1
|
Amaslidou A, Ierodiakonou-Benou I, Bakirtzis C, Nikolaidis I, Tatsi T, Grigoriadis N, Nimatoudis I. Multiple sclerosis and mental health related quality of life: The role of defense mechanisms, defense styles and family environment. AIMS Neurosci 2023; 10:354-375. [PMID: 38188008 PMCID: PMC10767059 DOI: 10.3934/neuroscience.2023027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 01/09/2024] Open
Abstract
Background Multiple sclerosis is a demyelinating chronic neurologic disease that can lead to disability and thus to deterioration of quality of life. Psychological parameters such as ego defense mechanisms, defense styles and family environment are important factors in the adaptation process, and as such they can play important roles in QoL. This study aims to assess the psychological factors as well as the clinical and demographic characteristics related to mental health quality of life (MHQoL). Methods This was an observational, cross-sectional study conducted in a sample of 90 people with MS in the years 2018-2020. All participants completed the following questionnaires: MSQoL-54, DSQ-88, LSI, FES-R, SOC, BDI-II, STAI. Disability was assessed using EDSS. Results In multiple linear regression, significant roles were played by depression (R2: 41.1%, p: 0.001) and, to a lesser extent, the event of a relapse (R2: 3.5%, p: 0.005), expressiveness (R2: 3.6%, p < 0.05) and image distortion style (R2: 4.5%, p: 0.032). After performing a hierarchical-stepwise analysis (excluding depression), the important factors were maladaptive defense style (R2: 23.7%, p: 0.002), the event of relapse (R2: 8.1%, p < 0.001), expressiveness (R2: 5.5%, p: 0.004) and self-sacrificing defense style (R2: 2.4%, p: 0.071). Conclusion Psychological factors play important roles in MHQoL of people with multiple sclerosis. Thus, neurologists should integrate in their practice an assessment by mental health specialists. Moreover, targeted psychotherapeutic interventions could be planned i to improve QoL.
Collapse
Affiliation(s)
- Anthi Amaslidou
- 3 Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioanna Ierodiakonou-Benou
- 3 Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Bakirtzis
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Nikolaidis
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Theano Tatsi
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Nimatoudis
- 3 Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| |
Collapse
|
2
|
Fradelos EC, Alikari V, Tsaras K, Papathanasiou IV, Tzavella F, Papagiannis D, Zyga S. Assessment of psychological distress in end stage renal disease: is it spirituality related? Med Pharm Rep 2021; 94:79-87. [PMID: 33629053 PMCID: PMC7880071 DOI: 10.15386/mpr-1623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/27/2020] [Accepted: 05/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients undergoing hemodialysis (HD) are faced with bearing this burden and report poor mental health. Spirituality can be a key factor in managing these problems among HD patients. Aim This cross-sectional study aimed at exploring possible factors that are associated with psychological distress among HD patients and testing its relation to spirituality. Methods HD patients were recruited from six dialysis units in Greece. Psychological distress was assessed using the scale Symptom Check List 90-R and spirituality using the Facit Sp-12 questionnaire. In addition, a special design questionnaire regarding demographic, social, and clinical characteristic was administrated. Results According to the results, factors such age, gender, marital status and area of residence are associated with psychological distress, while dimensions of spirituality such Meaning in Life and Peace can have a positive influence on psychological distress. Conclusion This study highlights the vital role of spirituality, which can act as a mechanism for managing stressful situations. In particular, this study highlights the positive effect of the meaning and purpose of life, as well as the role of peace and harmony.
Collapse
Affiliation(s)
- Evangelos C Fradelos
- Community Nursing Lab, Nursing department, University of Thessaly, Larissa, Greece.,Department of Nursing, University of Peloponnese, Sparta, Greece
| | - Victoria Alikari
- Department of Nursing, University of Peloponnese, Sparta, Greece
| | - Konstantinos Tsaras
- Community Nursing Lab, Nursing department, University of Thessaly, Larissa, Greece
| | | | - Foteini Tzavella
- Community Nursing Lab, Nursing department, University of Thessaly, Larissa, Greece
| | | | - Sofia Zyga
- Department of Nursing, University of Peloponnese, Sparta, Greece
| |
Collapse
|
3
|
Jaworski M, Panczyk M, Cedro M, Kucharska A. Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator. Patient Prefer Adherence 2018; 12:163-174. [PMID: 29416318 PMCID: PMC5790092 DOI: 10.2147/ppa.s147233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adherence by diabetic patients to dietary recommendations is important for effective therapy. Considering patients' expectations in case of diet is significant in this regard. The aim of this paper was to analyze the relationship between selected independent variables (eg, regular blood glucose testing) and patients' adherence to dietary recommendations, bearing in mind that the degree of disease acceptance might play a mediation role. SUBJECTS AND METHODS A cross-sectional study was conducted in 91 patients treated for type 2 diabetes mellitus in a public medical facility. Paper-and-pencil interviewing was administered ahead of the planned visit with a diabetes specialist. Two measures were applied in the study: the Acceptance and Action Diabetes Questionnaire and the Patient Diet Adherence in Diabetes Scale. Additionally, data related to sociodemographic characteristics, lifestyle-related factors, and the course of the disease (management, incidence of complications, and dietician's supervision) were also collected. The regression method was used in the analysis, and Cohen's methodology was used to estimate partial mediation. Significance of the mediation effect was assessed by the Goodman test. P-values of <0.05 were considered statistically significant. RESULTS Patients' non-adherence to dietary recommendations was related to a low level of disease acceptance (standardized regression coefficient =-0.266; P=0.010). Moreover, failure to perform regular blood glucose testing was associated with a lack of disease acceptance (standardized regression coefficient =-0.455; P=0.000). However, the lack of regular blood glucose testing and low level of acceptance had only partially negative impacts on adherence to dietary recommendations (Goodman mediation test, Z=1.939; P=0.054). This dependence was not seen in patients treated with diet and concomitant oral medicines and/or insulin therapy. CONCLUSION Effective dietary education should include activities promoting a more positive attitude toward the disease. This may be obtained by individual counseling, respecting the patient's needs, and focus on regular blood glucose testing.
Collapse
Affiliation(s)
- Mariusz Jaworski
- Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Panczyk
- Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Mariusz Panczyk, Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw, Zwirki i Wigury 61, Warsaw 02-091, Poland, Tel +48 22 572 0490, Fax +48 22 572 0491, Email
| | - Małgorzata Cedro
- Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Alicja Kucharska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
4
|
Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease. J Psychosom Res 2013; 75:362-9. [PMID: 24119944 DOI: 10.1016/j.jpsychores.2013.08.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 08/20/2013] [Accepted: 08/24/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Somatic symptoms are widespread in clinical practice. The association of somatic symptom severity with impaired health status holds both when symptoms are medically unexplained and when they are medically explained. The role of personality dimensions in the formation of somatic symptoms in patients with established, chronic diseases when compared to healthy participants had not been investigated prior to this study. METHODS In samples of 411 healthy subjects and 810 participants with any of 9 established, chronic medical conditions, we measured psychological distress (SCL-90-R), personality traits (Zuckerman-Kuhlman Personality Questionnaire), defensive profiles (Defense Style Questionnaire), individual defenses (Life Style Index) and hostility features (Hostility and Direction of Hostility Questionnaire). Hierarchical multivariate models were used to assess the independent associations between personality dimensions and somatic symptom severity in both samples. The SCL-90-R somatization scale served as the outcome variable. RESULTS In both samples, older age, less education, higher neuroticism, adoption of the displacement defense and depressive symptoms were independently and positively associated with somatic symptom severity. Higher somatic symptom severity was also associated with more "introverted" features (i.e., the self-sacrificing defensive style and self-criticism) among participants with established, chronic medical conditions. CONCLUSIONS These data suggest that similar personality traits and defense mechanisms are associated with somatic symptom severity in health and disease, indicating that somatic symptoms are not simply consequences of having a medical condition. The specific associations of the self-sacrificing defensive profile and self-criticism with somatic symptom severity in the patient sample may have important clinical implications.
Collapse
|
5
|
Abstract
Most patients starting dialysis can choose between peritoneal dialysis and haemodialysis. There is little evidence proving that one form of dialysis is better than the other; although there may be an early advantage to peritoneal dialysis (PD) in young patients with residual function this effect is short-lived. Technique failure develops after years on PD so dialysis modality will often change during a long dialysis career. Quality of life studies, which must be interpreted carefully, indicate that patients require information about the impact of dialysis on their lifestyle as well as health-related outcomes so that they can choose the most suitable dialysis modality. Increasing numbers of frail elderly patients are starting dialysis; support in the home by nursing staff may facilitate the use of PD in this group. In the UK guidelines prioritise the patient's choice of dialysis modality (where feasible) based on good quality predialysis education. Cost of treatment is generally lower on PD, which is particularly recommended for patients with residual renal function and few comorbidities.
Collapse
|
6
|
The psychological defensive profile of hemodialysis patients and its relationship to health-related quality of life. J Nerv Ment Dis 2013; 201:621-8. [PMID: 23787481 DOI: 10.1097/nmd.0b013e318298294d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preliminary data suggest that defensive profile of hemodialysis (HD) patients might influence adaptation to the disease. However, the association of defense mechanisms with health-related quality of life (HRQoL) of HD patients remains unknown. In this cross-sectional investigation, 170 HD patients and 170 age- and sex-matched healthy participants had their psychological profile assessed with the Defense Style Questionnaire-40 and the Hospital Anxiety and Depression Scale. Furthermore, the HD patients had their HRQoL measured with the World Health Organization Quality of Life instrument-abbreviated version. The HD patients had a more neurotic and immature defensive profile. Splitting, projection, reaction formation, and denial were significantly associated with impaired HRQoL, independent of psychological distress. Somatization was an independent correlate of worse overall and physical HRQoL. These findings suggest that, apart from the treatment of psychological distress symptoms, clinicians should also consider the defensive profile of HD patients because it is independently associated with HRQoL and may be amenable to treatment.
Collapse
|
7
|
Harwood L, Wilson B, Sontrop J, Clark AM. Chronic kidney disease stressors influence choice of dialysis modality. J Adv Nurs 2012; 68:2454-65. [PMID: 22299757 DOI: 10.1111/j.1365-2648.2012.05943.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM This article is a report of a study examining the relationships between chronic kidney disease stressors and coping strategies with dialysis modality. BACKGROUND People with chronic kidney disease are given information to enable dialysis modality choice. This education increases awareness and may alleviate concerns and stress. Disease-related stressors and coping may affect dialysis selection. Understanding the influence of stress and coping on dialysis choices will assist in providing responsive programmes. Reducing stress and encouraging coping may increase home dialysis which, despite economic and patient benefits, remains underused. DESIGN A prospective correlational design was used. METHODS Information was obtained from the Chronic Kidney Disease Stress Inventory and the Jalowiec Coping Scale in 223 individuals not on dialysis between the years 2005-2007. Data were recorded with respect to modality at dialysis initiation (n = 76) from 2005-2010. The effects of stress, coping and patient parameters on modality selection were compared using bivariate and multivariate analyses. RESULTS Individuals on home dialysis vs. in-centre haemodialysis reported significantly fewer pre-dialysis stressors. Coping was not associated with dialysis modality. Individuals on in-centre haemodialysis had a lower serum creatinine, less advanced kidney disease and weighed more than those who started on a home therapy. Physiological stressors were most common and are amenable to interventions. CONCLUSION Pre-dialysis stress levels predicted dialysis modality. Interventional studies are recommended to address chronic kidney disease stressors with the outcome of improving home-dialysis usage.
Collapse
Affiliation(s)
- Lori Harwood
- London Health Sciences Centre, and University of Western Ontario, Canada.
| | | | | | | |
Collapse
|
8
|
Hyphantis T, Goulia P, Floros GD, Iconomou G, Pappas AI, Karaivazoglou K, Assimakopoulos K. Assessing Ego Defense Mechanisms by Questionnaire: Psychometric Properties and Psychopathological Correlates of the Greek Version of the Plutchik's Life Style Index. J Pers Assess 2011; 93:605-17. [DOI: 10.1080/00223891.2011.608759] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
9
|
Hyphantis T. The Greek version of the Defense Style Questionnaire: psychometric properties in three different samples. Compr Psychiatry 2010; 51:618-29. [PMID: 20965309 DOI: 10.1016/j.comppsych.2010.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/21/2010] [Accepted: 03/23/2010] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The Defense Style Questionnaire (DSQ) was designed to assess behavior indicative of conscious derivatives of defensive styles. This study aimed to assess the factor structure and the main psychometric properties of its Greek version in 3 different samples. METHODS The DSQ-88 was translated into Greek using back-translation, and it was administered to 2308 participants (984 healthy subjects, 1084 medical patients, and 240 psychiatric patients). Exploratory factor analyses were performed; Symptom Distress Checklist-90-R and Minnesota Multiphasic Personality Inventory (MMPI) ego strength scales were administered for testing criterion and concurrent validity, followed by hierarchical multiple regression analysis. RESULTS Four factors were identified, largely corresponding to the original version's maladaptive, image-distorting, self-sacrificing, and adaptive styles, showing a remarkable stability in all 3 samples. Adaptive style was positively correlated to ego strength, whereas maladaptive, image-distorting, and self-sacrificing styles were negatively correlated, in descending order. This, along with the intercorrelations observed between the 4 styles, provides evidence that this version supports the hierarchical organization of defensive functioning. Test-retest reliabilities were adequate for all styles (r(1i)'s = 0.88, 0.81, 0.77, and 0.81, respectively). Internal consistencies were satisfactory for maladaptive style (0.82), sufficient for self-sacrificing (0.76), and rather low for image-distorting (0.68) and adaptive (0.66) styles. Maladaptive, image-distorting, and self-sacrificing-but not adaptive-styles could differentiate nonpatients from psychiatric patients. Maladaptive style was positively and adaptive style was negatively independently associated with psychological distress. CONCLUSIONS The present findings support the applicability of the Greek version of DSQ-88 within the Greek population. Future studies could improve its psychometric properties by finding new items for image-distorting and, especially, adaptive styles.
Collapse
Affiliation(s)
- Thomas Hyphantis
- Department of Psychiatry, Medical School, University of Ioannina, Ioannina 45110, Greece.
| |
Collapse
|