Fear of cancer recurrence in breast cancer: A moderated serial mediation analysis of a prospective international study

OBJECTIVE

Women dealing with breast cancer (BC) face many challenges, one of which is the fear of cancer recurrence (FCR). This study examined whether disease severity predicts FCR 6 months after cancer diagnosis through psychological distress and whether cognitive-emotion regulation moderates this effect.

METHOD

The study sample included 656 women from Italy (27.5%), Finland (31.9%), Israel (19.8%), and Portugal (20.8%) diagnosed with Stages I-III of BC. Participants' age ranged between 40 and 70 years (M = 54.92, SD = 8.22). Participants were tracked following BC diagnosis and at 3 and 6 months follow-up. Participants filled out self-report questionnaires, including the FCR inventory-short form, the Hospital Anxiety and Depression Scale, and the cognitive-emotion regulation questionnaire along with medical-social-demographic data.

RESULTS

Greater disease severity at baseline indicated by higher cancer stage predicted greater psychological distress, which in turn predicted greater psychological distress at 3 months. The latter predicted greater FCR at 6 months. This serial mediation model was moderated by negative cognitive-emotion regulation. The mediating effect of disease severity on FCR through psychological distress was significant only in women with mean or higher levels of negative cognitive-emotion regulation.

CONCLUSION

This study suggests that facilitating psychological well-being and effective cognitive-emotion regulation in the early stages after a cancer diagnosis may protect women from FCR. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Quality of Life and Incidence of Clinical Signs and Symptoms among Caregivers of Persons with Mental Disorders: A Cross-Sectional Study

BACKGROUND

Caring for individuals with mental disorders poses significant challenges for caregivers, often leading to compromised quality of life and mental health issues such as stress, anxiety, and depression. This study aims to assess the extent of these challenges among caregivers in Greece, identifying which demographic factors influence their well-being.

METHOD

A total of 157 caregivers were surveyed using the SF-12 Health Survey for quality-of-life assessment and the DASS-21 questionnaire for evaluating stress, anxiety, and depression symptoms. t-tests, Kruskal-Wallis tests, Pearson's correlation coefficients, and regression analyses were applied to understand the associations between demographics, quality of life, and mental health outcomes.

RESULTS

The study found that caregivers, especially women and younger individuals, faced high levels of mental health challenges. Marital status, educational level, and employment status also significantly influenced caregivers' well-being. Depression was the most significant factor negatively correlating with the mental component of quality of life. The magnitude of the burden experienced by caregivers highlighted the urgency for targeted social and financial support, as well as strategic treatment programs that consider caregiver well-being.

CONCLUSIONS

Caregivers of individuals with mental disorders endure significant stress, anxiety, and depression, influencing their quality of life. Demographic factors such as age, gender, marital status, education, and employment status have notable impacts. Findings emphasize the need for society-wide recognition of caregivers' roles and the creation of comprehensive support and intervention programs to alleviate their burden, particularly in the context of the COVID-19 pandemic.

The mutual determination of self-efficacy to cope with cancer and cancer-related coping over time: a prospective study in women with breast cancer

OBJECTIVE

The aim of this study was to examine the longitudinal impact of self-efficacy to cope with cancer on the cancer-related coping reactions of breast cancer patients and vice versa.

DESIGN AND MAIN OUTCOMES MEASURES

Data from the BOUNCE Project (https://www.bounce-project.eu/) were used to address the hypotheses. Participants (N = 403) were enrolled in the study a few weeks after surgery or biopsy. Coping self-efficacy was assessed at baseline and six months later (M6). Cancer-related coping was assessed three (M3) and nine months (M9) after baseline. The analyses were performed using structural equation modeling with Mplus 8.6.

RESULTS

Baseline coping self-efficacy predicted all M3 coping reactions, while M6 coping self-efficacy also predicted changes in all but one M9 coping reaction. Moreover, one of the M3 coping reactions, that is, hopelessness/helplessness, predicted the changes in M6 coping self-efficacy. The relation between coping self-efficacy and one coping reaction (i.e. cognitive avoidance) was rather weak. Stability paths from M3 to M9 coping reactions were moderate to high.

CONCLUSION

The relationship between self-efficacy to cope with cancer and cancer-related coping is complex. New theoretical models are needed to more accurately describe the diverse aspects of this association.

Well-being trajectories in breast cancer and their predictors: A machine-learning approach

OBJECTIVE

This study aimed to describe distinct trajectories of anxiety/depression symptoms and overall health status/quality of life over a period of 18 months following a breast cancer diagnosis, and identify the medical, socio-demographic, lifestyle, and psychological factors that predict these trajectories.

METHODS

474 females (mean age = 55.79 years) were enrolled in the first weeks after surgery or biopsy. Data from seven assessment points over 18 months, at 3-month intervals, were used. The two outcomes were assessed at all points. Potential predictors were assessed at baseline and the first follow-up. Machine-Learning techniques were used to detect latent patterns of change and identify the most important predictors.

RESULTS

Five trajectories were identified for each outcome: stably high, high with fluctuations, recovery, deteriorating/delayed response, and stably poor well-being (chronic distress). Psychological factors (i.e., negative affect, coping, sense of control, social support), age, and a few medical variables (e.g., symptoms, immune-related inflammation) predicted patients' participation in the delayed response and the chronic distress trajectories versus all other trajectories.

CONCLUSIONS

There is a strong possibility that resilience does not always reflect a stable response pattern, as there might be some interim fluctuations. The use of machine-learning techniques provides a unique opportunity for the identification of illness trajectories and a shortlist of major bio/behavioral predictors. This will facilitate the development of early interventions to prevent a significant deterioration in patient well-being.

Protective Factors against Fear of Cancer Recurrence in Breast Cancer Patients: A Latent Growth Model

The current study aimed to examine the fear of cancer recurrence (FCR) trajectory and protective predictors in women coping with breast cancer (BC). The study's model investigated whether a higher coping self-efficacy and positive cognitive-emotion regulation at the time of the BC diagnosis would lead to reduced levels of FCR at six months and in later stages (12 and 18 months) post-diagnosis. The sample included 494 women with stages I to III BC from Finland, Italy, Portugal, and Israel. They completed self-report questionnaires, including the Fear of Cancer Recurrence Inventory (FCRI-SF), the Cancer Behavior Inventory-Brief Version (CBI-B), the Cognitive-Emotion Regulation Questionnaire (CERQ short), and medical-social-demographic data. Findings revealed that a higher coping self-efficacy at diagnosis predicted lower FCR levels after six months but did not impact the FCR trajectory over time. Surprisingly, positive cognitive-emotion regulation did not predict FCR levels or changes over 18 months. FCR levels remained stable from six to 18 months post-diagnosis. This study emphasizes the importance of developing specific cancer coping skills, such as coping self-efficacy. Enhancing coping self-efficacy in the first six months after BC diagnosis may lead to lower FCR levels later, as FCR tends to persist in the following year.

The dyadic regulation approach of coping and illness representations in female cancer patients and their partners

Purpose

Adjustment to any illness is a 'dyadic' process whereby patients and their partners mutually determine each other's perceptions, behaviours, and well-being. The present study explored the association between dyadic coping strategies and illness representations in newly diagnosed female cancer patients and their partners.

Methods

The sample consisted of 92 female cancer patient-partner pairs from 3 oncology hospitals in Greece and Cyprus. The Actor Partner Interdependence Model was applied to test for dyadic regulation effects.

Results

The findings revealed that patients' evaluations of dyadic coping were related to their own illness representations and, in some cases, to partners' illness representations of control. However, partner evaluations of dyadic coping were not associated with either patients' or their own illness representations. Relationship satisfaction did not moderate the relationship between dyadic coping and illness representations.

Implications

The study suggests that patients' perceptions of support provided by themselves and their partners play a significant role in shaping their illness representations. Future research could delve into the underlying reasons for the observed differences in the impact of dyadic coping on illness representations between patients and partners, considering factors such as gender roles and specific gender-related issues.

Changes over time in self-efficacy to cope with cancer and well-being in women with breast cancer: a cross-cultural study

OBJECTIVE

This study aimed to examine whether self-efficacy to cope with cancer changes over time in patients with breast cancer and whether these potential changes are similar across patients. It also aimed to examine whether these trajectories are related to patient psychological well-being and overall quality of life.

METHODS

Participants (N = 404) from four countries (i.e. Finland, Israel, Italy, and Portugal) were enrolled in the study few weeks after breast surgery or biopsy. Self-efficacy to cope with cancer was assessed at baseline, six and 12 months later. Well-being indices were assessed at baseline, 12 and 18 months later.

RESULTS

Using Latent Class Growth Analysis, two groups of patients were identified. The majority of patients reported high levels of self-efficacy to cope, which increased over time. For almost 15% of the patients, however, self-efficacy declined over time. Diminishing levels of self-efficacy to cope predicted worse levels of well-being. The pattern of self-efficacy changes and their relationships to well-being was consistent across countries.

CONCLUSION

Monitoring self-efficacy to cope with cancer is probably important in order to detect alarming changes in its levels, as a declining self-efficacy to cope may serve as a signal of the need for intervention to prevent adaptation difficulties.

Trajectories of Quality of Life among an International Sample of Women during the First Year after the Diagnosis of Early Breast Cancer: A Latent Growth Curve Analysis

The current study aimed to track the trajectory of quality of life (QoL) among subgroups of women with breast cancer in the first 12 months post-diagnosis. We also aimed to assess the number and portion of women classified into each distinct trajectory and the sociodemographic, clinical, and psychosocial factors associated with these trajectories. The international sample included 699 participants who were recruited soon after being diagnosed with breast cancer as part of the BOUNCE Project. QoL was assessed at baseline and after 3, 6, 9, and 12 months, and we used Latent Class Growth Analysis to identify trajectory subgroups. Sociodemographic, clinical, and psychosocial factors at baseline were used to predict latent class membership. Four distinct QoL trajectories were identified in the first 12 months after a breast cancer diagnosis: medium and stable (26% of participants); medium and improving (47%); high and improving (18%); and low and stable (9%). Thus, most women experienced improvements in QoL during the first year post-diagnosis. However, approximately one-third of women experienced consistently low-to-medium QoL. Cancer stage was the only variable which was related to the QoL trajectory in the multivariate analysis. Early interventions which specifically target women who are at risk of ongoing low QoL are needed.

Psychological and somatic symptoms among breast cancer patients in four European countries: A cross-lagged panel model

Psychological and physical health among women with breast cancer are linked. However, more research is needed to test the interrelations between psychological and somatic symptoms, over time and throughout the different phases of breast cancer treatment, to determine when and which interventions should be prioritized. Six hundred and eighty nine women from four countries (Finland, Israel, Italy and Portugal) completed questionnaires during their first clinical consultation following diagnosis with breast cancer, and again after 3 and 6 months. The questionnaires included self-reported measures of psychological symptoms (Hospital Anxiety and Depression Scale; the Positive and Negative Affect Schedule Short Form) and somatic symptoms [selected items from the International European Organization for Research and Treatment of Cancer (EORTC) questionnaires]. Psychological and somatic symptoms were relatively stable across the three time-points. Cross-lagged paths leading from somatic to psychological symptoms (beta coefficients of 0.08-0.10), as well as vice-versa (beta 0.11-0.12), were found to be significant. No evidence was found for cross-cultural differences in mutual effects of psychological and somatic symptoms. The findings of this study call for tailoring personal interventions for breast cancer patients-either from a somatic perspective or a psychological perspective-and adjust them to the specific experiences of the individual patient.

The Interplay Between Trait Resilience and Coping Self-efficacy in Patients with Breast Cancer: An International Study

The role of self-efficacy to cope with breast cancer as a mediator and/or moderator in the relationship of trait resilience to quality of life and psychological symptoms was examined in this study. Data from the BOUNCE Project ( https://www.bounce-project.eu/ ) were used. Women diagnosed with and in treatment for breast cancer (N = 484), from four countries, participated in the study. Trait resilience and coping self-efficacy were assessed at baseline (soon after the beginning of systemic treatment), and outcomes (quality of life, psychological symptoms) 3 months later. Hierarchical regression, mediation, moderation, and conditional (moderated) mediation and moderation analyses were performed to examine the study hypotheses. Coping self-efficacy mediated the impact of trait resilience. In addition, higher levels of resilience in combination with higher levels of coping self-efficacy were associated with better outcomes. Country of origin had no impact on these results. Overall, it seems that coping self-efficacy is a key factor that should be taken into account for research and intervention efforts in cancer.

The Interplay Between Individual and Dyadic/Common Coping in Female Patients With Cancer

Abstract. Both individual and dyadic coping behaviors are important for adaptation to a severe illness. However, there is a theoretical controversy regarding the interplay between these two forms of coping. In this cross-sectional study, we examined (a) whether recently diagnosed cancer patients engage mostly with one form of coping or whether they use both in parallel; (b) the relationship of individual and supportive dyadic/common coping to emotional well-being and relationship satisfaction. Participants were 92 women recently diagnosed with cancer (mostly breast cancer) and receiving medical treatment ( Mage = 49.37 years; SD = 10.52). All had been living with their partner for at least 2 years. The parallel use of individual and supportive dyadic/common coping behaviors was frequently reported. Individual and dyadic/common coping proved to be related to each other ( p < .01), and both were related to emotional well-being and relationship satisfaction ( p < .05). The combination of high individual and high supportive dyadic/common coping was associated with greater satisfaction with the relationship ( p < .01). Patients probably use individual and dyadic coping behaviors in concert to better deal with the different aspects of their illness experience. Both types of coping should be considered in the context of personalized intervention programs to facilitate adaptation to cancer.

Mechanisms of change in acceptance and commitment therapy for primary headaches

BACKGROUND

Despite the demonstrated effectiveness of behavioural headache interventions, it is not yet known which intervention processes account for treatment responses. Acceptance and commitment therapy (ACT), an emerging behavioural intervention for headaches, proposes psychological flexibility (PF) processes as the mechanisms via which intervention change occurs. This is the first study examining these processes of change variables on headache-related disability and quality of life (treatment outcome).

METHODS

Data originated from a Randomized Clinical Trial evaluating the efficacy of ACT for primary headaches. Ninety-four individuals with primary headaches (M = 43 y; 84% females; M headache frequency/month = 9.30) were randomized to either an ACT-based or a Wait-list control group (N = 47 in each). Participants completed questionnaires related to their headache experiences and PF processes at pre- (T1), post-treatment (T2), and 3-month follow-up (T3).

RESULTS

Following a bootstrapped cross product of coefficients approach, results demonstrated mediating effects of headache acceptance, cognitive defusion, avoidance of headache, and mindfulness in the ACT group compared to control on parameters of headache-related disability and quality of life at post and 3-month follow-ups.

CONCLUSIONS

These findings demonstrate that changes in certain PF processes lower disability and improve quality of life in headache sufferers, supporting that ACT works via its proposed mechanisms of change. Interventions for headache management may be optimized if they target increases in headache acceptance, defusion from thoughts, and mindfulness.

SIGNIFICANCE

Psychological flexibility (PF) guides the ACT approach, an emerging behavioral headache intervention that focuses on optimizing head pain adjustment via flexible responses to pain. It targets at increasing daily functioning rather than preventing or controlling headache episodes. Pain acceptance, cognitive defusion, and mindfulness act as processes of functional change in ACT, lowering disability and increasing daily functioning and quality of life. These components can upgrade the established effectiveness of behavioral headache interventions with personalized, modularized therapeutic targets that can help headache sufferers re-establish optimal daily functioning even in fluctuating and persistent headache episodes.

TRIAL REGISTRATION

clinical trials.gov registry (NCT02734992).

Quality of life in patients with soft palate resection: The relationship between reported functional prosthetic outcomes and the patient's psychological adjustment

STATEMENT OF PROBLEM

Tumors of the soft palate and the adjacent tissues often create considerable soft palate defects that are challenging for the maxillofacial prosthodontist. Soft palate obturator prostheses can usually address functional and esthetic concerns; however, the effectiveness of the prosthetic rehabilitation in improving the patient's well-being and overall quality of life (QOL) has not been extensively researched.

PURPOSE

The purpose of the present research was to evaluate the function of the prosthesis, to review the interrelation between sociodemographic, medical, and treatment (SMT) characteristics, QOL, and prosthesis functioning, and to analyze the role of the prosthesis in how the patient represents the illness and the psychological coping response.

MATERIAL AND METHODS

Thirty-three patients who underwent resection of the soft palate and had been using a technically successful soft palate obturator prosthesis for at least 1 year were interviewed by means of 5 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), Obturator Functioning Scale (OFS), Illness Perceptions Questionnaire (IPQ-R), and Mental Adjustment to Cancer Scale (MAC). Data analysis was performed at α=.01.

RESULTS

The QOL (r=-0.53, P=.001), personal control (r=-0.53, P=.001), negative adjustment to cancer (r=0.47, P=.005), treatment control (r=-0.55, P=.001), consequences (r=0.62, P<.001), and emotional representations (r=0.30, P=.009) were significantly related to prosthesis functioning. Better QOL was significantly related to prosthesis functioning (P=.006), age (P=.001), sex (P=.011), and type of soft palate defect (P=.009). The most important predictors of favorable soft palate obturator functioning were age (P<.001) and type of soft palate defect (P=.01).

CONCLUSIONS

A patient-perceived effective soft palate obturator prosthesis was a significant predictor for advanced QOL, better adjustment to illness and illness-related disabilities, as well as the overall coping response to cancer.

Cognitive, emotional, and behavioral mediators of the impact of coping self-efficacy on adaptation to breast cancer: An international prospective study

OBJECTIVE

The main objective of this prospective multicenter study was to examine whether illness representations of control, affect, and coping behaviors mediate the effects of self-efficacy to cope with cancer on psychological symptoms and overall quality of life, in breast cancer patients.

METHOD

Data from 413 women (Mean age = 54.87; SD = 8.01), coming from four countries (i.e., Finland, Israel, Italy, Portugal), who received medical therapy for their early breast cancer, were analyzed. Coping self-efficacy was assessed at baseline. Potential mediators were assessed three months later, and outcomes after six months.

RESULTS

Coping self-efficacy was related to all mediators and outcomes. Illness representations of treatment control, positive and negative affect, and certain coping behaviors (mostly, anxiety preoccupation) mediated the effects of coping self-efficacy. Coping self-efficacy was related to each outcome through a different combination of mediators.

CONCLUSIONS

Coping self-efficacy is a major self-regulation factor which is linked to well-being through multiple cognitive, emotional, and behavioral pathways. Enhancement of coping self-efficacy should be a central intervention goal for patients with breast cancer, towards promotion of their well-being.

COVID-19 pandemic-related representations, self-efficacy, and psychological well-being in the general population during lockdown

The aim of this study was to examine the association among representations of the COVID-19 pandemic, self-efficacy to cope with the anti-pandemic measures (e.g., general lockdown), and psychological distress in the Greek general population. The study was conducted online, during the general lockdown in the country, and 358 individuals (239 females) participated (mean age = 36.89; SD = 12.15). A perception of personal control over the condition, negative emotions towards the pandemic, and self-efficacy to cope with the current anti-pandemic measures were related to psychological distress. Also, a significant interaction between representation clusters and self-efficacy to cope with potential future difficulties (i.e., after the anti-pandemic measures are ended), was found. Specifically, the association between this type of self-efficacy and psychological distress was significant only for the 'low-impact' representations cluster (i.e., a perception of the pandemic as less burdensome and more controllable). The findings indicate that the factors which, according to previous research and theory, are significantly related to psychological distress during a health threat, are important also in times of a pandemic. They also suggest a potential adaptation-promoting synergy between pandemic-related self-efficacy and a more positive representation of COVID-19, as far as psychological distress is conerned. Thus, these factors may serve as the basis for the development of pandemic-related health behavior promotion programs.

The role of self-esteem in the relationship between anxiety and depression of Albanian and Indian immigrants in Greece

Ιmmigrants' psychological health has been the focus of many studies as it is a timely subject due to the increasing numbers of immigrants and refugees who enter Greece the recent decades, and the resulting anxiety that this process brings about to the individual. The aim of the present study was to examine the relationship between immigrants' and Greeks' anxiety, self-esteem and depression. In addition, the present study aimed to compare the psychological health between immigrants and Greeks. The participants were 115 Albanian, 118 Indian immigrants, and 116 Greeks. Τhe Rosenberg Self-Esteem Scale, the CES-D Scale, and the State Anxiety Inventory were administrated for measuring self-esteem, depression, and anxiety, respectively. To test the bivariate relationships between the study variables, Pearson product-moment correlation coefficients were calculated. The potential differences of psychological health between immigrant groups were examined with ANOVA, and multiple linear regression was used to predict the variance of depression by self-esteem and anxiety, after controlling for ethnicity and demographics. Moreover, moderation analysis was used to examine the moderation role of self-esteem in the relationship between anxiety and depression and possible differences between ethnic groups. In line with our hypotheses, immigrants had higher levels of depression and lower self-esteem scores, compared to Greeks. However, Indians reported the lower levels of anxiety compared to both Albanians and Greeks. Differences were also observed between the two immigrant groups, with Albanians experiencing more mental health problems than Indians. Both self-esteem and anxiety explained a large proportion of the variance of depression in immigrants (45%), thus substantiating our theoretical model (i.e., depression depends on individuals' anxiety and self-esteem). Consistent to our expectations too, self-esteem was a moderator in the relationship between anxiety and depression; no differences between ethnic groups were observed though (e.g., the level of self-esteem acted protectively in the same way in Albanians, Indians, and Greeks). Despite the limitations, the findings of this study could be particularly useful to clinicians working with immigrants. Coping effectively with anxiety and enhancing immigrants' self-esteem could be tailored-based targets for both prevention and intervention programs.Ιmmigrants' psychological health has been the focus of many studies as it is a timely subject due to the increasing numbers of immigrants and refugees who enter Greece the recent decades, and the resulting anxiety that this process brings about to the individual. The aim of the present study was to examine the relationship between immigrants' and Greeks' anxiety, self-esteem and depression. In addition, the present study aimed to compare the psychological health between immigrants and Greeks. The participants were 115 Albanian, 118 Indian immigrants, and 116 Greeks. Τhe Rosenberg Self-Esteem Scale, the CES-D Scale, and the State Anxiety Inventory were administrated for measuring self-esteem, depression, and anxiety, respectively. To test the bivariate relationships between the study variables, Pearson product-moment correlation coefficients were calculated. The potential differences of psychological health between immigrant groups were examined with ANOVA, and multiple linear regression was used to predict the variance of depression by self-esteem and anxiety, after controlling for ethnicity and demographics. Moreover, moderation analysis was used to examine the moderation role of self-esteem in the relationship between anxiety and depression and possible differences between ethnic groups. In line with our hypotheses, immigrants had higher levels of depression and lower self-esteem scores, compared to Greeks. However, Indians reported the lower levels of anxiety compared to both Albanians and Greeks. Differences were also observed between the two immigrant groups, with Albanians experiencing more mental health problems than Indians. Both self-esteem and anxiety explained a large proportion of the variance of depression in immigrants (45%), thus substantiating our theoretical model (i.e., depression depends on individuals' anxiety and self-esteem). Consistent to our expectations too, self-esteem was a moderator in the relationship between anxiety and depression; no differences between ethnic groups were observed though (e.g., the level of self-esteem acted protectively in the same way in Albanians, Indians, and Greeks). Despite the limitations, the findings of this study could be particularly useful to clinicians working with immigrants. Coping effectively with anxiety and enhancing immigrants' self-esteem could be tailored-based targets for both prevention and intervention programs.

The role of acculturation attitudes and social support in anxiety and depression of Indian immigrants in Greece

In the present study, we examined factors that may impact immigrants' anxiety and depressive symptoms, focusing on the role of acculturation attitudes and social support. The participants of the present study were first generation Indian immigrants residing in Crete, Greece (N=114). Our first hypothesis was that Indian immigrants will choose two acculturation attitudes, namely integration and separation, as these may enable them maintain certain aspects of their culture of origin given their distinct differences from Greeks in religion, cultural values, and physical appearance. It was also hypothesized that integration and separation will be positively related to social support. Social support was also expected to mediate the negative relationship of separation and integration to anxiety and depression. Furthermore, social support was expected to act protectively for Indian immigrants who chose integration and separation, minimizing the levels of anxiety and depression (i.e., a moderation effect). Using specific measures for anxiety, depression, social support, and acculturation attitudes, the results showed that Indian immigrants report a greater preference for integration and separation. Separation was the only acculturation attitude positively related to social support and negatively to depression through social support from friends and family. Moreover, higher levels of social support seemed to protected immigrants who choose integration from depression and medium and high levels of social support protected immigrants who choose assimilation from anxiety. These findings indicate that both integration and separation are preferred by Indian immigrants in Greece. Moreover, it seems that in the case of Indian immigrants in Greece, separation could be related to more immigrants' social support than other acculturation attitudes, ending in turn to less depression symptoms. These findings demonstrate that different acculturation attitudes (i.e. assimilation, integration, separation) may have different effects on distinct psychological indices. Moreover, immigrants' social support is a protecting factor in the relationship between acculturation attitudes to anxiety and depression. The present study suggests that the increase of the immigrants' social networks could prove helpful for their adaptation to the Greek society.

The interpersonal impact of partner emotion regulation on chronic cardiac patients' functioning through affect

In this prospective study, we examined whether physical and psychological functioning of patients with a cardiovascular disease is related to their partners' emotion regulation strategies through both persons' affect. The final sample consisted of 104 patients (25 women) and their partners. All couples were of the opposite sex and married. Two spouse emotion regulation strategies (i.e., cognitive reappraisal and expressive suppression) were assessed at baseline; patient and spouse positive and negative affect was assessed 2 months later; patient functioning were assessed 4 months later. Spouse cognitive reappraisal, but not expressive suppression, was associated with patient functioning in an indirect way, with spouse and patient affect serving as mediators in-sequence. Specifically, spouse cognitive reappraisal was related to spouse affect which was associated with patient affect. In turn, patient affect was related to patient functioning. This adds to our understanding of the dyadic relationships between chronic patients' and partners' self-regulation processes and may also guide relevant psychological interventions.

Positive and negative affect and well-being in cardiac patients and their spouses: the mediating role of illness representations

OBJECTIVE

The aim of this study was to examine whether illness representations of control and consequences mediate the relation of cardiac patients' affect to well-being. A further aim was to examine this indirect relationship at a dyadic level (i.e. patient and spouse).

DESIGN AND MAIN OUTCOME MEASURES

One hundred and four patients with a cardiovascular disease and their spouses participated in the study. Positive and negative affect was assessed at baseline; illness representations were assessed 2 months later, and physical and psychological well-being 4 months later.

RESULTS

Illness representations generally mediated the impact of patients' and spouses' affect on well-being, while several actor and partner effects were found. However, it was only positive affect that was indirectly related to well-being, while the representations of personal and treatment control chiefly acted as mediators. The effects were stronger for patients than spouses, as well as for physical well-being.

CONCLUSION

The results underline the strong connection between illness-related self-regulation and the overall person/environment interaction as depicted by affect. They also indicate the need to integrate theories on adaptation to illness, with models describing adaptation of couples to stressful conditions, and specific theories about the role of emotion in adaptation to illness.

The relation of spouse illness representations to patient representations and coping behavior: A study in couples dealing with a newly diagnosed cancer

The central role of spouses/partners in patients' adaptation to cancer is well-established, but few studies have examined how partners facilitate adaptation. The Common Sense Model posits that a representation of illness as more controllable and less threatening promotes adaptive coping, but this has not been examined in a dyadic context. This cross-sectional study examined the relations of spouse illness representations of personal and treatment control, and emotional representations to recently diagnosed cancer patients' coping behaviors, through patient illness representations. One hundred forty-nine heterosexual couples (39.60% female patients; 77.18% dealing with early stage cancer) participated in the study. Structural Equation Modeling showed that spouse illness representations were related to patient coping directly and indirectly through patient illness representations. Both partners' representations of control were related to greater patient adaptive coping, and both partners' emotional representations were related to greater dysfunctional coping. These findings highlight the importance of partner illness representations in patients' adaptation to cancer. They also suggest that early intervention programs that address both partners' illness representations may enhance patients' adaptation to cancer.

Emotion regulation contributes to the well-being of patients with autoimmune diseases through illness-related emotions: A prospective study

This prospective study aimed to examine whether illness-related negative emotions mediate the relationship of cognitive reappraisal and expressive suppression to the well-being of 99 patients with rheumatoid arthritis or multiple sclerosis. After adjusting for disease and patient-related parameters, only cognitive reappraisal was associated with physical and psychological well-being through emotions. Expressive suppression was associated with psychological well-being only for patients reporting less use of cognitive reappraisal. These results underscore the need for prospective studies that will investigate the long-term impact of emotion regulation on adaptation to chronic illness and the conditions under which this impact takes place.

Financial strain, dyadic coping, relationship satisfaction, and psychological distress: A dyadic mediation study in Greek couples

Financial strain typically has a severe impact on a couple's functioning and the well-being of its members. In this study, we examined the indirect relation of financial strain to partners' relationship satisfaction and psychological distress, using dyadic coping as a mediator, in a sample of Greek couples. One hundred and eighteen couples participated in a cross-sectional study. Perceived material loss in the past and perceived threat of loss in the future were used as financial strain indices. The actor-partner interdependence mediation model was employed to test for the mediation hypotheses. According to the results, the complete mediation (i.e., only indirect) effects models showed an unsatisfactory fit to the data and were rejected. The partial mediation actor-partner interdependence mediation model revealed several statistically significant direct and indirect (actor and partner) effects of the financial strain indices. The results provide more support to the hypothesized mediated impact of financial strain on partners' relationship satisfaction than on psychological distress. The findings underline the importance of dyadic coping for couple's adaptation to financial strain. They also point to the need to examine responses to stress at a dyadic level.

Adaptation to inflammatory rheumatic disease: Do illness representations predict patients' physical functioning over time? A complex relationship

Patients with an inflammatory rheumatic disease (IRD), are often faced with significant limitations in physical functioning. Illness representations are a key-factor of their illness-related experience. Our aim was to examine (a) whether illness representations can predict or only reflect IRD patients' physical functioning over time, and (b) the specific pathways through which representations and physical functioning at baseline are associated with representations and functioning at follow-up. Patients with rheumatoid arthritis (N = 54) or systemic lupus erythematosus (N = 58) participated in the two phases of the study, 1 year apart. According to the results, illness representations were rather predicted by physical functioning than the other way around. At the same time, illness representations at baseline and at follow-up seemed to form a chain that mediated the relation between physical functioning at baseline and 1 year later. These findings may help us better delineate the interplay between the ways patients understand their condition and adaptation to illness.

Effects of sociodemographic, treatment variables, and medical characteristics on quality of life of patients with maxillectomy restored with obturator prostheses

STATEMENT OF PROBLEM

Restoration of maxillary defects resulting from tumor ablative surgery presents a difficult challenge, with both functional and esthetic issues. Whether rehabilitation with an obturator prosthesis could significantly contribute to improved quality of life in patients with maxillary resection has been scarcely studied, with relatively small study samples.

PURPOSE

The purpose of this survey study was to assess the overall functioning of the obturator prosthesis and the effect of specific sociodemographic, medical, and treatment variables on obturator functioning and quality of life in patients with maxillectomy.

MATERIAL AND METHODS

Global quality of life (QOL) and satisfaction with the obturator prosthesis of 57 patients who underwent maxillectomy and prosthetic rehabilitation at the National and Kapodistrian University of Athens were assessed using 3 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30), the EORTC QLQ-HN35, and the obturator functioning scale. The data were analyzed using the Kruskal-Wallis 1-way ANOVA on ranks, hierarchical multiple regression analysis, and the Spearman rank order correlation (α=.05).

RESULTS

Satisfactory functioning of the obturator prosthesis was the most significant predictor of improved QOL (P<.05). QOL was significantly related to additional treatments (P<.05), the size of the primary tumor (P<.05), and the size of the maxillectomy defect (P<.05). The most significant predictors of good obturator functioning were additional treatments (P<.01), age at the time of surgery (P<.05), presence of mandibular teeth (P<.05), and previous maxillary removable prosthetic experience (P<.05). Obturator functioning scale appearance and insertion subscales (r=0.47, P<.01), followed by speech (r=0.42, P<.01), were significantly related to better QOL.

CONCLUSIONS

A well-functioning obturator prosthesis was the most significant determinant for improved QOL in patients with maxillary resection. Age at the time of surgery, adjuvant treatments, presence of mandibular teeth, and previous maxillary removable prosthetic experience were the most significant predictors for better obturator functioning, whereas the size of the maxillectomy defect had a significant effect on QOL but did not influence the functional outcome.

The impact of mild cognitive impairment on the self-regulation process: A comparison study of persons with mild cognitive impairment and cognitively healthy older adults

This study examined whether mild cognitive impairment affects the associations between personal expectations (i.e. optimism and self-efficacy), illness-related coping, and quality of life. In total, two groups of older adults participated: 127 persons diagnosed with mild cognitive impairment and 225 cognitively healthy older persons (cognitively non-impaired group). Several significant relationships observed in the cognitively non-impaired group did not reach significance among mild cognitive impairment patients, with the opposite trend noted for others (e.g. between palliative coping and physical health). These findings indicate that mild cognitive impairment may lead to problems in the self-regulation process and highlight the significance of the interplay between neurocognitive and psychosocial aspects of self-regulation.

Cognitive deficits early in the course of rheumatoid arthritis

OBJECTIVE

The aim was to examine the severity and prevalence of cognitive difficulties in persons with rheumatoid arthritis (RA) within the first three years of diagnosis.

METHOD

One hundred consecutive RA patients aged 28-67 years (90% women) were administered a battery of 6 neuropsychological tests yielding 14 cognitive indices. Self-reported measures of trait anxiety, depression, impact of disease on daily activities, and pain severity were also obtained along with physician-rated disease severity.

RESULTS

Twenty percent of RA patients were classified as cognitively impaired, defined as age- and education-adjusted scores at least 1.5 standard deviations below the population mean on 3 or more cognitive indices. Impaired performance, controlling for age, education, and premorbid cognitive capacity, was detected primarily on measures of short-term memory, immediate and delayed episodic recall, and phonemic fluency. There were modest negative associations between cognitive indices and measures of perceived disease severity (pain level, impact of disease on daily functionality, and overall health quality).

CONCLUSIONS

Cognitive deficits on several domains are frequently encountered in relatively young RA patients during the first few years of the disease and may need to be taken into account as important correlates of disease severity and progression.

Patient and partner dispositional optimism as a long-term predictor of illness representations in autoimmune diseases

We examined whether the dispositional optimism of patients suffering from an autoimmune disease as well as of their partners can predict, at a dyadic level, their representations of illness consequences, and personal and treatment control, assessed 1 year later. Patient optimism predicted several patient and partner illness representations. Partner optimism was unrelated to own or patient illness representations. Results highlight the strong long-term predictive power of patient optimism and underline the importance of the interpersonal function of personality traits. At the same time, study findings indicate that the dyadic effects of optimism are complex and probably conditional on several factors.

Illness representations and psychological adjustment of Greek couples dealing with a recently-diagnosed cancer: dyadic, interaction and perception-dissimilarity effects

The aim was to examine the impact of the dyadic, interaction and dissimilarity effects of the illness representations on the psychological health of recently diagnosed cancer patients and spouses in Greece. The sample consisted of 298 individuals nested in 149 couples. Effects were examined with the Actor-Partner Interdependence Model. Both actor (i.e., within person) and partner (i.e., between partners) effects were detected for both patients' and spouses' psychological symptoms. The negative association of patients' psychological symptoms with their representations of illness coherence was weak at the higher and medium levels, and stronger at the lower levels of spouse corresponding representations. Patient-partner discrepancy in perceived illness consequences was associated with more psychological symptoms in patients. Adaptation to cancer is a dyadic process within the context of which patient and partner psychological well-being is affected by each other's understanding of illness. Thus, the parallel examination of the illness representations of both partners is needed from the early phases of the illness trajectory.

Patient and physician reports of the information provided about illness and treatment: what matters for patients' adaptation to cancer during treatment?

OBJECTIVE

The aim of this study was to examine (a) whether illness representations mediate the relation of the amount of information provided by physicians to patients' adaptation to illness; (b) whether patient-physician agreement on the information provided impacts the aforementioned relationship. The study focused on information that, according to the Common Sense Self-Regulation Model, is essential for adaptation to illness.

METHODS

The sample consisted of 93 patients undergoing chemotherapy and their physicians. Indirect (mediation) effects and conditional (moderated) indirect effects were examined using bootstrapping.

RESULTS

The more illness and treatment-related information was provided by physicians, the more positive illness representations (specifically, illness consequences, emotional representations, and personal control) were reported by patients. In turn, these illness representations were related to better physical functioning and better adjustment to cancer. The degree of the patient-physician agreement on the information provided did not affect this relationship.

CONCLUSIONS

What seems to be more crucial for patients' adaptation to cancer during treatment is the amount of information provided by physicians rather than their agreement with patients on the information provided. Also, there is a need to thoroughly examine the pathways through which information provision impacts adaptation to illness.

Maladaptive health beliefs, illness-related self-regulation and the role of the information provided by physicians

This prospective study in 119 patients with cardiovascular diseases aimed to examine whether (a) illness representations mediate the relation of general maladaptive health beliefs to patients’ coping behaviours and (b) these relations are moderated by the patients’ perception of the amount of information provided by their physicians. Personal control and illness coherence mediated the relation of maladaptive health beliefs to coping behaviour. The amount of the provided information buffered the negative relation of maladaptive health beliefs to illness representations and coping. Thus, the detrimental effect of general maladaptive health beliefs may be counterbalanced by the amount of information provided by physicians.

The psychological well-being of couples experiencing a chronic illness: A matter of personal and partner illness cognitions and the role of marital quality

This study aimed to examine the effects of 75 cardiac patients’ and their spouses’ illness cognitions of acceptance and helplessness on their own and their partner’s psychological symptoms, as well as the impact of marital quality. Dyadic responses were examined with the Actor–Partner Interdependence Model, while PROCESS was used to examine possible conditional indirect effects. Patients’ and spouses’ cognitions were related to their partners’ symptoms through the partners’ cognitions. These relationships were not statistically significant at the higher levels of marital quality. Thus, there seems to be a flow of information between partners, while marital quality may impact self-regulation processes.

Perceived primal threat, stress, and health: further examination of the role of perceived primal threat in the stress process

The general aim of the two studies presented here was to further examine the role of Perceived Primal Threat (PPT) in the stress process. PPT refers to threats against a four-component set of interdependent "primal" needs: self-preservation, social integration, personal identity and growth, and personal worldview. These threats are suggested to represent a pathway through which stress affects health. The first study (cross-sectional) was conducted in a sample of 216 healthy adults, while the second (prospective) in a sample of 137 chronically ill outpatients. The findings of both studies underlined the incremental and discriminant validity of PPT in relation to other stress-related variables. Furthermore, they provided support to the hypotheses that PPT is independently related to well-being and also mediates the relation of the stressful condition to well-being. Overall, the two studies underlined the important role of PPT in the stress process and indicated that PPT represents a promising research area.

Representations of control and psychological symptoms in couples dealing with cancer: a dyadic-regulation approach

The aim of this study was to examine the relation between illness representations of personal and treatment control and psychological symptoms (i.e. symptoms of anxiety and depression) in 72 married couples dealing with a recently diagnosed cancer. Patients were first-diagnosed with early stage (45.83%) or metastatic cancer (54.17%). Dyadic responses were examined with the actor-partner interdependence model. Also, in order to examine whether patients and spouses' representations of control moderate the relation of their partners' corresponding representations to psychological symptoms, we used the relevant bootstrapping framework developed by Hayes and Matthes [(2009). Computational procedures for probing interactions in OLS and logistic regression: SPSS and SAS implementations. Behavior Research Methods, 41, 924-936]. Patients' symptoms of anxiety and depression were associated with both partners' representations of control. Chi-square difference tests indicated that actor and partner effects were equal. Spouses' symptoms of anxiety and depression were related only to their own representations. Moreover, spouses' representations of personal control moderated the relation of patients' corresponding representations to depressive symptoms, whereas patients' representations of treatment control moderated the relation of their spouses' corresponding representations to both anxiety and depression. Findings suggest that both partners' representations of control are important for adaptation to illness. Moreover, they indicate that dyadic regulation may be equally important to self-regulation as far as adaptation to illness is concerned.

The association between pandemic influenza A (H1N1) public perceptions and reactions: a prospective study

The aim of this study was to examine the relation between the public perceptions and reactions to the pandemic influenza A(H1N1) in Crete, Greece. It was conducted in two phases: at the early phase of the outbreak and during the peak. The Common Sense Model was used as an appropriate theoretical framework. Participants were 273 healthy adults. Perceptions, especially perceived control and emotions, were related to protective behaviours, infection management behaviours and detachment at both phases of the study and also predicted follow-up reactions. Moreover, emotions predicted changes in behaviour and moderated the effects of several perceptions on pandemic-related behaviour.

Changes in health perceptions after exposure to human suffering: using discrete emotions to understand underlying processes

BACKGROUND

The aim of this study was to examine whether exposure to human suffering is associated with negative changes in perceptions about personal health. We further examined the relation of possible health perception changes, to changes in five discrete emotions (i.e., fear, guilt, hostility/anger, and joviality), as a guide to understand the processes underlying health perception changes, provided that each emotion conveys information regarding triggering conditions.

METHODOLOGY/FINDINGS

An experimental group (N = 47) was exposed to images of human affliction, whereas a control group (N = 47) was exposed to relaxing images. Participants in the experimental group reported more health anxiety and health value, as well as lower health-related optimism and internal health locus of control, in comparison to participants exposed to relaxing images. They also reported more fear, guilt, hostility and sadness, as well as less joviality. Changes in each health perception were related to changes in particular emotions.

CONCLUSION

These findings imply that health perceptions are shaped in a constant dialogue with the representations about the broader world. Furthermore, it seems that the core of health perception changes lies in the acceptance that personal well-being is subject to several potential threats, as well as that people cannot fully control many of the factors the determine their own well-being.

Conditional indirect relations of cardiac patients’ subjective health to optimism through illness representations: a self-regulation circuit

The aim of this study was to examine whether chronic patients’ subjective health can prospectively predict optimism through illness representations, as well as whether this relation depends on health levels. A sample of 97 cardiac patients participated in the two phases of the study. Subjective health predicted optimism with several illness representations serving as mediators. These relations were, however, conditional on the values of subjective health. Such findings suggest that the interplay between patients’ subjective health, illness representations, and optimism seems to function rather as a complex circuit system, than as a process of simple cyclical feedbacks.

The Impact of Emotion Regulation and Illness-focused Coping Strategies on the Relation of Illness-related Negative Emotions to Subjective Health

In this study we examined whether emotion regulation and illness-focused coping strategies mediate and/ or moderate the relation of illness-related negative emotions to patients’ subjective health. One hundred and thirty-five cardiac patients participated in the study. Illness-focused coping strategies were found to mediate the relation of emotions to physical functioning, whereas emotion regulation strategies mediated the relation to psychological well-being. Moreover, an emotion regulation strategy (i.e. emotion suppression) and two illness-focused coping strategies (instrumental coping and adherence) moderated the two relationships. These findings suggest that both emotion regulation and illness-focused coping strategies are integral parts of the illness-related negative emotions—health relationship.

Illness Cognitions as a Pathway Between Religiousness and Subjective Health in Chronic Cardiac Patients

The aim of this study was to examine the role of illness cognitions as a possible pathway between religiousness and subjective health in chronic illness. A sample of 135 chronic cardiac patients completed questionnaires about intrinsic religiousness, frequency of church service attendance, basic illness cognitions (i.e., helplessness, illness acceptance, perceived benefits), and physical and emotional well-being. According to the results, religiousness was significantly associated with subjective health. However, this relationship was indirect, with helplessness and illness acceptance serving as mediators between intrinsic religiousness and health. This finding is significant for understanding the complex relation of religiousness to chronic patients’ well-being.

Illness acceptance, hospitalization stress and subjective health in a sample of chronic patients admitted to hospital

The aim of this study was to examine the effects of illness acceptance on the subjective health of hospitalized chronic medical patients. Participants were 128 patients with a previous diagnosis of chronic coronary artery disease, cancer, or chronic renal disease, who were admitted to a public hospital. Illness acceptance was associated with higher levels of subjective health. It was negatively related to psychological symptoms and positively to self-rated health, even after controlling for demographic variables, type of disease, years since diagnosis, health-related quality of life and hospitalization stress. Furthermore, acceptance mediated the effects of hospitalization stress on subjective health measures.