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Almaazmi S, Simsekler MCE, Henschel A, Qazi A, Marbouh D, Luqman RAMA. Evaluating Drivers of the Patient Experience Triangle: Stress, Anxiety, and Frustration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5384. [PMID: 37047998 PMCID: PMC10094497 DOI: 10.3390/ijerph20075384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
Patient experience is a widely used indicator for assessing the quality-of-care process during a patient's journey in hospital. However, the literature rarely discusses three components: patient stress, anxiety, and frustration. Furthermore, little is known about what drives each component during hospital visits. In order to explore this, we utilized data from a patient experience survey, including patient- and provider-related determinants, that was administered at a local hospital in Abu Dhabi, UAE. A machine-learning-based random forest (RF) algorithm, along with its embedded importance analysis function feature, was used to explore and rank the drivers of patient stress, anxiety, and frustration throughout two stages of the patient journey: registration and consultation. The attribute 'age' was identified as the primary patient-related determinant driving patient stress, anxiety, and frustration throughout the registration and consultation stages. In the registration stage, 'total time taken for registration' was the key driver of patient stress, whereas 'courtesy demonstrated by the registration staff in meeting your needs' was the key driver of anxiety and frustration. In the consultation step, 'waiting time to see the doctor/physician' was the key driver of both patient stress and frustration, whereas 'the doctor/physician was able to explain your symptoms using language that was easy to understand' was the main driver of anxiety. The RF algorithm provided valuable insights, showing the relative importance of factors affecting patient stress, anxiety, and frustration throughout the registration and consultation stages. Healthcare managers can utilize and allocate resources to improve the overall patient experience during hospital visits based on the importance of patient- and provider-related determinants.
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Affiliation(s)
- Sumaya Almaazmi
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
| | - Andreas Henschel
- Department of Electrical Engineering and Computer Science, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
| | - Abroon Qazi
- School of Business Administration, American University Sharjah, Sharjah 26666, United Arab Emirates
| | - Dounia Marbouh
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
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Smith JL, Chung ML, Miller JL, Biddle M, Schuman DL, Rayens MK, Lennie TA, Smalls B, Hammash M, Mudd-Martin G, Moser DK. Profile of informal rural Appalachian caregivers of patients with chronic illnesses. J Rural Health 2022; 38:240-250. [PMID: 33644897 PMCID: PMC8397797 DOI: 10.1111/jrh.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Caring for a family member with chronic illness increases cardiovascular disease (CVD) risk by 82%, and rurality imparts additional CVD disparities. The purpose of this study was to describe a profile of rural caregivers of patients with chronic illnesses to determine the prevalence of CVD risk factors, and psychosocial and socioeconomic burden, as well as to compare these variables across gender. METHODS Baseline data from a trial of CVD risk reduction in rural caregivers of patients with chronic illnesses were used. We measured depression and anxiety with the PHQ-9 and Brief Symptom Inventory; social, economic, and environmental factors using the MOS-Social Support and Economic and Environmental surveys; body mass index (BMI); blood pressure (BP); and lipid profile. RESULTS Of 181 caregivers (age 53±14 years, 80% female), 69% were married; 88% were caring for a family member, including 46% caring for a spouse and 18% for a parent. A total of 51% were anxious, 25% depressed, and 25% reported lack of social support. Most (51%) caregivers had one or more types of CVD; and 49% were smokers. By examination, 76% had elevated BP; 35% had total cholesterol >200; 50% low-density lipoprotein >100; 56% triglycerides >150; and 79% high-density lipoprotein <60. Based on BMI, 91.5% were overweight or obese. Gender comparisons revealed that women reported higher levels of depressive symptoms than men. CONCLUSIONS Rural caregivers, regardless of gender, are at increased risk of CVD and struggle with factors that make caregiving burdensome and contribute to their own poor cardiac health.
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Affiliation(s)
| | - Misook L. Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky
- College of Nursing, Yonsei University, Seoul, Korea
| | | | - Martha Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Donna L. Schuman
- College of Social Work, University of Kentucky, Lexington, Kentucky
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Brittany Smalls
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Muna Hammash
- School of Nursing, University of Louisville, Louisville, Kentucky
| | - Gia Mudd-Martin
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Debra K. Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Kusi-Appiah E, Karanikola M, Pant U, Meghani S, Kennedy M, Papathanassoglou E. Tools for assessment of acute psychological distress in critical illness: A scoping review. Aust Crit Care 2021; 34:460-472. [PMID: 33648818 DOI: 10.1016/j.aucc.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/23/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Patients' experience of psychological distress in the intensive care unit (ICU) is associated with adverse effects, reduced satisfaction, and delayed physical and psychological recovery. There are no specific guidelines for the assessment and management of acute psychological distress during hospitalisation in the ICU. We reviewed existing tools for the assessment of acute psychological distress in ICU patients, examined evidence on their metric properties, and identified potential gaps and methodological considerations. METHOD A scoping review based on literature searches (Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted as per current scoping review guidelines. FINDINGS Overall, 14 assessment tools were identified having been developed in diverse ICU settings. The identified tools assess mainly anxiety and depressive symptoms and ICU stressors, and investigators have reported various validity and reliability metrics. It was unclear whether available tools can be used in specific groups, such as noncommunicative patients and patients with delirium, brain trauma, stroke, sedation, and cognitive impairments. CONCLUSION Available tools have methodological limitations worth considering in future investigations. Given the high prevalence of psychiatric morbidity in ICU survivors, rigorously exploring the metric integrity of available tools used for anxiety, depressive, and psychological distress symptom assessment in the vulnerable ICU population is a practice and research priority. RELEVANCE TO CLINICAL PRACTICE These results have implications for the selection and implementation of psychological distress assessment methods as a means for promoting meaningful patient-centred clinical outcomes and humanising ICU care experiences.
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Affiliation(s)
- Elizabeth Kusi-Appiah
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
| | - Maria Karanikola
- Cyprus University of Technology, Department of Nursing, 15 Vragadinou str-Limassol, 3041, Cyprus.
| | - Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
| | - Megan Kennedy
- John W. Scott Health Sciences Librarian, University of Alberta Library, 2K3.28 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB, T6G 2R7, Canada.
| | - Elizabeth Papathanassoglou
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, T6G 1C9, Canada.
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de la Rie SM, van Sint Fiet A, Bos JBA, Mooren N, Smid G, Gersons BPR. Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT): treatment protocol description and a case study. Eur J Psychotraumatol 2021; 12:1929026. [PMID: 34262665 PMCID: PMC8259855 DOI: 10.1080/20008198.2021.1929026] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as 'the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.' These events can provoke emotions such as remorse, guilt and shame, and affects someone's self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion: The case of Dusan has shown it is worthwhile to address moral trauma and BEP- MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT.
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Affiliation(s)
- Simone M de la Rie
- ARQ Centrum '45 , ARQ National Psychotrauma Center, Diemen, The Netherlands
| | | | - Jannetta B A Bos
- ARQ Centrum '45 , ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Nora Mooren
- ARQ Centrum '45 , ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Geert Smid
- ARQ Centrum '45 , ARQ National Psychotrauma Center, Diemen, The Netherlands.,Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, The Netherlands
| | - Berthold P R Gersons
- ARQ Centrum '45 , ARQ National Psychotrauma Center, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Amsterdams, The Netherlands
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Inflammatory Genotype Moderates the Association Between Anxiety and Systemic Inflammation in Adults at Risk for Cardiovascular Disease. J Cardiovasc Nurs 2020; 37:64-72. [PMID: 32769481 PMCID: PMC7864985 DOI: 10.1097/jcn.0000000000000742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cardiovascular disease is a significant health problem in the United States, attributed to more than 30% of all deaths annually. Anxiety has been associated with cardiovascular disease risk and is thought to be associated with cardiovascular disease risk through inflammatory pathways. OBJECTIVE The purposes of this study were to examine the relationship between anxiety and systemic inflammation in individuals at risk for cardiovascular disease and to determine if single-nucleotide polymorphisms (SNPs) associated with inflammation moderate this relationship. METHODS A secondary analysis was conducted using baseline data from a study investigating the impact of genetics on response to a cardiovascular disease risk reduction intervention. Anxiety was measured using the Brief Symptom Inventory. Protein levels for C-reactive protein and interleukin-6 (IL-6) were measured in serum, and genomic DNA was assayed for SNPs in the C-reactive protein, IL-6, and IL-6R genes. Multiple linear regressions were performed to examine if anxiety predicted inflammation and if SNPs moderated associations. RESULTS Participants (N = 398) were white, aged 51 ± 13 years, and 73% women. There was a significant interaction between rs4129267 genotype and anxiety (P = .010), with the association significant only for individuals with the CC genotype (b = 0.243, SE = 0.04, P < .001). No moderation effect existed for rs1205 or rs1800797. CONCLUSION Anxiety was positively associated with IL-6 protein levels, but moderation analysis indicated that this was significant only for individuals with the rs4129267 CC genotype. This suggests that genotypic differences may exist in anxiety response, placing certain individuals at higher risk for inflammation and, subsequently, cardiovascular disease.
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Al-Dweik G, AbuRuz ME. Validation of the Arabic Version of the Brief Symptom Inventory to Measure Anxiety in Patients With Acute Myocardial Infarction. J Nurs Meas 2020; 28:JNM-D-18-00089. [PMID: 32179722 DOI: 10.1891/jnm-d-18-00089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Anxiety after acute myocardial infarction is well-known phenomenon. This study aimed to examine the psychometric properties of the Arabic version of the Brief Symptom Inventory to measure anxiety in this population. METHODS This was a prospective observational study among 460 patients. Patients answered the Brief Symptom Inventory and the Hospital Anxiety and Depression Scale to measure anxiety. Complications and other clinical variables abstracted from medical records. RESULTS Cronbach's α was .86, indicating adequate internal consistency. The item-total correlations and all interitem correlations were all acceptable. Anxiety was independent predictor for complication after acute myocardial infarction and higher in females supporting the construct validity. CONCLUSION Arabic version of the Brief Symptom Inventory is a valid and reliable instrument to measure anxiety after acute myocardial infarction.
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Biddle MJ, Moser DK, Pelter MM, Robinson S, Dracup K. Predictors of Adherence to Self-Care in Rural Patients With Heart Failure. J Rural Health 2019; 36:120-129. [PMID: 31840332 DOI: 10.1111/jrh.12405] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The common reality of not following a recommended course of treatment is a major cause of poor health outcomes in patients with heart failure (HF). The purpose of this study was to identify predictors of adherence to HF self-care recommendations in rural HF patients who received an intervention to promote symptom management and self-care. METHODS Data from 349 rural HF patients (42% female, 90% Caucasian) randomized to the intervention arms of the study were used. Adherence was measured using the European Heart Failure Self-Care Scale questionnaire, a brief measure that asks patients to report their adherence to a variety of recommended HF symptom management behaviors (ie, daily weight monitoring, when to call the physician, medications, diet, and exercise). The following predictors were tested: age, gender, marital status, education level, depression score (measured using PHQ-9), anxiety score (measured with the Brief Symptom Inventory), and level of perceived control (measured using Control Attitudes Scale-R). Multivariate linear regression was used to test the model. RESULTS The model to predict adherence was significant (P < .0001). Of the covariates tested in the regression model, being a male (P = .009), having less anxiety (P = .018), not being depressed (P = .017), and having higher perceived control (P = .003) were predictors of improved self-care score at 3 months. CONCLUSION Adherence is a multifaceted and a challenging behavior based on the assumption that the patient agrees with self-care recommendations. These data suggest interventions designed to promote adherence behaviors should include an assessment of gender, anxiety, depression, and perceived control for optimal outcomes.
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Affiliation(s)
- Martha J Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Michele M Pelter
- School of Nursing, University of California, San Francisco, California
| | - Susan Robinson
- School of Nursing, University of California, San Francisco, California
| | - Kathleen Dracup
- School of Nursing, University of California, San Francisco, California
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Evidence of Arabic Version of the Control Attitude Scale-Revised Efficacy to Measure Perceived Control in Acute Myocardial Infarction Patients. J Nurs Meas 2019; 27:247-258. [PMID: 31511408 DOI: 10.1891/1061-3749.27.2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Perceived control plays a vital role in controlling negative consequences during disease process. The purpose of this study was to test the psychometric properties of the Arabic version of the Control Attitudes Scale-Revised (CAS-R) among patients with acute myocardial infarction (AMI). METHODS 375 patients with a confirmed diagnosis of AMI participated in this study. Reliability was assessed by Cronbach's alpha, item-total correlations, and interitem correlations. Construct validity was examined by hypotheses testing. RESULTS Cronbach's alpha was .85. All items were homogenous, since item-total correlation coefficients and interitem correlation coefficients were acceptable. Perceived control has a protective effect against anxiety and complications, supporting the construct validity. CONCLUSIONS The Arabic version of the CAS-R is a valid and reliable instrument to measure perceived control in patients with AMI.
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Dalle Grave R, Sartirana M, El Ghoch M, Calugi S. DSM-5 severity specifiers for anorexia nervosa and treatment outcomes in adult females. Eat Behav 2018; 31:18-23. [PMID: 30059831 DOI: 10.1016/j.eatbeh.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate treatment outcomes across the BMI (body mass index)-based DSM-5 severity specifiers in a sample of adult females with anorexia nervosa (AN) treated with enhanced cognitive behavioural therapy (CBT-E). METHOD One hundred and twenty-eight participants with AN (64 outpatients and 64 inpatients) were sub-categorised using DSM-5 severity specifiers and compared by baseline clinical characteristics and treatment outcomes at the end of treatment and at 6- and 12-month follow-ups. RESULTS No significant differences were found across the four severity groups for 'weight recovery' (i.e., BMI ≥ 18.5 kg/m2) or 'good outcome' (i.e., BMI ≥ 18.5 kg/m2 and minimal accompanying eating disorder psychopathology). DISCUSSION Our data suggest that the DSM-5 severity specifiers for anorexia nervosa may have limited clinical utility in predicting treatment outcomes of CBT-E.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy
| | - Massimiliano Sartirana
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda, Verona, Italy.
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Ferrand A, Gorgos A, Ali N, Payot A. Resilience Rather than Medical Factors: How Parents Predict Quality of Life of Their Sick Newborn. J Pediatr 2018; 200:64-70.e5. [PMID: 29958673 DOI: 10.1016/j.jpeds.2018.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/16/2018] [Accepted: 05/15/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the influence of resiliency and stress on parental perspectives of the future quality of life (QOL) of neonatal intensive care unit (NICU) newborns at high risk of neurodevelopmental disability. STUDY DESIGN We conducted a prospective multicenter questionnaire study. Perspectives from parents of newborns at high risk of disability as per neonatal follow-up criteria were compared with a low-risk group consisting of parents of all other NICU newborns. Parental anxiety and resiliency, measured using Brief Symptom Inventory and Sense of Coherence scales, respectively, were associated with QOL projections. RESULTS Parents returned 129 (81%) questionnaires. Parents considering their newborn as currently sicker were more stressed (P = .011) and worried about future physical (P < .001) and mental (P < .001) health, QOL (P < .001), coping (P = .019), and financial (P < .001) and emotional (P = .002) impact on the family. Ooverall, there was no difference between parents of high-risk and low-risk newborns on QOL projections. Almost all parents projected a good future QOL. Less resilient parents projected more pain (P = .04), more financial (P = .019), and emotional (P = .031) impact on their family, and were 10 times more likely to predict that their newborn would remain chronically ill. CONCLUSIONS Parental projection of future QOL of NICU newborns is not associated with risk of disability. Most parents predict overall a good future QOL and focus more on familial impact. The Sense of Coherence scale may be used in clinical settings to identify less resilient parents.
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Affiliation(s)
- Amaryllis Ferrand
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada
| | - Andreea Gorgos
- Division of Neonatology, Department of Pediatrics, McGill University Health Center, McGill University, Montreal, Québec, Canada
| | - Nabeel Ali
- Division of Neonatology, Department of Pediatrics, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Québec, Canada
| | - Antoine Payot
- Division of Neonatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada; Clinical Ethics Unit, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada; CHU Sainte-Justine Research Center, Department of Pediatrics, University of Montreal, Montreal, Québec, Canada; Palliative Care Unit, CHU Sainte-Justine, Montreal, Québec, Canada.
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Doering LV, Chen B, Deng M, Mancini D, Kobashigawa J, Hickey K. Perceived control and health-related quality of life in heart transplant recipients. Eur J Cardiovasc Nurs 2018; 17:513-520. [PMID: 29260888 PMCID: PMC5984108 DOI: 10.1177/1474515117749225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Perceived control has been associated with improved mental health and health-related quality of life (HRQOL) in cardiac populations. However, this concept has not been well-studied in heart transplant groups. AIMS We examine the relationship of perceived control to symptoms of anxiety and depression and HRQOL after transplant. We also examine the extent to which anxiety and depressive symptoms mediate the relationship between perceived control and HRQOL. METHODS Our cross-sectional analysis included 113 adult heart transplant patients from the NEW HEART study. High versus low perceived control groups were determined by median split for chi-square and t-test analyses. Hierarchical multiple linear regression models were used to examine the influence of perceived control on symptoms of depression and anxiety and HRQOL. Mediation analyses included Baron and Kenny's four-step regression approach and Preacher and Hayes' bootstrapping technique to test the indirect effect of perceived control on HRQOL. RESULTS Heart transplant patients who reported lower perceived control were more likely to be female ( p=0.003), and had significantly more depressive symptoms ( p<0.001) and anxiety ( p<0.001), and lower HRQOL ( p<0.001) than those with higher perceived control. Perceived control was a significant predictor in regression models of depressive and anxiety symptoms and HRQOL. In mediation analyses, depressive and anxiety symptoms mediated the effect of perceived control on HRQOL. CONCLUSION Perceived control is associated with improved depressive and anxiety symptoms and HRQOL after transplant. The relationship between perceived control and HRQOL is mediated by depressive and anxiety symptoms. Future interventions should target perceived control to improve overall HRQOL.
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Affiliation(s)
- Lynn V Doering
- Los Angeles School of Nursing, University of California, USA
| | - Belinda Chen
- Los Angeles School of Nursing, University of California, USA
| | - Mario Deng
- David Geffen School of Medicine at UCLA, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Donna Mancini
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, USA
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Bradizza CM, Brown WC, Ruszczyk MU, Dermen KH, Lucke JF, Stasiewicz PR. Difficulties in emotion regulation in treatment-seeking alcoholics with and without co-occurring mood and anxiety disorders. Addict Behav 2018; 80:6-13. [PMID: 29306117 PMCID: PMC5807148 DOI: 10.1016/j.addbeh.2017.12.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022]
Abstract
Emotion regulation difficulties (ERD) are known to underlie mental health conditions including anxiety and depressive disorders and alcohol use disorder (AUD). Although AUD, mood, and anxiety disorders commonly co-occur, no study has examined the association between these disorders and ERD among AUD outpatients. In the current study, emotion regulation (ER) scores of AUD individuals with no co-occurring mental health condition were compared to the ER scores of individuals who met diagnostic criteria for co-occurring mood and/or anxiety disorders. Treatment-seeking AUD individuals (N=77) completed measures of emotion regulation, alcohol use and psychological functioning prior to beginning a 12-week outpatient cognitive-behaviorally oriented alcohol treatment program. Individuals were classified as having no co-occurring mood or anxiety disorder (AUD-0, n=24), one co-occurring disorder (AUD-1, n=34), or two or more co-occurring disorders (AUD-2, n=19). Between-group differences in emotion regulation, quantity/frequency of alcohol consumption, positive and negative affect, affective drinking situations, negative mood regulation expectancies, distress tolerance, alexithymia, trait mindfulness, and psychological symptom severity were examined. Compared with the AUD-0 group, the AUD-2 group reported significantly greater ERD, psychiatric distress and alcohol consumption, more frequent drinking in response to negative affect situations, greater interference from negative emotions, and less use of mindfulness skills. The AUD-1 group differed from AUD-0 group only on the DERS lack of emotional awareness (Aware) subscale. Emotion regulation scores in the AUD-0 group were comparable to those previously reported for general community samples, whereas levels of ERD in the AUD-1 and AUD-2 were similar to those found in other clinical samples. Implications for the inclusion of ER interventions among AUD patients who might most benefit from such an intervention are discussed.
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Affiliation(s)
- Clara M Bradizza
- Research Institute on Addictions, University at Buffalo, State University of New York, United States.
| | - Whitney C Brown
- Research Institute on Addictions, University at Buffalo, State University of New York, United States.
| | - Melanie U Ruszczyk
- Research Institute on Addictions, University at Buffalo, State University of New York, United States.
| | - Kurt H Dermen
- Research Institute on Addictions, University at Buffalo, State University of New York, United States.
| | - Joseph F Lucke
- Research Institute on Addictions, University at Buffalo, State University of New York, United States.
| | - Paul R Stasiewicz
- Research Institute on Addictions, University at Buffalo, State University of New York, United States.
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Hsu FC, Sink KM, Hugenschmidt CE, Williamson JD, Hughes TM, Palmer ND, Xu J, Smith SC, Wagner BC, Whitlow CT, Bowden DW, Maldjian JA, Divers J, Freedman BI. Cerebral Structure and Cognitive Performance in African Americans and European Americans With Type 2 Diabetes. J Gerontol A Biol Sci Med Sci 2018; 73:407-414. [PMID: 29309525 PMCID: PMC5861881 DOI: 10.1093/gerona/glx255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/28/2017] [Indexed: 11/13/2022] Open
Abstract
Background African Americans typically perform worse than European Americans on cognitive testing. Contributions of cardiovascular disease (CVD) risk factors and educational quality to cognitive performance and brain volumes were compared in European Americans and African Americans with type 2 diabetes. Methods Association between magnetic resonance imaging-determined cerebral volumes of white matter (WMV), gray matter (GMV), white matter lesions (WMLV), hippocampal GMV, and modified mini-mental state exam (3MSE), digit symbol coding (DSC), Rey Auditory Verbal Learning Test (RAVLT), Stroop, and verbal fluency performance were assessed in Diabetes Heart Study Memory in Diabetes (MIND) participants. Marginal models incorporating generalized estimating equations were employed with serial adjustment for risk factors. Results The sample included 520 African Americans and 684 European Americans; 56 per cent female with mean ± SD age 62.8 ± 10.3 years and diabetes duration 14.3 ± 7.8 years. Adjusting for age, sex, diabetes duration, BMI, HbA1c, total intracranial volume, scanner, statins, CVD, smoking, and hypertension, WMV (p = .001) was lower and WMLV higher in African Americans than European Americans (p = .001), with similar GMV (p = .30). Adjusting for age, sex, education, HbA1c, diabetes duration, hypertension, BMI, statins, CVD, smoking, and depression, poorer performance on 3MSE, RAVLT, and DSC were seen in African Americans (p = 6 × 10-23-7 × 10-62). Racial differences in cognitive performance were attenuated after additional adjustment for WMLV and nearly fully resolved after adjustment for wide-range achievement test (WRAT) performance (p = .0009-.65). Conclusions African Americans with type 2 diabetes had higher WMLV and poorer cognitive performance than European Americans. Differences in cognitive performance were attenuated after considering WMLV and apparent poorer educational quality based on WRAT.
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Affiliation(s)
- Fang-Chi Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kaycee M Sink
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nicholette D Palmer
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jianzhao Xu
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - S Carrie Smith
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Benjamin C Wagner
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Donald W Bowden
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joseph A Maldjian
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory; University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jasmin Divers
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Barry I Freedman
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Centers for Genomics and Personalized Medicine Research and Diabetes Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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14
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Lopes A, Fonseca I, Sousa A, Branco M, Rodrigues C, Coelho T, Sequeiros J, Freitas P. Psychopathological Dimensions in Portuguese Subjects with Transthyretin Familial Amyloid Polyneuropathy. Biomed Hub 2017; 2:1-14. [PMID: 31988916 PMCID: PMC6945894 DOI: 10.1159/000485118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/09/2017] [Indexed: 11/21/2022] Open
Abstract
Background Transthyretin familial amyloid polyneuropathy (TTR-FAP) is a fatal, chronic, progressive disease. It is a rare hereditary amyloidosis, which manifests as a sensorimotor neuropathy and autonomic dysfunction. It begins during adulthood. Aims and Methods Our aim is to evaluate psychopathological dimensions in a population attending a consultation center for TTR-FAP. Two hundred and nine subjects (symptomatic and asymptomatic carriers), 84 men and 127, women participated in the study. Most subjects were married (67.1%) and most of them were still working; 33% were retired from work or on a sick leave. A sociodemographic questionnaire and The Brief Symptom Inventory (BSI) were applied. Statistical analysis was performed (descriptive analysis, Mann-Whitney, Wilcoxon, and Spearman tests). Results The Global Symptom Index (GSI) was significantly higher in patients (p = 0.001). Considering GSI, 32.7% of total subjects were above the median for general population. When subgroups were evaluated, 25.6% of symptomatic carriers, 26.3% of subjects without established diagnosis, and 39.1% of patients were above median. GSI was significantly higher in patients (p = 0.001). Some BSI dimensions were also significantly higher in the patient group (somatization, depression, anxiety, and psychoticism) when compared with carriers. Women scored higher than men. Sick women scored higher for all dimensions except somatization. Asymptomatic carriers scored statistically higher for phobic anxiety (p = 0.01), interpersonal sensitivity, anxiety, and depression. In patients, most dimensions and GSI (rho = 0.33, p = 0.002) had positive correlations with years of disease. Conclusions TTR-FAP patients and carriers are a very vulnerable group for psychological distress and psychopathological problems. Women and patients are at higher risk.
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Affiliation(s)
- Alice Lopes
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal.,ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Fonseca
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal.,EPIUnit and Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal
| | - Alexandra Sousa
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Margarida Branco
- Unidade Corino de Andrade, Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar do Porto, Porto, Portugal
| | - Carla Rodrigues
- Unidade Corino de Andrade, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade, Serviço de Neurofisiologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Sequeiros
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal.,IBMC - Institute for Molecular and Cell Biology and i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- ICBAS - Instituto de Ciências Biomédicos Abel Salazar, Universidade do Porto, Porto, Portugal
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15
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Ventus D, Gunst A, Kärnä A, Jern P. No Evidence for Long-Term Causal Associations Between Symptoms of Premature Ejaculation and Symptoms of Anxiety, Depression, and Sexual Distress in a Large, Population-Based Longitudinal Sample. JOURNAL OF SEX RESEARCH 2017; 54:264-272. [PMID: 27982691 DOI: 10.1080/00224499.2016.1255301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Premature ejaculation (PE) is one of the most common male sexual complaints, but its etiology is unclear. Psychological problems, such as symptoms of anxiety and depression, have traditionally been seen as causal or maintaining etiological components of PE, and previous cross-sectional studies have found weak positive associations between them. The aim of the present study was to test possible causal pathways over time between PE and symptoms of the psychological problems anxiety, depression, and sexual distress. A sample of 985 male Finnish twins and brothers of twins completed a questionnaire in 2006 and 2012. Significant bivariate correlations were found both within and across time between PE and the psychological problems. When fitting structural equation models to test hypothesized causal pathways, symptoms of anxiety and sexual distress at the first measurement time point did not predict future PE. Likewise, PE symptoms at the first measurement did not predict increments or decrements in anxiety, sexual distress, or depression later on. These null findings regarding hypothesized associations may partly be explained by the relatively long time between measurements, or that the measures possibly did not capture the aspects of anxiety that are related to PE.
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Affiliation(s)
| | - Annika Gunst
- b Department of Psychology , University of Turku
| | | | - Patrick Jern
- a Department of Psychology , Åbo Akademi University
- b Department of Psychology , University of Turku
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16
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Easton K, Coventry P, Lovell K, Carter LA, Deaton C. Prevalence and Measurement of Anxiety in Samples of Patients With Heart Failure: Meta-analysis. J Cardiovasc Nurs 2016; 31:367-79. [PMID: 25930162 PMCID: PMC4915759 DOI: 10.1097/jcn.0000000000000265] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Rates of anxiety in patients with heart failure (HF) vary widely, and not all assessment instruments used in this patient population are appropriate. It is timely to consolidate the evidence base and establish the prevalence and variance of anxiety in HF samples. METHODS A systematic review, meta-analysis, and meta-regression were conducted to identify the prevalence, variance, and measurement of anxiety in patients with HF. RESULTS A total of 14,367 citations were identified, with 73 studies meeting inclusion criteria. A random effects pooled prevalence of 13.1% (95% confidence interval [CI], 9.25%-16.86%) for anxiety disorders, 28.79% (95% CI, 23.30%-34.29) for probable clinically significant anxiety, and 55.5% (95% CI, 48.08%-62.83%) for elevated symptoms of anxiety was identified. Rates of anxiety were highest when measured using the Brief Symptom Scale-Anxiety scale (72.3%) and lowest when measured using the Generalised Anxiety Disorder-7 (6.3%). CONCLUSION Many patients with HF would benefit if screened for anxiety and treated. The conceptualization and measurement of anxiety accounted for most variance in prevalence rates. The Generalised Anxiety Disorder-7 or the Hospital Anxiety and Depression Scale appear to be the most appropriate instruments for this clinical population, with evidence to suggest they can discriminate between depression and anxiety, omit somatic items that may contaminate identification of anxiety in a population with physical comorbidities, and provide thresholds with which to differentiate patients and target treatments. Although there are limitations with the collation of diverse measurement methods, the current review provides researchers and clinicians with a more granular knowledge of prevalence estimates of anxiety in a population of HF patients.
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Affiliation(s)
- Katherine Easton
- Katherine Easton, PhD, MRes, BSc (Hons) Translational Research Scientist, CATCH (Centre for Assistive Technology and Connected Healthcare), University of Sheffield, United Kingdom. Peter Coventry, PhD, MSc, MA (Econ), BSc Senior Research Fellow, Institute of Population Health, University of Manchester, United Kingdom. Karina Lovell, PhD, MSc, BA (Hons), RN Director of Research and Professor of Mental Health, School of Nursing, Midwifery & Social Work, University of Manchester, United Kingdom. Lesley-Anne Carter, MSc NHR Doctoral Fellow, Institute of Population Health, University of Manchester, United Kingdom. Christi Deaton, PhD, RN, FAHA, FESC Florence Nightingale Foundation Professor of Clinical Nursing Research, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, United Kingdom
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17
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Raffield LM, Brenes GA, Cox AJ, Freedman BI, Hugenschmidt CE, Hsu FC, Xu J, Wagner BC, Williamson JD, Maldjian JA, Bowden DW. Associations between anxiety and depression symptoms and cognitive testing and neuroimaging in type 2 diabetes. J Diabetes Complications 2016; 30:143-9. [PMID: 26476474 PMCID: PMC4698057 DOI: 10.1016/j.jdiacomp.2015.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
AIMS Anxiety, depression, accelerated cognitive decline, and increased risk of dementia are observed in individuals with type 2 diabetes. Anxiety and depression may contribute to lower performance on cognitive tests and differences in neuroimaging observed in individuals with type 2 diabetes. METHODS These relationships were assessed in 655 European Americans with type 2 diabetes from 504 Diabetes Heart Study families. Participants completed cognitive testing, brain magnetic resonance imaging, the Brief Symptom Inventory Anxiety subscale, and the Center for Epidemiologic Studies Depression-10. RESULTS In analyses adjusted for age, sex, educational attainment, and use of psychotropic medications, individuals with comorbid anxiety and depression symptoms had lower performance on all cognitive testing measures assessed (p≤0.005). Those with both anxiety and depression also had increased white matter lesion volume (p=0.015), decreased gray matter cerebral blood flow (p=4.43×10(-6)), decreased gray matter volume (p=0.002), increased white and gray matter mean diffusivity (p≤0.001), and decreased white matter fractional anisotropy (p=7.79×10(-4)). These associations were somewhat attenuated upon further adjustment for health status related covariates. CONCLUSIONS Comorbid anxiety and depression symptoms were associated with cognitive performance and brain structure in a European American cohort with type 2 diabetes.
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Affiliation(s)
- Laura M Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gretchen A Brenes
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J Cox
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Barry I Freedman
- Department of Internal Medicine - Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Benjamin C Wagner
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA; Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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18
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Abstract
BACKGROUND Heart failure (HF) is a potentially disabling condition requiring significant patient knowledge to manage the requirements of self-care. The need for self-care is important for all patients but particularly for those living in rural areas that are geographically remote from healthcare services. OBJECTIVE The aim of this study was to identify the level of knowledge of rural patients with HF and the clinical and demographic characteristics associated with low levels of HF knowledge. METHODS Baseline data from 612 patients with HF enrolled in the Rural Education to Improve Outcomes in Heart Failure trial were analyzed using the Heart Failure Knowledge Scale, the Short Test of Functional Health Literacy in Adults, and the anxiety subscale of the Brief Symptom Inventory. Multiple linear regression was used to explore the contribution of sociodemographic and clinical variables to levels of HF knowledge. RESULTS The mean (SD) age was 66 (13) years; 59% were men, and 50.5% had an ejection fraction of less than 40%. The mean (SD) percent correct on the Heart Failure Knowledge Scale was 69.5% (13%; range, 25%-100%), with the most frequent incorrect items related to symptoms of HF and the need for daily weights. The men and the older patients scored significantly lower in HF knowledge than did the women and the younger patients (P = 0.002 and 0.011, respectively). The patients with preserved systolic function also scored significantly lower than those with systolic HF (P = 0.030). CONCLUSIONS Patients who are at risk for poor self-care because of low levels of HF knowledge can be identified. Older patients, men, and, patients with HF with preserved systolic function may require special educational strategies to gain the knowledge required for effective self-care.
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19
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Pachankis JE, Rendina HJ, Restar A, Ventuneac A, Grov C, Parsons JT. A minority stress--emotion regulation model of sexual compulsivity among highly sexually active gay and bisexual men. Health Psychol 2014; 34:829-40. [PMID: 25528179 DOI: 10.1037/hea0000180] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Sexual compulsivity represents a significant public health concern among gay and bisexual men, given its co-occurrence with other mental health problems and HIV infection. The purpose of this study was to examine a model of sexual compulsivity based on minority stress theory and emotion regulation models of mental health among gay and bisexual men. METHOD Gay and bisexual men in New York City reporting at least nine past-90-day sexual partners (n = 374) completed measures of distal minority stressors (i.e., boyhood gender nonconformity and peer rejection, adulthood perceived discrimination), hypothesized proximal minority stress mediators (i.e., rejection sensitivity, internalized homonegativity), hypothesized universal mediators (i.e., emotion dysregulation, depression, and anxiety), and sexual compulsivity. RESULTS The hypothesized model fit the data well (RMSEA = 0.05, CFI = 0.98, TLI = 0.95, SRMR = 0.03). Distal minority stress processes (e.g., adulthood discrimination) were generally found to confer risk for both proximal minority stressors (e.g., internalized homonegativity) and emotion dysregulation. Proximal minority stressors and emotion dysregulation, in turn, generally predicted sexual compulsivity both directly and indirectly through anxiety and depression. CONCLUSIONS The final model suggests that gay-specific (e.g., internalized homonegativity) and universal (e.g., emotion dysregulation) processes represent potential treatment targets to attenuate the impact of minority stress on gay and bisexual men's sexual health. Tests of interventions that address these targets to treat sexual compulsivity among gay and bisexual men represent a promising future research endeavor.
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Affiliation(s)
- John E Pachankis
- Department of Chronic Disease Epidemiology, Social and Behavioral Sciences Division
| | | | - Arjee Restar
- Center for HIV/AIDS Educational Studies & Training (CHEST)
| | - Ana Ventuneac
- Center for HIV/AIDS Educational Studies & Training (CHEST)
| | - Christian Grov
- Center for HIV/AIDS Educational Studies & Training (CHEST)
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20
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Nesbitt T, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, Moser DK, Pelter MM, Robinson S, Wilson MD, Cooper L, Dracup K. Correlates of quality of life in rural patients with heart failure. Circ Heart Fail 2014; 7:882-7. [PMID: 25146960 DOI: 10.1161/circheartfailure.113.000577] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is abundant research indicating poor physical, psychological, and social functioning of patients with chronic heart failure (HF), a reality that can lead to poor health-related quality of life (QoL). Little is known about the experience of rural patients with HF. METHODS AND RESULTS This study was part of a randomized clinical trial titled Rural Education to Improve Outcomes in Heart Failure (REMOTE-HF) designed to test an education and counseling intervention to improve self-care in patients with HF. We evaluated 612 rural patients. Multiple validated questionnaires were administered to assess patient perceptions of health and health literacy. Baseline factors were collected and compared with baseline QoL measures only. Patients' health-related QoL was assessed using the Minnesota Living with Heart Failure scale. The data were analyzed using a general linear model to test the association of various patient characteristics with QoL in rural patients with HF. Patients were 65.8 (+12.9) years of age. The majority were men (58.7%), married (56.4%), and had completed a high-school education (80.9%). Factors associated with reduced QoL among this population include geographic location, younger age, male sex, higher New York Heart Association class, worse HF knowledge, poorer perceived control, and symptoms of depression or anxiety. The data provided no evidence of an association between left ventricular ejection fraction and QoL. CONCLUSIONS This study of rural patients with HF confirms previously identified factors associated with perceptions of QoL. However, further study is warranted with an urban control group. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
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Affiliation(s)
- Thomas Nesbitt
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Sahar Doctorvaladan
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Jeffrey A Southard
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.).
| | - Satinder Singh
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Anne Fekete
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Kate Marie
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Debra K Moser
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Michelle M Pelter
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Susan Robinson
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Machelle D Wilson
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Lawton Cooper
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
| | - Kathleen Dracup
- From the School of Medicine, Associate Vice Chancellor for Strategic Technologies and Alliances (T.N.), School of Medicine (S.D.), Division of Cardiovascular Medicine (J.A.S.), Department of Internal Medicine (S.S.), Clinical Translational Science Center (A.F.), Center for Health and Technology (K.M.), and School of Medicine, Division of Biostatistics (M.D.W.), University of California, Davis; Center for Biobehavioral Research in Self-Management of Cardiopulmonary Disease, College of Nursing, University of Kentucky, Lexington (D.K.M.); Orvis School of Nursing, University of Nevada, Reno (M.M.P.); School of Nursing, Department of Physiological Nursing, University of California, San Francisco (S.R., K.D.); and National Heart, Lung, and Blood Institute, Bethesda, MD (L.C.)
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Howie-Esquivel J, Bibbins-Domingo K, Clark R, Evangelista L, Dracup K. A Culturally Appropriate Educational Intervention Can Improve Self-Care in Hispanic Patients With Heart Failure: A Pilot Randomized Controlled Trial. Cardiol Res 2014; 5:91-100. [PMID: 28348704 PMCID: PMC5358169 DOI: 10.14740/cr346w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hispanics constitute the largest US ethnic group and have been shown to have more frequent heart failure (HF) hospitalizations than non-Hispanic whites. Disease management programs can reduce HF hospitalizations and mortality by increasing patient self-care, but most programs are limited to patients who speak English. Therefore, we hypothesize that Project Fluido, a culturally appropriate self-care education intervention, will improve self-care behaviors and knowledge in Hispanic patients with HF compared with usual care (UC). METHODS Project Fluido (N = 42) was a randomized controlled pilot trial over 3 months. Patients in the experimental group (n = 22) received individualized education in Spanish using the "teach-back" method on the following: high salt foods, when to call the physician, when to report weight gain and the use of diuretics. They also received a nurse-initiated phone call every 2 weeks, a script for calling their physician with increased symptoms, a weight scale and a daily diary to complete. The UC group (n = 20) received a scale and written information. Self-care was measured using the self-care heart failure index and knowledge using teach-back scores. Four knowledge topics were included when using teach-back. RESULTS Participants' mean age was 57 ± 14 years, 57% (24) were male, 64% (27) had hypertension, 86% (36) were New York Heart Association Class I-III and 65% (26) had HF with reduced ejection fraction. Participant health literacy scores showed poor health literacy in 31% (n = 13) and 67% (n = 28) spoke Spanish only. Household income was reported as < $20,000 in 93% (n = 39). Self-care and knowledge scores significantly improved (P < 0.04 and P < 0.02, respectively) in the intervention group compared to UC. CONCLUSION The intervention utilized in Project Fluido was a remarkably effective method to improve self-care and HF knowledge in a group of Spanish-speaking HF patients. This improvement is in spite of low physical function, health literacy, acculturation and economic challenges. In addition, teach-back was an effective teaching strategy to improve HF knowledge. Future work is needed to investigate the relationship between increased self-care knowledge, readmissions, and mortality in Spanish-speaking patients with HF.
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Affiliation(s)
- Jill Howie-Esquivel
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco General Hospital, San Francisco, CA, USA
| | - Robyn Clark
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
| | | | - Kathleen Dracup
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
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Dekker RL, Lennie TA, Doering LV, Chung ML, Wu JR, Moser DK. Coexisting anxiety and depressive symptoms in patients with heart failure. Eur J Cardiovasc Nurs 2014; 13:168-76. [PMID: 24408885 DOI: 10.1177/1474515113519520] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Among patients with heart failure (HF), anxiety symptoms may co-exist with depressive symptoms. However, the extent of overlap and risk factors for anxiety symptoms have not been thoroughly described. PURPOSE The aim of this study was to describe the coexistence of anxiety and depressive symptoms, and to determine the predictors of anxiety symptoms in patients with HF. METHODS The sample consisted of 556 outpatients with HF (34% female, 62±12 years, 54% New York Heart Association (NYHA) class III/IV) enrolled in a multicenter HF quality of life registry. Anxiety symptoms were assessed with the Brief Symptom Inventory-anxiety subscale. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI). We used a cut-point of 0.35 to categorize patients as having anxiety symptoms or no anxiety symptoms. Logistic regression was used to determine whether age, gender, minority status, educational level, functional status, comorbidities, depressive symptoms, and antidepressant use were predictors of anxiety symptoms. RESULTS One-third of patients had both depressive and anxiety symptoms. There was a dose-response relationship between depressive symptoms and anxiety symptoms; higher levels of depressive symptoms were associated with a higher level of anxiety symptoms. Younger age (odds ratio (OR)= 0.97, p=0.004, 95% confidence interval (CI) 0.95-0.99) and depressive symptoms (OR =1.25, p<0.001, 95% CI 1.19-1.31) were independent predictors of anxiety symptoms. CONCLUSIONS Patients with HF and depressive symptoms are at high risk for experiencing anxiety symptoms. Clinicians should assess these patients for comorbid anxiety symptoms. Research is needed to test interventions for both depressive and anxiety symptoms.
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Abstract
OBJECTIVE Our objectives were to describe trajectories of depressive symptoms and pain at hospital discharge and 6 weeks later and to examine the relationship of persistent depressive symptoms to pain. METHODS Before and 6 weeks after hospital discharge, 251 patients undergoing cardiac surgery (mean [SD] age = 67.3 [9.5] years; 73% male) completed the Beck Depression Inventory and the Brief Pain Inventory (BPI). Patients were categorized into two groups based on the presence or absence of persistent depressive symptoms (Beck Depression Inventory score >10 at both times). Between-group differences in pain interference (BPI-INT) and pain severity (BPI-SEV) were evaluated using repeated-measures analysis of variance. Linear regressions were performed to determine if changes in depressive symptoms were related to BPI-INT and BPI-SEV, controlling for demographic and clinical data. RESULTS Persistent (16.3%) or worsening depressive symptoms (15.3%) from hospital discharge to 6 weeks were observed; many experienced at least some persistent pain (BPI-INT 67.8%, BPI-SEV 47.8%). From discharge to 6 weeks, patients with persistent depressive symptoms sustained higher levels of BPI-INT (p < .001) and BPI-SEV (p < .003). In multivariate analysis, only changes in depressive symptoms, not clinical and demographic variables, were related to BPI-INT (p < .001) and BPI-SEV (p = .001). CONCLUSIONS Persistent depressive symptoms are independently associated with continued pain up to 6 weeks after hospital discharge. Successful treatment of ongoing pain should include screening for depressive symptoms and initiation of appropriate treatment. TRIAL REGISTRATON Clinicaltrials.gov Identifier: NCT00522717.
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Abstract
BACKGROUND Despite high rates of postcardiac surgery depression, studies of depression treatment in this population have been limited. OBJECTIVE The aim of this study was to evaluate early cognitive behavioral therapy (CBT) in a home environment in patients recovering from cardiac surgery. METHODS : From July 2006 through October 2009, we conducted a randomized controlled trial and enrolled 808 patients who were screened for depressive symptoms using the Beck Depression Inventory (BDI) in the hospital and 1 month later. Patients were interviewed using the Structured Clinical Interview for DSM-IV; those who met criteria for clinical depression (n = 81) were randomized to CBT (n = 45) or usual care (UC; n = 36). After completion of the UC period, 25 individuals were offered later CBT (UC + CBT). RESULTS Main outcomes (depressive symptoms [BDI] and clinical depression [Structured Clinical Interview for DSM-IV]) were evaluated after 8 weeks using intention-to-treat principles and linear mixed models. Compared with the UC group, in the CBT group, there was greater decline in BDI scores (β = 1.41; 95% confidence interval [CI], 0.81-2.02; P = < .001) and greater remission of clinical depression (29 [64%] vs 9 [25%]; number need to treat, 2.5; 95% CI, 1.7-4.9; P < .001). Compared with the early CBT group (median time from surgery to CBT, 45.5 days) the later UC + CBT group (median time from surgery to CBT, 122 days) also experienced a reduction in BDI scores, but the group × time effect was smaller (β = 0.79; 95% CI, 0.10-1.47; P = .03) and remission rates between the 2 groups did not differ. CONCLUSIONS Early home CBT is effective in depressed postcardiac surgery patients. Early treatment is associated with greater symptom reduction than similar therapy given later after surgery.
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25
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Wu JR, Lennie TA, Dekker RL, Biddle MJ, Moser DK. Medication adherence, depressive symptoms, and cardiac event-free survival in patients with heart failure. J Card Fail 2013; 19:317-24. [PMID: 23663814 DOI: 10.1016/j.cardfail.2013.03.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/07/2013] [Accepted: 03/23/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medication nonadherence and depressive symptoms predict hospitalization and death in patients with heart failure (HF). Depressed patients have lower medication adherence than nondepressed patients. However, the predictive power of the combination of medication adherence and depressive symptoms for hospitalization and death has not been investigated in patients with HF. OBJECTIVE The aim of this study was to explore the combined influence of medication adherence and depressive symptoms for prediction of cardiac event-free survival in patients with HF. METHODS AND RESULTS We monitored medication adherence in 216 HF patients who completed the Patient Health Questionnaire-9 (PHQ-9) at baseline. Medication adherence was measured objectively with the use of the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data on cardiac events. Survival analyses were used to compare cardiac event-free survival among groups. The risk of experiencing a cardiac event for patients with medication nonadherence and depressive symptoms was 5 times higher than those who were medication adherent without depressive symptoms. The risk of experiencing a cardiac event for patients with only 1 risk factor was 1.2-1.3 times that of those with neither risk factor. CONCLUSIONS Medication nonadherence and depressive symptoms had a negative synergistic effect on cardiac event-free survival in patients with HF.
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Affiliation(s)
- Jia-Rong Wu
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.
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26
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Moser DK, Heo S, Lee KS, Hammash M, Riegel B, Lennie TA, Arslanian-Engoren C, Mudd-Martin G, Albert N, Watkins J. 'It could be worse ... lot's worse!' Why health-related quality of life is better in older compared with younger individuals with heart failure. Age Ageing 2013; 42:626-32. [PMID: 23832262 DOI: 10.1093/ageing/aft078] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND health-related quality of life (HRQOL) is markedly impaired in patients with heart failure (HF). Despite worse prognosis and physical status, older patients have better HRQOL than younger patients. OBJECTIVE to determine reasons for differences in HRQOL in older compared with younger HF patients. METHODS a mixed methods approach was used. HRQOL was assessed using the Minnesota Living with HF Questionnaire and compared among HF patients (n = 603) in four age groups (≤ 53, 54-62, 63-70 and ≥ 71 years). Socio-demographic/clinical and psychological factors related to HRQOL were determined in four groups using multiple regressions. Patients (n = 20) described their views of HRQOL during semi-structured interviews. RESULTS HRQOL was worse in the youngest group, and best in the two oldest groups. The youngest group reported higher levels of depression and anxiety than the oldest group. Anxiety, depression and functional capacity predicted HRQOL in all age groups. Qualitatively, patients in all age groups acknowledged the negative impact of HF on HRQOL; nonetheless older patients reported that their HRQOL exceeded their expectations for their age. Younger patients bemoaned the loss of activities and roles, and reported their HRQOL as poor. CONCLUSIONS better HRQOL among older HF patients is the result, in part, of better psychosocial status. The major factor driving better HRQOL among older patients is a change with advancing age in expectations about what constitutes good HRQOL.
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Affiliation(s)
- Debra K Moser
- College of Nursing, University of Kentucky, 527 CON Rose Street, Lexington, Kentucky 40515, USA.
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Hwang B, Moser DK, Dracup K. Knowledge is insufficient for self-care among heart failure patients with psychological distress. Health Psychol 2013; 33:588-96. [PMID: 23815766 DOI: 10.1037/a0033419] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We conducted a study to identify barriers to, and factors promoting, self-care among heart failure (HF) patients with higher or lower levels of knowledge. METHOD Baseline data from 612 patients with HF enrolled in the REMOTE-HF trial were analyzed. Using median splits on the HF Knowledge Scale and the European HF Self-Care Behavior Scale, patients were divided into four groups: (a) low knowledge and good self-care, (b) low knowledge and poor self-care, (c) high knowledge and good self-care, and (d) high knowledge and poor self-care. Characteristics of the groups were compared using ANOVA, Kruskal-Wallis tests, and chi-square tests, followed by pairwise tests with Bonferroni correction. Variables significant in the univariate analyses were evaluated as predictors of self-care using hierarchical multiple linear regression. The potential moderating effect of knowledge was tested with interaction terms. RESULTS The four groups did not differ in sociodemographics or health literacy scores, but differed in New York Heart Association (NYHA) class, comorbidities, and scores on depression, anxiety, and perceived control. In post hoc pairwise tests, patients with high knowledge and poor self-care tended to have worse NYHA class, greater depression and anxiety, and lower levels of perceived control than others. In the multivariate analysis, knowledge, depressive symptoms, and perceived control were significant predictors of self-care, as was the interaction between knowledge and anxiety. CONCLUSIONS Screening and treatment of depression and anxiety is important in improving self-care among HF patients. HF management programs need to include strategies for increasing patients' perceived control over their heart disease.
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Affiliation(s)
- Boyoung Hwang
- School of Nursing, University of California-Los Angeles
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28
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Affiliation(s)
| | - John Sharp
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow
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29
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Robinson S, Moser D, Pelter MM, Nesbitt T, Paul SM, Dracup K. Assessing health literacy in heart failure patients. J Card Fail 2012; 17:887-92. [PMID: 22041324 DOI: 10.1016/j.cardfail.2011.06.651] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/15/2011] [Accepted: 06/29/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL). METHODS AND RESULTS We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores (P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores. CONCLUSION Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.
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Affiliation(s)
- Susan Robinson
- University of California, San Francisco, San Francisco, California, USA.
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Psychosocial Concerns and Interventions for Patients and Their Identified Support Givers to Help Cope With Acute Manifestations of Advanced Coronary Artery Diseases. J Cardiovasc Nurs 2012; 27:132-46. [DOI: 10.1097/jcn.0b013e318239f647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease. Psychosom Med 2011; 73:803-9. [PMID: 22021458 DOI: 10.1097/psy.0b013e3182364992] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association of symptoms of persistent anxiety with the development of acute cardiac events in patients with coronary heart disease (CHD) followed for 2 years. The prevalence of symptoms of anxiety is high in patients with CHD, but their effect on cardiac events and mortality has not been well characterized. METHODS Of 3522 patients with confirmed CHD enrolled, data on symptoms of anxiety were available at two time points in 3048 patients who were then followed up for detection of the composite end point of hospitalization for myocardial infarction, unstable or stable angina, other cardiac causes, or all-cause mortality. A composite anxiety symptoms score composed of baseline and 3-month anxiety data, in which the continuous-level scores were used, was tested using Cox proportional hazards regression model. Groups (persistent anxiety [anxiety at both time points] versus nonanxious [no anxiety at either time point] versus not persistently anxious [anxiety only at one time point]) were also compared. RESULTS Symptoms of persistent anxiety, whether considered as a continuous- or categorical-level variable, were associated with shorter time to event. Persistent anxiety remained as an independent predictor of the end point after controlling for multiple variables (persistent anxiety as a summary score [hazard ratio = 1.27, 95% confidence interval = 1.067-1.514] and persistent anxiety as a categorical variable [hazard ratio = 1.52, 95% confidence interval = 1.149-2.015]). CONCLUSIONS By measuring anxiety symptoms at more than one time point and controlling for relevant sociodemographic, comorbidity, risk factor, and psychological covariates, we illustrate that symptoms of persistent anxiety are a strong, independent predictor of cardiac event-free survival.
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Schär M, Bodenmann G. Behandlungsverlauf bei depressiven Störungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2011. [DOI: 10.1026/1616-3443/a000069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Derzeit ist unklar, auf welche Faktoren frühe Symptomveränderungen während einer Psychotherapie zurückzuführen sind. Fragestellung: Die vorliegende Studie untersucht verschiedene intrapsychische und interpersonelle Prädiktoren des Patienten und seines Partners auf den Symptomverlauf während einer Depressionsbehandlung. Methode: Die Analysen wurden mittels hierarchisch-linearen Modellen durchgeführt und basieren auf Daten von 60 Paaren, die im Rahmen einer kontrolliert-randomisierten Studie Psychotherapie in Anspruch nahmen. Resultate: Die Ergebnisse zeigen, dass bei den intrapsychischen Variablen vor allem Depressionsdauer, individuelles Coping und allgemeine Lebenszufriedenheit und bei den interpersonellen Variablen die soziale Unterstützung und das negative Verhalten im Konfliktgespräch den Symptomverlauf während der Therapie vorhersagen können. Das Hinzufügen von interpersonellen zu den intrapsychischen Variablen erhöht die Varianzaufklärung von 30% auf 50%. Schlussfolgerung: Interpersonelle Probleme sollten vermehrt in die Therapieplanung einbezogen werden, da sie einen wichtigen Einfluss auf den Symptomverlauf haben, jedoch bisher oft vernachlässigt wurden.
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Affiliation(s)
- Marcel Schär
- Züricher Hochschule für Angewandte Wissenschaften
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