliency, optimism, quality of life, and coping strategies) in adults over the age of 18, two or more years after diagnosis.

INCLUSION CRITERIA

The review considered adults (18 years and older) who have survived lung cancer two or more years post diagnosis.The review included studies that examined the experiences (including psychological/affective well-being dimensions such as resiliency, optimism, quality of life, and coping strategies) of surviving lung cancer two or more years post diagnosis.The review considered patients' experiences of surviving lung cancer post two years diagnosis, including the examination of specific psychological/affective well-being aspects such as resiliency, optimism, quality of life and coping strategies.The review included quantitative descriptive studies and qualitative studies.

SEARCH STRATEGY

A search for published and unpublished studies in English language from January 1999 through December 2010 was undertaken in multiple databases including MEDLINE, CINAHL, ProQuest and Psyc INFO.

METHODOLOGICAL QUALITY

Assessment of methodological quality of studies was undertaken using critical appraisal tools from the Joanna Briggs Institute.

DATA COLLECTION

Data was extracted using the Joanna Briggs Institute Data Extraction forms.

DATA SYNTHESIS

Results were presented in a narrative format as the synthesis of qualitative or quantitative data was not appropriate.

RESULTS

13 studies were included in the review: one mixed methods study (including a qualitative research component) and 12 quantitative studies.The qualitative component of the included mixed methods study identified five findings related to the meaningfulness of surviving lung cancer post two years. The central themes that emerged were existential issues, health and self-care, physical ability, adjustment, and support.Quantitative studies identified that distressed groups had less meaningful experiences related to lung cancer survival than not distressed groups. The studies also found that emotional states and style of coping were related to the meaningfulness of lung cancer survival.

CONCLUSIONS

With less emotional distress, seeing the good in everything, adjusting life to fit the changes from lung cancer, and adding physical activity to the daily routine, the life of a lung cancer survivor can be more meaningful.

IMPLICATION FOR PRACTICE

Healthcare providers must assess lung cancer survivors for potential symptom clusters affecting key patient outcomes such as quality of life. Consider introducing interventions to promote light to moderate physical activity in older patients and moderate to vigorous physical activity in younger patients, and ceasing smoking. Teach active coping strategies.

IMPLICATIONS FOR RESEARCH

There is a need for qualitative research studies exploring the experiences of lung cancer survivors. Further research is recommended on symptom clusters that might impact outcomes such as quality of life.

Developing a culturally based cardiac rehabilitation program: the HELA study

BACKGROUND

Heart disease disproportionately affects Native Hawaiians and other Pacific people. In response, researchers proposed and communities endorsed, developing a cardiac rehabilitation (CR) program based on the hula, a Native Hawaiian dance form. The utilization of cultural practices in health interventions can improve outcomes and increase enrollment and retention, but requires sensitivity and understanding.

OBJECTIVE

This paper provides the conceptual framework and methods used for integration of multiple communities' perspectives to inform the design of a hula-based CR intervention.

METHODS

Specific strategies and processes were established to ensure the equity of scientific-clinical and patient- cultural knowledge and perspectives. Multiple methods were used and a flow diagram defined steps for the intervention development.

RESULTS

Patient and cultural consultations provided information about the multidimensional benefits of hula and its use in a CR intervention. Clinical and scientific consultations provided specific guidelines for exercise prescription and patient monitoring. Integrating findings from all consultations identified important direction and requirements.

CONCLUSIONS

Community-based participatory research (CBPR) principles guided a complex collaboration of multiple communities; although time consuming, inclusive consultations provided valuable information and relationships.

The effect of optimism on depression: the mediating and moderating role of insomnia

This article aims to clarify if insomnia exerts a mediating or moderating effect on the optimism-depression association in Chinese college students. 529 Chinese college students completed the Beck Depression Inventory (BDI-II), the Pittsburgh Sleep Quality Index (PSQI), the Revised Life Orientation Test (LOT-R) and the Multidimensional Scale of Social Support (MSPSS). The results failed to show any moderating effect but after adjustment for age, gender and social support, a mediating effect was observed. In conclusion, insomnia qualifies as a mediator, suggesting considerable variance in depressive symptoms of college students could be due to change in their sleep status.

Psychosocial factors associated with the effects of physiotherapy in the acute hospital

PURPOSE

To examine the associations between psychosocial factors and physical functioning at admission, and functional recovery during an acute hospital admission.

METHOD

Included into this multi-centre cohort study were 642 patients with cardiopulmonary, musculoskeletal and neurological conditions recruited from 32 Swiss hospitals. Functional status was measured at admission and discharge using the Barthel Index (BI); BI change was used as an indicator for functional recovery. Sense of coherence (SOC) and depression were assessed at admission using the SOC questionnaire and the Hospital Anxiety and Depression Scale (HADS); patient motivation was judged at discharge by physiotherapists on a Visual Analogue Scale. Mixed effect regression was used to assess associations of SOC, depression and motivation with functional status at admission and functional recovery. Distinct models were built to control for sets of behavioural, socio-economic and disease-related variables.

RESULTS

Functional status at admission was significantly associated with SOC, depression and motivation. Functional recovery was significantly associated with motivation, but not with SOC. Significant associations between functional recovery and depression were found in some of the models.

CONCLUSIONS

As motivation showed strong associations with functional recovery, future studies should examine how functional recovery is influenced by motivation and how motivation can be improved.

Social Support as Mediator of the Stress Buffering Effect of Optimism: The Importance of Differentiating the Recipients’ and Providers’ Perspective

Using a dyadic design, this longitudinal study with 85 couples examined whether the stress buffering effect of optimism is due to an actual higher availability of social support or to positive illusions about available social support by taking simultaneously the recipients’ and the providers’ perspective on social support into account. At baseline, optimism and social support from the recipients’ and the providers’ perspective were assessed. Perceived stress was measured at 3 months follow–up. Actor–Partner Interdependence Models showed that optimism was prospectively related to lower stress. Social support from the recipients’, but not from the providers’ perspective, partially mediated this relationship. The results suggest that optimists hold positive illusions about available support and that these illusions account at least partly for the stress buffering effect. Copyright © 2010 John Wiley & Sons, Ltd.

Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

BACKGROUND

Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation.

METHODS

N = 331 patients with chronic ischemic heart disease were surveyed using questionnaires at two time points (beginning and end of 3-weeks inpatient rehabilitation). In addition, characteristics of the disease and cardiac risk factors were provided by the physician. HRQOL was measured using a total of six scales and three instruments: SF-12, MacNew questionnaire, and SAQ. Hierarchical regression analyses were carried out to predict HRQOL after rehabilitation, in which the baseline values of HRQOL, sociodemographic variables, characteristics of the disease and risk factors, personality traits, and finally the aspects of the physician-patient relationship were included stepwise. As a number of variables were used for the regression models, multiple imputation was conducted.

RESULTS

The baseline values explain most of the variance (42%-60%). After controlling the baseline values, the sociodemographic variables explain up to 5% incremental variance of HRQOL, with income being the most important predictor. The characteristics of the disease and cardiac risk factors explain between 0.4% and 3.8% incremental variance, however, variance increase is often not significant. The personality traits added in the fourth step explain up to 2% additional variance; trait anger is a significant predictor of HRQOL in three of the six scales. The features of the physician-patient relationship included in the last step lead to a significant increase in explained variance (between 1.3% and 3.9%) for all six scales. In particular, the physician's promotion of patient participation has a significant influence. The overall explanation of variance for HRQOL is between 50% and 64%.

CONCLUSIONS

Low income, a high level of trait anger, and low patient participation are significant risk factors, even if a number of potential confounders are adjusted. Research is needed that shows which causal pathway low income functions on and what therapies in rehabilitation can mitigate the disadvantage of persons with a high level of trait anger. The providers should implement measures to actively integrate rehabilitation patients in treatment (e.g. encourage them to ask questions).

Testing a Model of Physical and Psychological Recovery After a Cardiac Event

Little is known about the specific sources and types of support that assist patients in alleviating stress and achieving positive recovery outcomes after a cardiac event. The purpose of this study is to examine the effects of illness-related stress, emotional and tangible support from a significant other, and informational support from a health care provider on physical and psychological recovery outcomes in cardiac patients 8 weeks after their cardiac event. The sample consists of 220 cardiac patients. Data analysis uses structural equation modeling. Final fit indices were as follows: χ2 ( df = 110) = 156.169, comparative fit index = .963, Tucker—Lewis index = .949, and root mean square error of approximation = .044 suggesting an acceptable model. Illness-related stress has direct effects on depression, physical recovery, and activity levels. Partner emotional support has a direct effect on depression. The findings provide direction for developing social support interventions aimed at improving recovery outcomes.

Association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA)

OBJECTIVE

To investigate the association between optimism/pessimism and concentrations of seven inflammation and hemostasis markers. Optimism and pessimism are associated with cardiovascular disease mortality and progression; however, the biological mechanism remains unclear.

METHODS

This cross-sectional study used data from the Multi-Ethnic Study of Atherosclerosis (MESA), a study of 6814 persons aged 45 to 84 years with no history of clinical cardiovascular disease. The Life-Orientation Test-Revised (LOT-R) was used to measure dispositional optimism and pessimism. Regression analyses were used to estimate associations of optimism and pessimism with interleukin (IL)-6, C-reactive protein (CRP), fibrinogen, homocysteine, Factor VIII, D-dimer, and plasmin-antiplasmin, before and after adjustment for sociodemographics, depression, cynicism, health behaviors, body mass index (BMI), hypertension, and diabetes.

RESULTS

Higher scores on the LOT-R (positive disposition) were related to lower concentrations of IL-6 (p = .001), fibrinogen (p < .001), and homocysteine (p = .031). Associations were stronger for the pessimism subscale. After adjustment for demographics, the percentage differences in inflammatory markers corresponding to a 2-standard deviation increase in pessimism were 6.01% (p = .001) for IL-6, 10.31% (p = .001) for CRP, 2.47% (p < .0001) for fibrinogen, and 1.36% (p = .07) for homocysteine. Associations were attenuated but significant after adjustment for sociodemographics, depression, cynical distrust, and behaviors. Further adjustment for hypertension, BMI, and diabetes reduced associations for CRP and IL-6. Pessimism remained associated with a 1.36% (p = .02) increase in fibrinogen in the fully adjusted model. Factor VIII, D-dimer, and plasmin-antiplasmin were not associated with the LOT-R or subscales.

CONCLUSIONS

Pessimism is related to higher levels of inflammation. Health behaviors, BMI, hypertension, and diabetes seem to play a mediating role.

Equity of access to cardiac rehabilitation: the role of system factors

Background

When patient selection processes determine who can and cannot use healthcare there can be inequalities and inequities in individuals' opportunities to benefit. This paper evaluates the influence of a hospital selection process on opportunities to access outpatient cardiac rehabilitation (CR).

Methods

A secondary data analysis was conducted on a cohort of inpatients (n = 2,375) who were all eligible for invitation to an Australian CR program. Eligibility was determined by hospital discharge diagnosis codes. Only invited patients could attend. Logistic regression analysis tested the extent to which individual patient characteristics were statistically significantly associated with the outcome 'invitation' after adjusting for cardiac disease and other factors.

Results

Less than half of the eligible patients were invited to the CR program. After allowing for known factors that may have justified not being selected, there was bias towards inviting males, younger patients, married patients, and patients who nominated English as their preferred language.

Conclusions

Health service managers typically monitor service utilisation patterns as indicators of access but often pay little attention to ways in which locally determined system factors influence access to care. The paper shows how a hospital selection process can unreasonably influence patients' opportunities to benefit from an evidence-based healthcare program.

Optimism and physical health: a meta-analytic review

BACKGROUND

Prior research links optimism to physical health, but the strength of the association has not been systematically evaluated.

PURPOSE

The purpose of this study is to conduct a meta-analytic review to determine the strength of the association between optimism and physical health.

METHODS

The findings from 83 studies, with 108 effect sizes (ESs), were included in the analyses, using random-effects models.

RESULTS

Overall, the mean ES characterizing the relationship between optimism and physical health outcomes was 0.17, p < .001. ESs were larger for studies using subjective (versus objective) measures of physical health. Subsidiary analyses were also conducted grouping studies into those that focused solely on mortality, survival, cardiovascular outcomes, physiological markers (including immune function), immune function only, cancer outcomes, outcomes related to pregnancy, physical symptoms, or pain. In each case, optimism was a significant predictor of health outcomes or markers, all p < .001.

CONCLUSIONS

Optimism is a significant predictor of positive physical health outcomes.