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Cheng C, Christensen M. Living with Multimorbidity through Time: A Meta-Synthesis of Qualitative Longitudinal Evidence. Healthcare (Basel) 2024; 12:446. [PMID: 38391821 PMCID: PMC10887575 DOI: 10.3390/healthcare12040446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study's aim was to identify, appraise, and synthesize published qualitative longitudinal research on individuals' experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and CINAHL, and performed an additional literature search in Google Scholar. A thematic synthesis approach was used to analyze the qualitative data across the studies. A total of 10 reports that met the inclusion and exclusion criteria were included in the synthesis. Five descriptive themes emerged from the analysis of the living experiences of individuals with multimorbidity: (1) perceiving multimorbidity, (2) managing chronic conditions, (3) emotional struggles in everyday life with multimorbidity, (4) interactions with the healthcare system and healthcare professionals, and (5) family support. This meta-synthesis provides insights into the diverse perceptions of multimorbidity and how individuals cope with their chronic conditions in their daily lives. The findings highlight the importance of establishing effective patient-centered care that acknowledges and supports the multifaceted needs of this population. It is also recommended to involve a psychological component in the care of individuals with multimorbidity, as part of a collaborative and interprofessional approach.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- School of Nursing, Fudan University, Xuhui District, Shanghai 200032, China
| | - Martin Christensen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Horn AB, Zimmerli L, Maercker A, Holzer BM. The worse we feel, the more intensively we need to stick together: a qualitative study of couples' emotional co-regulation of the challenge of multimorbidity. Front Psychol 2023; 14:1213927. [PMID: 37637914 PMCID: PMC10450955 DOI: 10.3389/fpsyg.2023.1213927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Being faced with multimorbidity (i.e., being diagnosed with at least two chronic conditions), is not only demanding in terms of following complicated medical regimes and changing health behaviors. The changes and threats involved also provoke emotional responses in the patients but also in their romantic partners. This study aims at exploring the ways of emotional co-regulation that couples facing multimorbidity express when interviewed together. Method N = 15 opposite sex couples with one multimorbid patient after an acute health crisis that led to hospitalization were asked in a semi-structured interview about how they found ways to deal with the health situation, what they would recommend to other couples in a similar situation, and how they regulated their emotional responses. Interviews were analyzed qualitatively following open, axial, and selective coding, as in the grounded theory framework. Results Emerging categories from the romantic partners' and the patients' utterances revealed three main categories: First, overlapping cognitive appraisals about the situation (from fighting spirit to fatalism) and we-ness (construing the couple self as a unit) emerged as higher order factor from the utterances. Second, relationship-related strategies including strategies aimed at maintaining high relationship quality in spite of the asymmetric situation like strengthening the common ground and balancing autonomy and equity in the couple were often mentioned. Third, some couples mentioned how they benefit from individual strategies that involve fostering individual resources of the partners outside the couple relationship (such as cultivating relationships with grandchildren or going outdoors to nature). Discussion Results underline the importance of a dyadic perspective not only on coping with disease but also on regulating the emotional responses to this shared challenging situation. The utterances of the couples were in line with earlier conceptualizations of interpersonal emotion regulation and dyadic perspectives on we-disease. They broaden the view by integrating the interplay between individual and interpersonal regulation strategies and underline the importance of balancing individual and relational resources when supporting couples faced with chronic diseases.
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Affiliation(s)
- Andrea B. Horn
- CoupleSense: Health and Interpersonal Emotion Regulation Lab, University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
- Center of Gerontology, Healthy Longevity Center, University of Zurich, Zurich, Switzerland
- Gerontopsychology and Gerontology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine, Cantonal Hospital Olten (KSO), Olten, Switzerland
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Barbara M. Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
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Harris BE, Rice K, Murray CV, Thorsteinsson EB. Validation of the brief Adjustment Disorder New Modules with Australian oncology patients. Biopsychosoc Med 2023; 17:2. [PMID: 36698144 PMCID: PMC9875190 DOI: 10.1186/s13030-022-00259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Evidence suggests that up to 30% of cancer patients may meet the criteria for adjustment disorder. However, no assessment instruments have been validated for use with cancer patients. The Adjustment Disorder New Module (ADNM)-8 and ADNM-4 are brief screening tools for adjustment disorder mapped directly to the new ICD-11 criteria. The aim of this study was to investigate the factor structure and validity of both instruments in an Australian sample of adult oncology patients. METHODS: A total of 405 participants with a cancer diagnosis were recruited online from across Australia. Participants reported cancer-specific information, such as time since diagnosis, treatment stage, cancer stage, type of cancer, and the following questionnaires: 8-item Adjustment Disorder New Module (ADNM-8), the World Health Organisation Well-Being Index (WHO-5), and the short form Depression Anxiety and Stress Scale (DASS-21). The predictiveness of stressors was assessed using multiple regression analysis and the structure of the ADNM-8 and the ADNM-4 was tested using confirmatory factor analysis. RESULTS: Six previously tested models were examined, and the results suggested a 2-factor structure reflecting the two ICD-11 diagnostic criteria clusters of preoccupation with the stressor and failure to adapt was a good fit for both scales. The ADNM-4 outperformed the longer version of the scale on numerous fit indices though the ADNM-8 and ADNM-4 were highly correlated. Correlations of both scales with the psychological distress scale, the stress subscale, and the wellbeing index indicated good construct validity. CONCLUSIONS Our results suggest that the ADNM-8 and ADNM-4 are useful screening tools for assessing adjustment disorder symptoms in cancer patients. The prompt screening of cancer patients encourages early intervention for those at risk of adaptation difficulties and informs research and clinical decisions regarding appropriate treatments.
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Affiliation(s)
- Bernadette E. Harris
- grid.1020.30000 0004 1936 7371School of Psychology, University of New England, Armidale, NSW 2351 Australia
| | - Kylie Rice
- grid.1020.30000 0004 1936 7371School of Psychology, University of New England, Armidale, NSW 2351 Australia
| | - Clara V. Murray
- grid.1020.30000 0004 1936 7371School of Psychology, University of New England, Armidale, NSW 2351 Australia
| | - Einar B. Thorsteinsson
- grid.1020.30000 0004 1936 7371School of Psychology, University of New England, Armidale, NSW 2351 Australia
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Zhang Z, Huang P, Li S, Liu Z, Zhang J, Li Y, Liu Z. Neural mechanisms underlying the processing of emotional stimuli in individuals with depression: An ALE meta-analysis study. Psychiatry Res 2022; 313:114598. [PMID: 35544984 DOI: 10.1016/j.psychres.2022.114598] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/29/2022]
Abstract
Depression is the leading cause of physiological problems and suicide. Previous studies have indicated that individuals with depression show abnormal processing of both positive and negative emotional stimuli. However, the common and distinct patterns of brain activity during the processing of positive and negative emotional stimuli in individuals with depression remain controversial. The current meta-analysis study used the activation likelihood estimation method to investigate these issues across 21 functional magnetic resonance imaging studies. Results revealed that, compared with individuals without depression, individuals with depression showed higher activation in the anterior cingulate gyrus, insula, and middle frontal gyrus (MFG) for positive emotional stimuli and higher activation in the MFG, inferior frontal gyrus, and insula for negative emotional stimuli. Moreover, we identified that the MFG was consistently activated in individuals with depression regardless of the type of emotional stimuli. However, we did not find distinct patterns of brain activity between positive and negative emotional stimuli in individuals with depression. Our results demonstrated that both positive and negative emotional stimuli processing shares the same cognitive control-related brain regions in individuals with depression.
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Affiliation(s)
- Zhenyu Zhang
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Pujiang Huang
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Shuyu Li
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Zhiyu Liu
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Jiayao Zhang
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an, China
| | - Ya'nan Li
- School of Education, Qinghai Normal University, Xining, China
| | - Zhiyuan Liu
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi Normal University, Xi'an, China.
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Horn AB, Holzgang SA, Rosenberger V. Adjustment of Couples to the Transition to Retirement: The Interplay of Intra- and Interpersonal Emotion Regulation in Daily Life. Front Psychol 2021; 12:654255. [PMID: 34220624 PMCID: PMC8249691 DOI: 10.3389/fpsyg.2021.654255] [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: 01/15/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Retirement is a central transition in late adulthood and requires adjustment. These processes not only affect the retired individuals but also their romantic partners. The aim of this study is to investigate the interplay of intrapersonal emotion regulation (rumination) with interpersonal regulation processes (disclosure quality). Furthermore, the associations of daily retirement-related disclosure with adjustment symptoms in disclosing and the listening partner will be investigated. It is expected that the effects of disclosure alter after providing the couples with a self-applied solitary written disclosure task in order to support their intrapersonal emotion regulation. Methods: In this dyadic online-diary study, 45 couples (N = 45) with one partner perceiving the adjustment to a recent retirement as challenging reported rumination, perceived disclosure quality (repetitive, focused on negative content, hard to follow, disclosing partner open for common/authentic), retirement-related disclosure, and ICD-11 adjustment symptoms preoccupation and failure to adapt were assessed at the end of the day over 14 days. In the middle of this assessment period, couples performed a modified online-expressive writing about their thoughts and feelings regarding the transition to retirement. Results: The double-intercept multilevel Actor-Partner Interdependence Models (APIM) reveal that on days with more daily rumination, the spouse perceived that disclosure of the retiree is more difficult to follow, more negative, and repetitive. In contrast, the retiree perceived less authenticity and openness to comments during disclosure on days when the spouse reports more rumination. Retirement-related disclosure showed no within-couple association with failure to adapt but actor effects on preoccupation. Moreover, a partner effect of disclosure of the retirees on the preoccupation of spouses could be observed. This contagious effect of the retiree disclosure, however, disappeared during the week after writing. Conclusion: Our results support the notion that disclosure processes are altered during maladaptive intrapersonal emotion regulation processes. This in turn seems to lead to less effective interpersonal regulation and contagious spilling over of symptoms. Supporting intrapersonal emotion regulation seems to have the potential to allow more favorable interpersonal regulation processes and to free interpersonal resources for an individual adjustment. This has implications for further planning of support for couples facing life transitions and aging-related changes.
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Affiliation(s)
- Andrea B. Horn
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
- Center of Competence for Gerontology, University of Zurich, Zurich, Switzerland
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Sarah A. Holzgang
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vanessa Rosenberger
- University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
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