Health locus of control and depression in chronic kidney disease: a dynamic perspective

Social capital and health beliefs: Exploring the effect of bridging and bonding social capital on health locus of control among women in Dhaka

This cross-sectional study examined if social capital affects women's health attributions. The study used the Internet Social Capital Scale (ISCS) and Multidimensional Health Locus of Control (MHLC) Scale to measure Social Capital and Health Locus of Control. A predefined 38-item questionnaire was used to survey 485 purposively selected women. A bidirectional reciprocal structural equation model was used to measure the covariance between Social Capital and Health Locus of Control. We hypothesized that women with strong social capital, particularly those rich in bridging ties, would exhibit a greater sense of agency and empowerment over their health, attributing their health outcomes less to internal factors like fate and more to external influences like powerful others and broader social support. However, we found that when women have higher social capital, their external health locus of control increases. Bridging and bonding social capital lower women's internal health control, but bridging social capital leads to higher attributes to powerful others. Likewise, we expected women with more social capital would exhibit a lower perception of uncontrollability over their health, but is not the case. The findings underscore the necessity for women to have more social capital.

"My body is a cage": A qualitative investigation into the self-discrepancy experiences of young women with metastatic cancer

OBJECTIVES

The current study investigated self-discrepancy experiences of young women with metastatic cancer.

METHODS

Semistructured interviews were conducted. Data were analyzed through interpretative phenomenological analysis.

FINDINGS

Eight female patients with metastatic cancer aged between 27 and 38 years formed the sample. Three superordinate themes emerged: (1) compulsory changes in self-concept with ambivalent evaluations; (2) new ideals not on the agenda of a healthy young woman; and (3) so-called 'minimalist' expectations from others.

DISCUSSION

Findings indicated that diagnosis and treatment of metastatic cancer impose unique developmental challenges for young adult women. Advanced cancer disrupted the tasks and responsibilities of young adulthood, resulting in frustration, grief, isolation, and overcompensation. These findings suggest that a developmental perspective is crucial when working with self-discrepancy experiences of young women with metastatic cancer.

Health Control Beliefs and Attitude Toward Treatment in Psychiatric and Non-Psychiatric Clinical Samples

Although there is accumulating evidence on the potential influencing factors of medication adherence, the knowledge about patients' attitudes and beliefs toward treatment is only partly utilized in adherence-improving strategies. Several internal and external factors determining adherence have been described regarding many chronic somatic diseases but in recent research, insight on psychiatric patients has been exclusively lacking. As a result, there is a scarcity of effective adherence-improving interventions. Identification of any specific differences or similarities between the attitudes toward treatment of psychiatric and non-psychiatric patients would help to support adherent behavior. We recruited 189 participants from four departments of general psychiatry (GEN PSYCH, n = 106), addictology (ADDICT, n = 42) and somatic diseases (NON PSYCH, n = 41). The Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) was performed to assess the patients' attitude toward drug treatment, perceived health locus of control, and psychological reactance. The most robust difference of the PHBQT scores occurred between the GEN PSYCH and ADDICT subgroups. ADDICT patients scored significantly higher on the internal and external health locus of control and on the Psychological Reactance subscale as well. While GEN PSYCH subjects provided higher scores on the Positive Aspect of Medication compared to ADDICT persons. Interestingly, the only difference between the GEN PSYCH and NON-PSYCH groups was the more pronounced mistrust in physicians in the case of psychiatric patients. Our data suggest that mistrust toward medication does not differ in psychiatric and non-psychiatric samples, while the acceptance of the doctor's competency may be stronger in the non-psychiatric sample. The analysis of these factors provides information which could help us better understand this important issue and to develop more efficient interventions for improving adherence.

Opinions of hemodialysis and peritoneum patients regarding depression and psychological problems which they experience: A qualitative study

BACKGROUND

Dialysis are the treatment modalities that affect the quality of life. The objective of this qualitative study is to reveal how hemodialysis and peritoneal dialysis patients perceive depression and psychological problems which they experience.

METHODS

An interpretative phenomenological analysis approach, as espoused by Smith and Osborn provided the framework for this study. The study was performed in hemodialysis and peritoneal dialysis units of a university hospital. 10 adult hemodialysis patients and 10 adult peritoneal dialysis patients, selected. In-depth, semi-structured, face-to-face interviews were held with the patients. All interviews were digitally recorded and subjected to qualitative analysis after transcription.

RESULTS

Analysis revealed themes suggesting that hemodialysis and peritoneal dialysis patients frequently experienced depression as well as psychological problems such as decreased social support, burnout, despair, and anxiety.

CONCLUSIONS

It was concluded as a result of this study that the prolonged hemodialysis and peritoneal dialysis process negatively affected patients with chronic kidney disorders.

The Influence of Coping and Personality Styles on Satisfaction with Life in Patients with Chronic Kidney Disease

The objective of this ex post facto study was to find out how different coping and personality styles influence satisfaction with life in a group of 55 people with chronic kidney disease, 34 of whom were receiving haemodialysis and 21 had undergone a kidney transplant. The participants completed three questionnaires, the SWLS, CAEPO and MIPS. The results showed the relationship between active coping strategies and satisfaction with life in haemodialysis patients, kidney transplant recipients and the total sample. A Pleasure-Enhancing personality style was significantly related to Satisfaction with Life, both in the total sample, and in the two groups separately. There were no significant differences in Satisfaction with Life between the haemodialysis patients and kidney transplant recipients. The theoretical repercussions of these results are discussed, highlighting their applications to clinical practice, in which training in active coping is essential.

The influence of cognitive-behavioral therapy on depression in dialysis patients - meta-analysis

INTRODUCTION

Depressive disorders are the most common mental health problem among patients undergoing dialysis. Furthermore, depression is an independent factor increasing the mortality and frequency of hospitalization in this group of patients, yet psychological intervention programs aimed at improving the mental health of dialysis patients have still not been developed. This meta-analysis aimed to assess the effects of cognitive-behavioral therapy on depressive symptoms in dialysis patients. The main hypothesis of this study is that cognitive-behavioral therapy is an effective psychological method of reducing the severity of depression symptoms among patients undergoing dialysis.

MATERIAL AND METHODS

A systematic search was conducted using Medline, PubMed, Web of Science, Scopus and Google Scholar. Data extraction was carried out by two independent researchers. The severity of depression symptoms in the included studies was measured by the Beck Depression Inventory. A random-effects model was used to estimate the pooled mean difference of these values between patients undergoing CBT and the controls.

RESULTS

Four of the 1841 search results met the inclusion criteria with data from 226 patients who had undergone dialysis therapy due to renal disorders and psychological intervention based on cognitive-behavioral therapy. This therapy significantly reduced the level of depression symptoms in all studies included in the meta-analysis (mean difference = -5.3, p = 0.001; 95% CI: -7.95 to -2.66).

CONCLUSIONS

The study showed that the use of psychological intervention based on cognitive- behavioral therapy was an effective method of decreasing the severity of depressive symptoms in hemodialyzed patients. For the sake of patient well-being, it seems reasonable to extend renal replacement therapy with psychological intervention such as cognitive-behavioral therapy.

The prevalence of mild-to-moderate distress in patients with end-stage renal disease: results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK

OBJECTIVES

To assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics.

DESIGN

Cross-sectional survey using emotion thermometer and distress thermometer problem list.

SETTING

Renal units in four hospital Trusts in the West Midlands, UK.

PARTICIPANTS

Adult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant.

OUTCOMES

The prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs.

RESULTS

In total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalence was significantly higher in younger versus older patients (χ²=14.33; p=0.0008), in women versus men (χ²=6.63; p=0.01) and in black and minority ethnic patients versus patients of white ethnicity (χ²=10.36; p=0.013). Over 40% of patients (n=141) reported needing support. More than 95% of patients reported physical problems and 91.9% reported at least one emotional problem.

CONCLUSIONS

Mild-to-moderate distress is common in patients with ESRD, and there may be substantial unmet support needs. Regular screening could help identify patients whose distress may otherwise remain undetected. Further research into differences in distress prevalence over time and at specific transitional points across the renal disease pathway is needed, as is work to determine how best to support patients requiring help.

Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis

BACKGROUND

Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context.

OBJECTIVE

The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country.

DESIGN

A cross-sectional, descriptive design was used.

METHODS

Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions.

RESULTS

The majority of participants were married men over 60 years of age; 48% achieved high school education. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both conditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014).

CONCLUSION

Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed.

Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross-sectional analysis of the LuLa-cohort

Objective

Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs.

Methods

The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients’ health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression.

Results

Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02–3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97–2.49), a higher age (OR: 1.06; 95% CI: 1.03–1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01–1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82–0.97) was detrimental.

Conclusion

A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician–patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome.

‘Locus of control’, health-related quality of life, emotional distress and disability in Parkinson’s disease

This cross-sectional study evaluated locus of control and its subscales in Parkinson’s disease. A total of 50 consecutive Parkinson’s disease participants and 50 healthy volunteers (control group) were enrolled. External locus of control was significantly higher in Parkinson’s disease participants, whereas internal locus of control had no significant differences. External locus of control and internal locus of control were correlated in control group, but not in Parkinson’s disease. In Parkinson’s disease participants, external locus of control was negatively associated with health-related quality of life as well as positively associated with emotional distress and disease severity (but not with disability). After adjusting to confound variables, the associations remained. On the other hand, internal locus of control was negatively associated with depression.

Health locus of control in Indonesian women with breast cancer: a comparison with healthy women

The aims of this study were to assess whether Indonesian women with breast cancer havea higher external health locus of control (HLC) than healthy women, and to explore the association between HLC and symptoms of anxiety and depression. In this study, 120 consecutive women with breast cancer were recruited at the outpatient surgical oncology clinic at the Hasan Sadikin Hospital in Bandung. One hundred and twenty two healthy women were recruited from the Bandung area as controls. A standard demographic form, Form C of the Multidimensional Health Locus of Control, as well as the Hospital Anxiety and Depression Scale and patients' medical records were used. Data were analyzed using descriptive statistics, t-test, Pearson's correlation, MANOVA and multiple linear regressions. Women with breast cancer had higher scores on all external HLC subscales, i.e. chance, doctor, powerful others and God, and lower internal HLC compared to healthy women. High God LHC scores were associated with a high level of anxiety (β=0.21, p<0.05), whereas none of the HLC subscales were associated with depression. Our results suggest that women with breast cancer tend to have high external HLC, while healthy women tend to have high internal HLC. A strong belief in an external source of control, i.e. God, might be negatively associated with patient emotional adjustment. Further research is needed to give an insight into the direction of this association.

Illness perceptions in dialysis patients and their association with quality of life

The present study explored illness perceptions of end stage renal disease (ESRD) patients on both haemodialysis (HD) and peritoneal dialysis (PD) treatment, and their associations with quality of life. Leventhal's self-regulation model (SRM) was used as a theoretical framework. Illness perceptions and quality of life were assessed with the IPQ-R and the SF-36 in 91 HD and 42 PD patients participating in the NECOSAD-study. Compared to HD patients, PD patients experienced more personal control and had a better understanding of the illness. Illness perceptions explained from 17 to 51% of the variance in quality of life scores. Perception of more symptoms, more consequences and lower personal control were associated with lower well-being. The concept of illness perceptions is useful in understanding the impact of ESRD and of dialysis treatment on quality of life. Interventions aimed at providing more knowledge about ESRD and dialysis, and provision of skills to coping with the illness and its consequences may improve quality of life in dialysis patients.

Gender and health control beliefs among middle-aged and older adults

OBJECTIVE

Internal health locus of control (HLOC) reflects individuals' beliefs that their own behavior influences their health. This study explores the gender difference in internal HLOC among middle-aged and older adults.

METHOD

Using data from two waves of the National Survey of Midlife Development in the United States (MIDUS; N = 1,748), I estimate two-level random-intercept models predicting internal HLOC.

RESULTS

Women report higher levels of health control beliefs than men, especially in older cohorts born in the 1920s and 1930s. Adjustment for health, socioeconomic status, generalized control, and masculinity increases this gender gap, whereas adjustment for femininity and religiosity significantly reduces this difference. Women's higher religiosity and more feminine traits, such as warmth, nurturance, and care, partly explain their higher internal HLOC relative to men.

DISCUSSION

Because femininity and religiosity are positively associated with other-orientation, interventions to increase communal orientation may enhance beliefs in proactive responsibility for one's health among older adults.

The influence of sense of control and cognitive functioning in older cancer patients' depression

OBJECTIVE

This study aimed to evaluate the associations between depression, sense of control, and cognitive functioning, as well as the predictive power of sense of control and cognitive functioning in older cancer patients' depression.

METHODS

Eighty-six cancer patients were referred to a palliative care unit. They completed the 15-item Geriatric Depression Scale, the Cancer Locus of Control, and the Mini Mental State Examination questionnaires.

RESULTS

Higher perceived control over the 'course of illness' was associated with higher levels of depressive symptoms (p < 0.0005), whereas lower perceived control over the 'cause of illness' was associated with higher depressive symptoms. The same results were found for 'cause of illness' between non-depressed and depressed patients (p = 0.001). Multivariate analysis revealed that whereas an external orientation in 'course of illness' increased the likelihood of depression (p = 0.002), an external orientation in 'cause of illness' decreased the likelihood of depression (p = 0.05).

CONCLUSIONS

Older cancer patients' sense of control orientation over the course of illness and the cause of illness predicted the levels of depressive symptomatology.

Participant attributions for global change ratings in unexplained chronic fatigue and chronic fatigue syndrome

The purpose of this mixed methods study was to identify participants' attributions for their global impression of change ratings in a behavioral intervention for unexplained chronic fatigue and chronic fatigue syndrome. At 3-month follow-up, participants (N = 67) were asked "Why do you think you are (improved, unchanged, worse)?" Improved patients pointed to specific behavioral changes, unchanged patients referred to a lack of change in lifestyle, and worsened patients invoked stress and/or specific life events. Identifying patient perceptions of behaviors associated with patient global impression of change-rated improvement and non-improvement may assist in developing more effective management strategies in clinical care.

Psychological factors associated with successful outcomes in home haemodialysis

AIM

Performing haemodialysis therapy at home has been associated with improved survival for end-stage kidney disease patients and can generally be delivered at a lower cost to the healthcare system when compared with centre and satellite unit dialysis. However, only a minority of dialysis dependent end-stage kidney disease patients successfully sustain haemodialysis at home. Current practice for determining dialysis treatment modality and location takes into account medical suitability and social situation, but infrequently formally examines the contribution of psychological factors. This study explores demographic, health, and psychological factors that may predict patients' ability to sustain home haemodialysis.

METHODS

One hundred and thirteen successful and unsuccessful home haemodialysis users were recruited to the study, and 55 responded to self-report measures. Demographic (age, gender, education level, carer support), health (comorbidities, diabetes, psychiatric condition) and psychological (locus of control beliefs, coping styles) information was used as predictor variables for the participants' time maintaining home therapy (Home Time).

RESULTS

In a three-step regression, the model explained 32% of variance in Home Time. Coping styles significantly contributed 16% of the variance in Home Time after accounting for other variables. Adaptive Coping was significantly correlated with the length of time sustaining home therapy.

CONCLUSION

Adaptive coping strategies are associated with improved ability to sustain home haemodialysis therapy. Evidence-based psychological approaches can help patients develop more adaptive coping strategies. More research is needed to assess whether instituting these psychological interventions will assist patients to adopt and sustain dialysis therapies which require increased patient self-management.

Exploring the process of adjusting to diabetic kidney disease

The psychological process of adjusting to diabetic kidney disease (DKD) has been afforded little attention within previous literature. This study aimed to explore the process of adjusting to DKD as a secondary condition to type 1 diabetes. A qualitative method was used in the study design. Eleven participants were interviewed using a semi-structured and exploratory approach. Through inductive thematic analysis, three super-ordinate themes were identified from the data: coming to an understanding over time, managing the impact of DKD and facing the future. The themes demonstrate that the DKD population has complex physical and psychological needs at all stages of their condition. Making sense of kidney disease as a secondary condition and integration of this information with existing beliefs was integral to the adjustment process. Attempts to manage uncertainty and change included asserting control of the situation and use of cognitive strategies. The results support the use of psychological models of adjustment in conceptualising the 'process' of adjustment and suggest the need for psychological interventions to support this population.

The psychosocial experience of patients with end-stage renal disease and its impact on quality of life: findings from a needs assessment to shape a service

Background. A needs assessment was conducted on renal patients registered to a leading hospital trust in London in order to explore their psychological, social, and spiritual needs. The aim of the needs assessment was to create an evidence base for the development of a comprehensive health psychology service to run concurrently with a renal counselling support service within the department. Methodology. This study utilised a series of semistructured face-to-face interviews and focus groups with renal patients and their carers, to explore how ESRD impacted quality of life. Results. A thematic analysis was undertaken. Seven emergent themes were identified that influenced the quality of life of people with EDRD: physiological impact, impact of treatment, impact on daily life, psychological impact, impact on relationships, social impact and coping responses. Conclusion. The needs assessment clearly identified that ESRD carries with it emotional, physical, psychological, social, and existential burdens. The data from this needs assessment study has created an evidence base upon which future health psychology services can be built within this leading UK hospital.

Self-efficacy and health locus of control: relationship to occupational disability among workers with back pain

OBJECTIVES

Although self-efficacy and health locus of control (HLC) have been extensively studied in health research, little is known about their contribution to occupational disability among workers with back pain. This 2 year prospective study examined the association between these control belief constructs and "return to work in good health" (RWGH), a four-category, composite index of back pain outcome.

METHODS

The participants (n = 1,007, participation = 68.4%, follow-up = 86%) were workers with occupational disruptions who sought a medical consultation for non specific back pain in primary care and emergency settings in the Quebec City area, Canada. Information about self-efficacy for return to work (SERW) and HLC, as well as potential confounders, was collected during a telephone interview about 3 weeks after the baseline medical consultation. Polytomous logistic regression was used to assess the relationship between the baseline control variables and RWGH at 2 year. Odds ratios (OR) and their 95% confidence intervals were used to quantify the strength of associations. For all analyses, the "success" category was considered the reference group.

RESULTS

Although bivariate analyses showed a significant association between external HLC and RWGH at 2 year, this relationship was not significant in multivariate analyses. Higher scores on the self-efficacy questionnaire were however protective of "failure to return to work after attempt(s)" (OR: 0.28; 95% CI: 0.14-0.57) and of "failure to return to work" (OR: 0.19; 95% CI: 0.07-0.48) in multivariate analyses.

CONCLUSION

Self-efficacy is an important determinant of the occupational outcome of back pain.

Anxiety, locus of control, and coping strategies among end-stage renal disease patients undergoing maintenance hemodialysis

End-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) have a lot of anxiety. Anxiety and coping are associated with the locus of control; the present investigation aimed to study the state and trait anxiety, locus of control, and active and passive coping among patients on MHD. Thirty MHD patients and 30 controls were administered State-Trait Anxiety Inventory, Rotter's Locus of Control Scale, and Coping Responses Inventory. There were significantly higher scores on state and trait anxiety, respectively (67.53 ± 10.89 vs. 59.40 ± 6.97, P < 0.01, and 62.97 ± 8.45 vs. 58.07 ± 7.06, P < 0.05), and locus of control (11.27 ± 3.55 vs. 9.04 ± 1.86, P < 0.01) in patients as compared to controls. On coping responses, patients and controls differed on positive reappraisal (54.33 ± 4.67 vs. 51.17 ± 3.12, P < 0.01), seeking guidance and support (58.07 ± 5.51 vs. 53.27 ± 4.22, P < 0.01), problem solving (51.03 ± 4.70 vs. 47.57 ± 4.73, P < 0.01), cognitive avoidance (60.27 ± 6.76 vs. 56.80 ± 4.08, P < 0.05), acceptance or resignation (61.67 ± 6.30 vs. 58.83 ± 4.23, P < 0.01), emotional discharge (68.07 ± 6.78 vs. 64.30 ± 4.50, P < 0.05), approach coping (205.57 ± 10.55 vs. 189.70 ± 11.37, P < 0.01), and avoidance coping (255.30 ± 16.45 vs. 241.10 ± 10.50, P < 0.01). A higher prevalence of anxiety trait could be the cause of anxiety in MHD patients besides the medical problems. The locus of control among patients though a mixed one was significantly more toward externalism. Thus, there is a need to identify this group well in advance and prepared not only medically but also psychologically for MHD.

Defining information need in health - assimilating complex theories derived from information science

BACKGROUND

Key policy drivers worldwide include optimizing patients' roles in managing their care; focusing services around patients' needs and preferences; and providing information to support patients' contributions and choices. The term information need penetrates many policy documents. Information need is espoused as the foundation from which to develop patient-centred or patient-led services. Yet there is no clear definition as to what the term means or how patients' information needs inform and shape information provision and patient care.

THEORETICAL SYNTHESIS

The assimilation of complex theories originating from information science has much to offer considerations of patient information need within the context of health care. Health-related research often focuses on the content of information patients prefer, not why they need information. This paper extends and applies knowledge of information behaviour to considerations of information need in health, exposing a working definition for patient information need that reiterates the importance of considering the patient's goals and understanding the patient's context/situation. A patient information need is defined as 'recognition that their knowledge is inadequate to satisfy a goal, within the context/situation that they find themselves at a specific point in the time'. This typifies the key concepts of national/international health policy, the centrality and importance of the patient.

CONCLUSIONS

The proposed definition of patient information need provides a conceptual framework to guide health-care practitioners on what to consider and why when meeting the information needs of patients in practice. This creates a solid foundation from which to inform future research.

Locus of control, depression, and quality of life in Parkinson's Disease

People can attribute the source of control of events that involve them either to internal or external factors. Through this view, depression can be defined as a belief that one's own behavior is not effective. In case of chronic diseases, such as Parkinson's Disease, depression is more frequent than in the general population. The present study aimed to assess locus of control orientation and its relation with depression and quality of life in 30 patients with Parkinson's Disease. Results showed positive correlation between external locus orientation and depression and quality of life scores, and negative correlation between internal orientation and depression.

Association between depressive symptoms and mortality risk in chronic kidney disease

OBJECTIVE

Previous examinations of depression as a predictor of mortality in end-stage renal disease have yielded inconsistent findings. We sought to clarify the possible link with mortality by assessing depression at an earlier stage of renal impairment before the uremic disease state and depressive symptoms become highly confounded, and then following patients during the period of disease progression.

DESIGN

Prospective design using an assessment of depression before initiation of renal replacement therapy to predict mortality status an average of 81 months later in patients in the early stages of chronic kidney disease.

MAIN OUTCOME MEASURES

Mortality status.

RESULTS

After controlling for relevant mortality risk factors (i.e., age, gender, presence of diabetes and cardiovascular disease, and potassium level), results of Cox regression analyses indicated that higher levels of nonsomatic depression symptoms were predictive of an increased mortality risk, χ²(1, N = 359) = 8.02, p = .005. Patients with nonsomatic depression scores 1 SD above the mean had an estimated mortality rate 21.4% higher than average scorers in this sample.

CONCLUSION

Clinical implications of these findings point to the importance of assessment and treatment of depressive symptoms in patients with chronic kidney disease.

[The role of psychological interventions in dialysis: an exploratory study]

Patients suffering from end-stage renal disease (ESRD) have a very reduced quality of life accompanied by a severe emotional distress (high worries-anxiety-depression). However, in Belgium, no regular psychological intervention is proposed to dialyzed patients. Our objective is to show that psychological intervention can significantly decrease the emotional distress of patients with ESRD. Eleven sessions of structured interventions are proposed to ESRD patients. Eligibility criteria are to be major, to not present confusion or/and dementia, to have been on dialysis treatment for at least 3months, to have obtained 14 or more on HAD-scale. Interventions carry on the management of anxious and depressive symptoms and of the disease itself. This constitutes three independent modules. Questionnaires are filled in by the patients at various stages to evaluate the anxiety and the depression (HADS), the worries (Penn State) and the quality of life (KDQoL-SF). Results for the 47 ESRD patients show a significant reduction of the scores of anxiety, depression and worries and a significant growth of quality of life. In parallel, a decrease in the serum calcium-phosphorus product analyzed before dialysis has been noted.

Age, Relative Autonomy and Change in Health Locus of Control Beliefs

Health locus of control (HLC) describes an individual’s characteristic attribution of health outcomes to internal or external causes. This four-year longitudinal study examined changes in HLC beliefs among 124 members of a health-promotion facility, related to their age (22—81) and relative autonomy toward health-related goals. HLC beliefs changed with age as developmental theories of control striving would predict. Holding age aside, the pursuit of health goals with more relative autonomy significantly offset the growth of external-chance HLC beliefs. Lack of autonomy thus appears to permit development of fatalistic attributions that may affect later coping with adverse health events.

Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients

End-stage renal disease (ESRD) is a growing public health concern and non-adherence to treatment has been associated with poorer health outcomes in this population. Depression, likely to be the most common psychopathology in such patients, is associated with increased morbidity and mortality. We compared psychological measures and self-reported medication adherence of 94 kidney transplant recipients to those of 65 patients receiving hemodialysis in a major medical center in Brooklyn, New York. Compared to the transplant group, the hemodialysis cohort was significantly more depressed as determined by the Beck Depression Inventory score. They also had a significantly lower adherence to medication as reported on the Medication Therapy Adherence Scale. Using hierarchical multiple regression analysis, the variance in depression was the only statistically significant predictor of medication adherence beyond gender and mode of treatment, accounting for an additional 12% of the variance. Our study strongly suggests that a depressive affect is an important contributor to low medication adherence in patients with ESRD on hemodialysis or kidney transplant recipients.

Self-reported outcomes after anterior cruciate ligament reconstruction: an internal health locus of control score comparison

PURPOSE

The purpose of this study was to evaluate the influence of high or low internal health locus of control (HLOC) scores on knee function and sports activity self-reports.

METHODS

The Multidimensional HLOC Scale, the Knee Outcome Survey (KOS) Activities of Daily Living Scale (ADLS) and Sports Activity Scale (SAS), and the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation and Current Health Assessment surveys were mailed to 335 subjects at a minimum of 2 years after anterior cruciate ligament reconstruction.

RESULTS

Of the subjects, 198 returned completed surveys at 5.1 +/- 2.9 years after surgery. Compared with the group with low internal HLOC scores, the group with high internal HLOC scores had better KOS-ADLS scores (89.6 +/- 13.7 v 77.4 +/- 23.9, P < .0001), KOS-SAS scores (85.2 +/- 18 v 70 +/- 29, P < .0001), global ADLS ratings (90.7 +/- 12.8 v 77.4 +/- 23.9, P < .0001), global SAS ratings (81.8 +/- 20.6 v 70 +/- 29.4, P < .0001), 2000 IKDC Subjective Knee Evaluation scores (80.9 +/- 17.7 v 68.3 +/- 25.2, P < .0001), and 2000 IKDC Current Health Assessment scores for physical function (90.2 +/- 14 v 80.5 +/- 24.6, P = .001), social function (92.6 +/- 14.8 v 85.8 +/- 21.1, P = .014), bodily pain (80.7 +/- 17.7 v 68.7 +/- 24.6, P < .001), mental health (77.9 +/- 14.2 v 70.6 +/- 19.2, P = .005), and vitality (65.1 +/- 19 v 58.8 +/- 21, P = .04). Current knee function scores (8.7 +/- 1.8 v 7.1 +/- 2.9, P < .0001) and KOS-SAS sports activity level scores (chi(2) = 11.2, P = .01) were also higher in the group with high internal HLOC scores compared with the group with low scores.

CONCLUSIONS

Patients with high internal HLOC scores were more satisfied with knee function.

LEVEL OF EVIDENCE

Level IV, prognostic case series.