A Prospective Study of the Effects of Psychological Resources and Depression in Essential Hypertension

How Online Patient-Provider Communication Impacts Quality of Life: Examining the Role of Patient-Centered Care and Health Competence

The question of how patient-provider communication affects health outcomes has been a longstanding concern for health communication scholarship and practice. As patient-provider communication becomes increasingly mediated by digital technologies, much research has sought to compare online patient-provider communication (OPPC) with that conducted in-person, weighing its relative merits against its costs and barriers. This line of inquiry has mostly focused on the comparative benefits of OPPC for service delivery with little attempt to link these benefits to the wider health implications of OPPC. Consequently, the mechanisms that explain the impacts of OPPC on patients' overall wellbeing have been underexamined. Through a survey of 681 participants in China, this study examined the direct and indirect pathways between OPPC and quality of life (i.e., sleep, exercise, social activities, and psychological wellbeing). Our results demonstrate statistically significant direct relationships between OPPC and the four quality-of-life constructs examined as well as the mediation effects of patient-centered care and health competence in these relationships. The findings call for greater attention to the longer-term contributions of OPPC in empowering patients, especially those who are underserved by the healthcare system.

Impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students

The aim of this study was to assess the impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students. Participants completed the instruments Body Shape Questionnaire (reduced version, BSQ-8B), Male Body Dissatisfaction Scale (reduced version, MBDS-R), Three-Factor Eating Questionnaire (reduced version, TFEQ-18), Perceived Health Competence Scale (bifactorial version, PHCS-B), World Health Organization Quality of Life Questionnaire-Short Form (WHOQoL-bref) and a questionnaire for characterization of sample. Psychometric properties of instruments were previously evaluated by confirmatory factor analysis. A hypothetical model for each sex was developed and tested. In both model surveys the aspects of the body image (BSQ-8B: body shape concern; MBDS-R: musculature and general body appearance), of eating behavior (TFEQ-18: cognitive restriction, emotional eating, and uncontrolled eating) and of the perceived health competence (PHCS-B: expectations of achieving the desired health results and competence in health behaviors) were used as direct predictors on quality of life (WHOQoL-bref). The variables age, medication use for body change, food supplement use for body change, and body mass index (BMI) were inserted in the aspects of the body image. The variables course shift, initial expectation regarding the course, self-reported performance in the course, concomitant work activities to studies, and economic class were inserted into the quality of life. The model surveys were evaluated using structural equation modeling. A level of significance of 5% was used. A total of 2,198 university students (female = 63.5%), including 1,151 Brazilians and 1,047 Portuguese, participated of study (locally representative samples). The average age of women was 20.8 ± 2.4 years and of men was 21.3 ± 3.3 years. The psychometric properties of the instruments were adequate, except for the PHCS, which was adjusted for each sex. The models presented variance explained of 54% and 49% for women and men, respectively. In both sexes, the students' perceived health competence and academic variables contributed significantly to their quality of life, and age, BMI, and medication and supplement use were significant factors relating to how a student views his or her body image. Women's quality of life was associated with body shape concern and emotional eating aspects. Men's quality of life was associated with general body appearance and cognitive restriction aspects. These results can be used to create and implement educational programs to improve quality of life of university students.

Effects of psychotherapy in combination with pharmacotherapy, when compared to pharmacotherapy only on blood pressure, depression, and anxiety in female patients with hypertension

We investigated effects of metacognitive detached mindfulness therapy and stress management training on hypertension and symptoms of depression and anxiety, as compared to a control condition. A total of 45 female patients (mean age: M = 36.49 years) were randomly assigned to one of three conditions: metacognitive detached mindfulness therapy, stress management training, and the control condition. Blood pressure and symptoms of depression and anxiety decreased from baseline to post-test, to follow-up. Group comparisons showed that blood pressure and symptoms of depression and anxiety decreased more in psychotherapeutic groups than in the control group. Psychotherapeutic treatment of hypertension reduced blood pressure and symptoms of depression and anxiety. Positive effects were observable at follow-up 8 weeks later.

Correlates of Health-Related Quality of Life Among Korean Immigrant Elders

Health-related quality of life (HRQOL) is a key clinical outcome, particularly for individuals with chronic conditions such as hypertension (HTN). While no previous research has examined contributors to HRQOL among Asian Americans in the United States, this study was conducted to identify correlates of HRQOL in hypertensive Korean immigrant elders (≥ 60 years of age) to address the gap. A total of 440 Korean elders with HTN participated in the study. The hierarchical regression model for HRQOL explained 32.8% of the variance. Female gender (β = .109, p = .036), a greater number of comorbid conditions (β = .183, p = .000), lower social support (β = -.240, p = .000), and greater depressive symptoms (β = .402, p = .000) were associated with poorer HRQOL. Depression was the most potent correlate of HRQOL among elderly Korean Americans (KA) with HTN. Future intervention should consider managing depression as an essential component of comprehensive HTN care for this minority population.

Relations between Life Satisfaction, Adjustment to Illness, and Emotional Distress in a Sample of Men with Ischemic Cardiopathy

Fifty-two men who had suffered a first episode ischemic heart disease reported their degree of life satisfaction, the strategies they used to adjust to the illness, and the symptoms of anxiety and depression they felt. The multiple regression analyses carried out indicated that emotional distress was associated with a lower level of life satisfaction. In the analyses of anxiety symptoms, the use of negative adjustment strategies was also a significant predictor. Lastly, a significant Life Satisfaction x Type of Adjustment interaction was obtained. According to this, the patients who felt more satisfaction with their lives used more positive strategies to adjust to the illness and fewer negative ones, than the group of patients who were less satisfied. In conclusion, life satisfaction predicts emotional well-being of patients with ischemic heart disease and it enhances the implementation of appropriate strategies to cope with the disease. Moreover, although life satisfaction has been considered a stable measure, we suggest it may change as the experience of illness limits individuals' important goals.

Psychological correlates in patients with different levels of hypertension

The evidence linking essential systemic arterial hypertension (SAH) with psychological characteristics remains equivocal. The aims of this study were to assess clinical and subclinical distress, psychosocial aspects and psychological well-being in treated hypertensive patients and to evaluate the psychosocial variables associated with higher levels of blood pressure according to guidelines for hypertension management. A consecutive series of 125 hypertensive patients were evaluated using both self- and observer-rated reliable measures. Generalized anxiety disorder, minor depression, demoralization and alexithymia were the most frequent diagnoses. Cluster analysis revealed an association of three distinct symptomatological groups such as the Anxiety-Depression, the Alexithymia and the Somatization groups, with different levels of hypertension. In particular, patients with moderate to severe hypertension were more frequently in the Anxiety-Depression and the Alexithymia groups, whereas the Somatization cluster has been shown to be associated with isolated systolic hypertension. The results provide new insight into the psychosocial characteristics among patients with different levels of SAH according to recent guidelines of the management of hypertension. They also outline the need to monitor the clinical course of hypertensive patients characterized by these specific clinical and subclinical psychological conditions.

Association between anxiety or depressive symptoms and arterial hypertension, and their impact on the quality of life

OBJECTIVE

Despite all progress made in understanding and treating systemic arterial hypertension (SAH), the study of the impact of psychological disorders in SAH is still controversial and is not well understood. Our aim was to test the hypothesis that SAH can be associated with anxiety and depressive symptoms and to verify its effect on the quality of life.

METHOD

A controlled cross-sectional study included 302 patients (152 hypertensive and 150 normotensive) outpatients at Hospital São Lucas of PUC-RS. Measurements were made in individual interviews and included data collection and application of general scales such as State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and Medical Outcome Study Short Form, General Health Survey (SF-36).

RESULTS

Anxiety was significantly associated with SAH only after adjusted for relevant risk factors (odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.55 to 5.18). Depressive symptoms were significantly associated with SAH (OR) = 4.34 (95% CI: 2.34 to 8.06). A significant association between quality of life and SAH were also found. However, this association diminished after adjusted for BDI and STAI. This shows the effect of depressive symptoms, in particular, and anxiety, in the worsening of quality of life.

CONCLUSIONS

This study suggested that anxiety, especially depressive symptoms, are significantly associated with SAH and had a significant effect on hypertensive patients' worse quality of life.

Validity of the Perceived Health Competence Scale in a UK primary care setting

The Perceived Health Competence Scale (PHCS) is a measure of self-efficacy regarding general health-related behaviour. This brief paper examines the psychometric properties of the PHCS in a UK context. Questionnaires containing the PHCS, the SF-36 and questions about perceived health needs were posted to 486 patients randomly selected from a GP practice list. Complete questionnaires were returned by 320 patients. Analyses of these responses provide strong evidence for the validity of the PHCS in this setting. Consequently, we conclude that the PHCS is a useful addition to measures of global self-efficacy and measures of self-efficacy regarding specific behaviours in the toolkit of health psychologists. This range of self-efficacy assessment tools will ensure that psychologists can match the level of specificity of the measure of expectancy beliefs to the level of specificity of the outcome of interest.