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Shanahan ML, Rand KL, Galloway A, Matthias MS. Treatment Goals and Preferences of Black Veterans with Chronic Musculoskeletal Pain. J Pain 2024:S1526-5900(24)00368-7. [PMID: 38336030 DOI: 10.1016/j.jpain.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Understanding patient goals and preferences is critical in the context of complex conditions such as chronic pain. This need may be especially pronounced for Black patients, who experience significant health and healthcare disparities. The primary aim of this study was to describe the treatment goals and preferences of Black veterans with chronic musculoskeletal pain who were enrolled in the intervention arm of a randomized controlled trial testing a coaching intervention. In the coaching sessions, participants (n = 106) identified their most important pain-related treatment goals and preferences. Participants' top treatment goals were to improve physical functioning (61%), increase engagement in valued activities (45%), and reduce pain intensity (37%). Most participants (73%) preferred non-pharmacological treatments (eg, physical therapy, exercise, acupuncture, yoga). The 17% of participants who identified medications as a preferred treatment demonstrated higher levels of depression and anxiety compared to those who did not. Approximately 42% and 21% of participants stated a preference to avoid pharmacological and surgical pain treatments, respectively. Black patients with chronic pain prioritize improving physical functioning and pain intensity in service of increasing their engagement in exercise, work, relationships, and leisure activities. Also, in the current study, patients expressed a clear preference for non-pharmacological pain treatments. Future research should investigate ways to improve communication of goals and preferences with providers and facilitate access to non-pharmacological treatments for Black patients with chronic pain. PERSPECTIVE: This article describes the treatment goals and preferences of Black veterans with chronic pain. Most patients prioritized goals to improve physical functioning, pain severity, and participation in valued activities. Patients primarily preferred non-pharmacological treatments. This emphasizes the need for clear communication with Black patients regarding pain-related goals and non-pharmacological treatment options.
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Affiliation(s)
- Mackenzie L Shanahan
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Kevin L Rand
- Department of Psychology, Indiana University, Indianapolis, Indiana
| | - Amanda Galloway
- Department of Psychology, Indiana University, Indianapolis, Indiana
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Myers EJ, Abel DB, Mickens JL, Russell MT, Rand KL, Salyers MP, Lysaker PH, Minor KS. Meta-analysis of the relationship between metacognition and disorganized symptoms in psychosis. Schizophr Res 2024; 264:178-187. [PMID: 38154360 DOI: 10.1016/j.schres.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/10/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Disorganized symptoms show associations with metacognitive deficits in psychosis. However, the magnitude of this relationship is unclear. This meta-analysis aimed to 1) quantify relationships between metacognition and both disorganized symptoms and disorganized speech; and 2) examine moderators of these relationships (e.g., metacognition type, neurocognition). METHOD A literature search was conducted using PsycINFO, Web of Science, PubMed, and EMBASE databases. English-language studies measuring disorganized symptoms and metacognition (i.e., introspective accuracy, metacognitive beliefs, or metacognitive capacity) in psychosis were included. Random effects meta-analyses were conducted using Pearson's r. RESULTS Meta-analysis of 20 studies (n = 1490) resulted in a significant negative medium correlation between disorganized symptoms and metacognition (r = -0.332, 95 % CI [-0.423, -0.235]). Magnitude was moderated by metacognition type. A significant negative small correlation between disorganized speech and metacognition (r = -0.173, 95 % CI [-0.254, -0.089], n = 1470) was observed, with no significant moderators. CONCLUSIONS Results clarify the magnitude of the relationships between metacognition and both disorganized symptoms and disorganized speech. Significant relationships may indicate conceptual links, yet the different magnitudes may reflect a distinction between disorganized symptoms and speech. The moderator finding highlights that metacognitive capacity has an especially strong link to disorganized symptoms and underscores the need for careful distinction between types of metacognition in future work.
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Affiliation(s)
- Evan J Myers
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
| | - Danielle B Abel
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
| | - Jessica L Mickens
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
| | - Madisen T Russell
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
| | - Kevin L Rand
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
| | - Michelle P Salyers
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Department of Psychiatry, 1481 W. 10th St., Indianapolis, IN 46202, United States; Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St., Indianapolis, IN 46202, United States.
| | - Kyle S Minor
- Department of Psychology, Indiana University - Purdue University Indianapolis, 402 N Blackford St., LD 124, Indianapolis, IN 46202, United States.
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Matthias MS, Daggy JK, Perkins AJ, Adams J, Bair MJ, Burgess DJ, Eliacin J, Flores P, Myers LJ, Menen T, Procento P, Rand KL, Salyers MP, Shanahan ML, Hirsh AT. Communication and activation in pain to enhance relationships and treat pain with equity (COOPERATE): a randomized clinical trial. Pain 2024; 165:365-375. [PMID: 37733487 DOI: 10.1097/j.pain.0000000000003021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Racialized disparities in chronic pain care are well-documented and persist despite national priorities focused on health equity. Similar disparities have been observed in patient activation (ie, having the knowledge, confidence, and skills to manage one's health). As such, interventions targeting patient activation represent a novel approach to addressing and reducing disparities in pain care. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity is a randomized controlled trial of a 6-session telephone-delivered intervention to increase patient activation for Black patients with chronic pain. Two hundred fifty Black patients from a Midwestern Veterans Affairs medical center were randomized to the intervention or attention control. The primary outcome was patient activation; secondary outcomes included communication self-efficacy, pain, and psychological functioning. Outcomes were assessed at baseline and at 3 (primary endpoint), 6, and 9 months (sustained effects). Analyses used an intent-to-treat approach. Compared with baseline, patient activation increased 4.6 points at 3 months (versus +0.13 in control group, 95% CI: 0.48, 7.34; P = 0.03). These improvements in the intervention group were sustained, with +7 from baseline at 6 months and +5.77 at 9 months, and remained statistically significant from the control group. Communication self-efficacy increased significantly relative to the control group from baseline to 3 months. Pain intensity and interference improved at 3 months, but differences were not significant after adjusting for multiple comparisons. Most other secondary outcomes improved, but group differences were not statistically significant after controlling for multiple comparisons. Results suggest that increasing patient activation is a potentially fruitful path toward improving pain management and achieving health equity.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Diana J Burgess
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, United States
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Perla Flores
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Philip Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Mackenzie L Shanahan
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
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Shanahan ML, Fischer IC, Rogers SK, Rand KL. Coping with COVID-19: a snapshot of college student mental health, coping, and expectancies during stay-at-home orders. J Am Coll Health 2024; 72:451-462. [PMID: 35298356 DOI: 10.1080/07448481.2022.2039670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/13/2021] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has disrupted people's lives around the world, including college students. This cross-sectional study aimed to 1) describe psychological distress, coping, and expectancies of undergraduates during COVID-19 "stay-at-home" orders and 2) examine the associations among these variables. PARTICIPANTS AND METHODS Midwestern US undergraduates (N = 186) completed measures of psychological distress, coping behaviors, and expectancies in March-April 2020 during the initial round of "stay-at-home" orders. RESULTS Students engaged in approach coping and disease prevention behaviors and had low expectations for contracting COVID-19. Most students reported clinically significant depression or anxiety. Adherence to disease prevention behaviors was associated with less stress but more anxiety. Positive expectancies and approach coping were associated with less distress. Avoidance coping was associated with more distress. CONCLUSIONS This study describes the toll that COVID-19 has had on college students. Continued attention to the mental health of college students during the pandemic is imperative.
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Affiliation(s)
- Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Ian C Fischer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Sarah K Rogers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Krueger E, Secinti E, Stewart JC, Rand KL, Mosher CE. Cognitive-behavioral and mindfulness-based interventions for distress in patients with advanced cancer: A meta-analysis. Psychooncology 2024; 33:e6259. [PMID: 38054530 DOI: 10.1002/pon.6259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/17/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE Various psychosocial interventions have been developed to reduce distress and improve quality of life (QoL) in patients with advanced cancer, many of which are traditional cognitive-behavioral interventions (CBIs) or mindfulness-based interventions (MBIs). The aims of this meta-analysis were to determine and compare the overall effects of traditional CBIs and MBIs on distress and QoL in this population and to explore potential moderators of intervention efficacy. METHODS A systematic search was conducted in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Randomized controlled trials (RCTs) comparing CBIs or MBIs to controls on distress and QoL outcomes were eligible for inclusion. Random effects meta-analyses using standardized baseline to post-intervention mean differences were calculated using Hedges's g. Meta-regressions were used to compare intervention effects and examine potential moderators. RESULTS Across 37 RCTs (21 CBIs, 14 MBIs, 2 combination therapies), there was a small decrease in distress (Hedges's g = 0.21) and a minimal improvement in QoL (Hedges's g = 0.15). Traditional CBIs and MBIs did not differ in effect sizes. Heterogeneity was significant across distress effect sizes but not across QoL effects. Interventions delivered to individuals (vs. dyads/group) had larger effects on QoL. No moderators of intervention effects on distress were found. CONCLUSIONS Findings suggest traditional CBIs and MBIs produce small reductions in distress compared to controls in patients with advanced cancer, although effects on QoL appear minimal. Given limitations in the number of studies and their quality, rigorous trials are needed to directly compare the impact of traditional CBIs and MBIs in this population.
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Affiliation(s)
- Ellen Krueger
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Rogers SK, Ahamadeen N, Chen CX, Mosher CE, Stewart JC, Rand KL. Dysmenorrhea and psychological distress: a meta-analysis. Arch Womens Ment Health 2023; 26:719-735. [PMID: 37632569 DOI: 10.1007/s00737-023-01365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
Dysmenorrhea is characterized by pelvic pain associated with menstruation. Similar to people with other pain conditions, females who experience dysmenorrhea report increased psychological distress. However, the pooled magnitude of this association has not been quantified across studies. Accordingly, this meta-analytic review quantifies the magnitude of the associations between dysmenorrhea severity and psychological distress. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, Embase, and Web of Science. Analyzed studies provided observational data on dysmenorrhea severity and anxiety symptoms, depressive symptoms, and/or global psychological distress. A total of 44 studies were included, and three random-effects meta-analyses were conducted, with average pooled effect sizes calculated using Person's r. We found significant, positive associations between measures of dysmenorrhea severity and measures of depressive symptoms (r = 0.216), anxiety symptoms (r = 0.207), and global psychological distress (r = 0.311). Our review suggests that females with greater dysmenorrhea severity experience greater psychological distress. Future directions include defining a clinically meaningful dysmenorrhea severity threshold, understanding the mechanisms and directionality underlying the dysmenorrhea-psychological distress relationship, and designing and testing interventions to jointly address dysmenorrhea and psychological distress.
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Affiliation(s)
- Sarah K Rogers
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA.
| | - Naheeda Ahamadeen
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Chen X Chen
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Catherine E Mosher
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Jesse C Stewart
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- School of Science, Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 113A, Indianapolis, IN, 46202, USA
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Crawford CA, Williams MK, Shell AL, MacDonald KL, Considine RV, Wu W, Rand KL, Stewart JC. Effect of modernized collaborative care for depression on brain-derived neurotrophic factor (BDNF) and depressive symptom clusters: Data from the eIMPACT trial. Psychiatry Res 2023; 330:115581. [PMID: 37931480 PMCID: PMC10842310 DOI: 10.1016/j.psychres.2023.115581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
Brain-derived neurotrophic factor (BDNF) levels are lower in people with depression and are normalized following pharmacological treatment. However, it is unknown if psychological treatments for depression improve BDNF and if change in BDNF is a mediator of intervention effects on depressive symptoms. Therefore, using data from the eIMPACT trial, we sought to determine the effect of modernized collaborative care for depression on 12-month changes in BDNF and cognitive/affective and somatic depressive symptom clusters and to examine whether BDNF changes mediate intervention effects on depressive symptoms. 216 primary care patients with depression from a safety net healthcare system were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. Plasma BDNF was measured with commercially available kits, and depressive symptom clusters were assessed by the Patient Health Questionnaire-9. The intervention did not influence BDNF but did improve both the cognitive/affective and somatic clusters over 12 months. Changes in BDNF did not mediate the intervention effect on either cluster. Our findings suggest that modernized collaborative care is an effective treatment for both the cognitive/affective and somatic symptoms of depression and that the mechanism of action is not improvements in BDNF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02458690.
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Affiliation(s)
- Christopher A Crawford
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA
| | - Michelle K Williams
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA
| | - Aubrey L Shell
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA
| | - Krysha L MacDonald
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA; Sandra Eskenazi Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Robert V Considine
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 North Blackford Street, LD 100E, Indianapolis, IN 46202, USA.
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Fischer IC, Davis LW, Cyders MA, Salyers MP, Rand KL. Posttraumatic stress and depressive symptoms and symptom clusters in a sample of treatment-seeking US veterans: Longitudinal associations with meaning in life and general self-efficacy. J Affect Disord 2023; 339:781-787. [PMID: 37479042 DOI: 10.1016/j.jad.2023.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES To quantify the associations between general self-efficacy, subjective meaning in life, and posttraumatic stress and depressive symptoms and symptom clusters in US veterans, both cross-sectionally and longitudinally. METHODS Data from a Veteran Affairs (VA) funded intervention study (n = 191) were examined. Self-report measures of depressive symptoms, general self-efficacy, and meaning in life were collected, along with clinician-rated symptoms of PTSD. RESULTS Meaning in life was consistently inversely associated with posttraumatic stress and depressive symptoms and symptom clusters cross-sectionally, whereas general self-efficacy was only inversely associated with some aspects of depressive symptoms. Longitudinal analyses further revealed that meaning in life was inversely associated with the cluster D symptoms of PTSD and the cognitive-affective symptoms of depression. CONCLUSIONS Higher meaning in life is associated with less severe symptoms of posttraumatic stress and depressive symptoms, particularly those related to mood. Additional research is needed to determine whether interventions designed to increase meaning in life attenuate these symptoms.
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Affiliation(s)
- Ian C Fischer
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA.
| | - Louanne W Davis
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa A Cyders
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Michelle P Salyers
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kevin L Rand
- Indiana University-Purdue University at Indianapolis (IUPUI), Indianapolis, IN, USA
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Rogers SK, Galloway A, Hirsh AT, Zapolski T, Chen CX, Rand KL. Efficacy of psychological interventions for dysmenorrhea: a meta-analysis. Pain Med 2023; 24:1086-1099. [PMID: 37154693 DOI: 10.1093/pm/pnad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
Dysmenorrhea is pelvic pain associated with menstruation and is one of the most common pain conditions among reproductive-age women. It is commonly treated with medications, complementary and alternative medicine, and self-management techniques. However, there is increased focus on psychological interventions which modify thoughts, beliefs, emotions, and behavioral responses to dysmenorrhea. This review examined the efficacy of psychological interventions on dysmenorrhea pain severity and interference. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, and Embase. A total of 22 studies were included; 21 examined within-group improvement (ie, within-group analysis) and 14 examined between-group improvement (ie, between-group analysis). Random-effects meta-analyses were conducted on pain severity and interference, with average effect sizes calculated using Hedges's g. Within-group analyses showed decreased pain severity and interference at post-treatment (g = 0.986 and 0.949, respectively) and first follow-up (g = 1.239 and 0.842, respectively). Between-group analyses showed decreased pain severity at post-treatment (g = 0.909) and decreased pain severity and interference at first follow-up (g = 0.964 and 0.884, respectively) compared to control groups. This review supports the efficacy of psychological interventions for dysmenorrhea, but conclusions are tempered by suboptimal methodological quality of the included studies and high heterogeneity across studies. Additional, rigorous research is needed to determine the clinical utility of psychological interventions for dysmenorrhea.
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Affiliation(s)
- Sarah K Rogers
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Amanda Galloway
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Tamika Zapolski
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Chen X Chen
- Indiana University School of Nursing, Indianapolis, IN 46202, United States
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, United States
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Abel DB, Rand KL, Salyers MP, Myers EJ, Mickens JL, Minor KS. Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure. Schizophr Bull 2023; 49:809-822. [PMID: 36820515 PMCID: PMC10154728 DOI: 10.1093/schbul/sbac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants. DESIGN A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g. RESULTS Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure. CONCLUSIONS Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia.
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Affiliation(s)
- Danielle B Abel
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Evan J Myers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Jessica L Mickens
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
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Anastas TM, Stewart JC, Rand KL, Hirsh AT. Pain in People Experiencing Homelessness: A Scoping Review. Ann Behav Med 2023; 57:288-300. [PMID: 36745022 PMCID: PMC10094969 DOI: 10.1093/abm/kaac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prior work suggests that people experiencing homelessness (PEH) are at heightened risk for developing pain and have a uniquely burdensome pain experience. PURPOSE The aim of this scoping review was to map the current peer-reviewed, published literature on the pain experience of PEH. METHODS In accordance with the US Annual Homeless Assessment Report, we defined homelessness as lacking shelter or a fixed address within the last year. We conceptualized the pain experience via a modified version of the Social Communication Model of Pain, which considers patient, provider, and contextual factors. Published articles were identified with CINHAL, Embase, PubMed, PsycINFO, and Web of Science databases. RESULTS Sixty-nine studies met inclusion criteria. Studies revealed that PEH have high rates of pain and experience high levels of pain intensity and interference. Substantially fewer studies examined other factors relevant to the pain experience, such as self-management, treatment-seeking behaviors, and pain management within healthcare settings. Nonetheless, initial evidence suggests that pain is undermanaged in PEH. CONCLUSIONS Future research directions to understand pain and homelessness are discussed, including factors contributing to the under-management of pain. This scoping review may inform future work to develop interventions to address the specific pain care needs of PEH.
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Affiliation(s)
- Tracy M Anastas
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University – Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
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12
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Acquati C, Head KJ, Rand KL, Alwine JS, Short DN, Cohee AA, Champion VL, Draucker CB. Psychosocial Experiences, Challenges, and Recommendations for Care Delivery among Partners of Breast Cancer Survivors: A Qualitative Study. Int J Environ Res Public Health 2023; 20:2786. [PMID: 36833489 PMCID: PMC9956235 DOI: 10.3390/ijerph20042786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
For women diagnosed with breast cancer, partners are consistently identified as the primary support person. Despite growing consensus about the psychosocial experience and unmet needs of cancer caregivers, limited evidence exists about strategies to offer partner-centered care across the cancer continuum. This study describes challenges endured by partners of breast cancer survivors (BCS), strategies implemented to manage these experiences, and recommendations for healthcare providers to inform targeted psychosocial care. Using convenience sampling, 22 partners of female BCS were recruited and completed semi-structured interviews. Conventional content analysis was used to code and synthesize findings. Participants described undergoing five experiences in their role as romantic partners: (a) assuming the role of caregiver, (b) becoming healthcare advocates for BCS, (c) connecting emotionally with the partner, (d) managing their own painful emotions, and (e) connecting with others for support. Experience-specific coping strategies and recommendations were identified. Romantic partners face multiple transitions across the cancer care continuum, which warrant investigation to sustain their well-being and active participation in illness management. Psychosocial interventions for this group will benefit from flexible implementation and attention to care delivery, mental health, and supportive/social needs.
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Affiliation(s)
- Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX 77004, USA
- Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77004, USA
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Katharine J. Head
- Department of Communication Studies, School of Liberal Arts, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Kevin L. Rand
- School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | | | | | - Andrea A. Cohee
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN 46202, USA
| | - Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Melvin and Bren Simon Comprehensive Cancer Center, Indiana University, Indianapolis, IN 46202, USA
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13
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Rand KL, Rogers SK. Cognitive models of hope. Curr Opin Psychol 2023; 49:101510. [PMID: 36459929 DOI: 10.1016/j.copsyc.2022.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin L Rand
- Indiana University-Purdue University Indianapolis, USA.
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14
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Matthias MS, Adams J, Burgess D, Daggy J, Eliacin J, Flores P, Hirsh AT, Myers LJ, Perkins AJ, Menen T, Philip Procento, Rand KL, Salyers MP, Shanahan ML, Bair MJ. Corrigendum to: Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics (Contemporary Clinical Trials, volume 118, article number 106790). Contemp Clin Trials 2022; 120:106883. [PMID: 35999166 DOI: 10.1016/j.cct.2022.106883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Diana Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Joanne Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Perla Flores
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Philip Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
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15
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Matthias MS, Adams J, Burgess DJ, Daggy J, Eliacin J, Flores P, Hirsh AT, Myers LJ, Perkins AJ, Menen T, Procento P, Rand KL, Salyers MP, Shanahan ML, Bair MJ. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics. Contemp Clin Trials 2022; 118:106790. [PMID: 35568376 DOI: 10.1016/j.cct.2022.106790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic pain is associated with profound negative effects, and racial disparities are well-documented in chronic pain treatment. In addition, Black patients report poorer communication with providers and exhibit lower levels of patient activation (self-management self-efficacy) than White patients. Although the causes of healthcare disparities are complex and require intervention at multiple levels, empowering patients is one critical path to achieving health equity. The current study is a coaching intervention focused on increasing patient activation and building communication skills for Black patients with chronic pain. METHODS In this randomized controlled trial, 250 Black patients with chronic pain were randomized to either the coaching intervention or an attention control arm. Intervention patients attended 6 telephone-delivered individual coaching sessions over 12 weeks. Coaching focused on clarifying and prioritizing goals and on communication skills, such as agenda setting. The primary outcome is patient activation. Secondary outcomes include communication self-efficacy, pain intensity and interference, and psychological functioning. DISCUSSION Having the knowledge and confidence to participate in one's pain care, coupled with the skills needed to effectively communicate with providers, is essential to optimize chronic pain care. This is particularly important for Black patients who often experience lower quality pain care. Interventions such as COOPERATE hold promise for helping patients to acquire the requisite tools to take greater control of their chronic pain care. TRIAL REGISTRATION clinicaltrials.gov, # NCT03562793.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Joanne Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Perla Flores
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Philip Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
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16
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Anastas TM, Miller MM, Hollingshead NA, Stewart JC, Rand KL, Hirsh AT. The Unique and Interactive Effects of Patient Race, Patient Socioeconomic Status, and Provider Attitudes on Chronic Pain Care Decisions. Ann Behav Med 2021; 54:771-782. [PMID: 32227158 DOI: 10.1093/abm/kaaa016] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Compared to White and high socioeconomic status (SES) patients, Black and low SES patients receive less adequate pain care. Providers may contribute to these disparities by making biased decisions that are driven, in part, by their attitudes about race and SES. PURPOSE We examined the effects of patient race and SES on providers' chronic pain decisions and the extent to which providers' implicit and explicit attitudes about race and SES were related to these decisions. METHODS Physician residents/fellows (n = 436) made pain care decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Physicians also completed measures assessing implicit and explicit attitudes about race and SES. RESULTS There were three significant race-by-SES interactions: (a) For high SES patients, Black (vs. White) patients were rated as having more pain interference; the opposite race difference emerged for low SES patients. (b) For high SES patients, Black (vs. White) patients were rated as being in greater distress; no race difference emerged for low SES patients. (c) For low SES patients, White (vs. Black) patients were more likely to be recommended workplace accommodations; no race difference emerged for high SES patients. Additionally, providers were more likely to recommend opioids to Black (vs. White) and low (vs. high) SES patients, and were more likely to use opioid contracts with low (vs. high) SES patients. Providers' implicit and explicit attitudes predicted some, but not all, of their pain-related ratings. CONCLUSION These results highlight the need to further examine the effects of patient race and SES simultaneously in the context of pain care.
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Affiliation(s)
- Tracy M Anastas
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | - Megan M Miller
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | | | - Jesse C Stewart
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | - Kevin L Rand
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
| | - Adam T Hirsh
- Department of Psychology, Indiana University - Purdue University Indianapolis, Indianapolis, IN
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17
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Abstract
BACKGROUND Generalized expectancies have been theorized to play key roles in pain-related outcomes, but the empirical findings have been mixed. PURPOSE The primary aim of this meta-analysis was to quantify the relationships between two of the most researched positive generalized expectancies (i.e., hope and optimism) and pain-related outcomes (i.e., pain severity, physical functioning, and psychological dysfunction) for those experiencing clinical pain. METHODS A total of 96 studies and 31,780 participants with a broad array of pain diagnoses were included in analyses, using random-effects models. RESULTS Both hope and optimism had negative correlations with pain severity (hope: r = -.168, p < .001; optimism: r = -.157, p < .001), positive correlations with physical functioning (hope: r = .199, p < .001; optimism: r = .175, p < .001), and negative correlations with psychological dysfunction (hope: r = -.349, p = .001; optimism: r = -.430, p <.001). CONCLUSION The current findings suggest that hope and optimism are similarly associated with adaptive pain-related outcomes. Future research should examine the efficacy of interventions on hope and optimism in ameliorating the experience of clinical pain.
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Affiliation(s)
- Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Ian C Fischer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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18
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Rogers SK, Rand KL, Chen CX. Comparing dysmenorrhea beliefs and self-management techniques across symptom-based phenotypes. J Clin Nurs 2021; 30:2015-2022. [PMID: 33761154 PMCID: PMC8180506 DOI: 10.1111/jocn.15754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare beliefs about dysmenorrhea and self-management techniques across three dysmenorrhea symptom-based phenotypes. BACKGROUND Many reproductive-age women experience dysmenorrhea, with varying symptoms and intensity. Dysmenorrhea symptom-based phenotypes have been identified in previous research, defining distinctive phenotypes of mild localised pain, severe localised pain, and multiple severe symptoms. It is unknown if women from different phenotypes hold different beliefs about dysmenorrhea or if they engage in different self-management techniques. DESIGN Quantitative secondary analysis of cross-sectional survey data. METHODS This online study surveyed 762 women with dysmenorrhea in the United States. Participants reported their dysmenorrhea symptom intensity, beliefs about dysmenorrhea (i.e. beliefs about consequences, timeline, controllability, symptom severity, normalcy, emotional response to symptoms and treatments) and self-management techniques to prevent or treat symptoms. Beliefs regarding dysmenorrhea and types of self-management techniques used were compared across three phenotypes utilising ANOVA tests and Tukey's HSD for pairwise comparisons. Reporting followed the STROBE guidelines. RESULTS Women with multiple severe symptoms had significantly more negative beliefs regarding dysmenorrhea and utilised significantly more self-management techniques than women with severe localised pain and women with mild localised pain. Women with severe localised pain had significantly more negative beliefs regarding dysmenorrhea and utilised significantly more self-management techniques than women with mild localised pain. Negative beliefs regarding dysmenorrhea included: consequences of dysmenorrhea, timeline of symptoms, personal and treatment control, symptom severity, normalcy of symptoms, emotional response to symptoms and willingness to utilise complementary medicine. CONCLUSION Results further support the distinction between dysmenorrhea symptom-based phenotypes. Not only do women in different phenotypes experience different severity and number of dysmenorrhea symptoms, they also perceive and manage their dysmenorrhea differently. RELEVANCE TO CLINICAL PRACTICE These findings have implications for tailoring interventions to different dysmenorrhea symptom-based phenotypes.
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Affiliation(s)
| | - Kevin L Rand
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Chen Xiao Chen
- Indiana University School of Nursing, Indianapolis, IN, USA
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19
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Heit M, Carpenter JS, Chen CX, Rand KL. Operationalizing Postdischarge Recovery From Laparoscopic Sacrocolpopexy for the Preoperative Consultative Visit. Female Pelvic Med Reconstr Surg 2021; 27:427-431. [PMID: 32910078 PMCID: PMC10590052 DOI: 10.1097/spv.0000000000000942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective was to establish a threshold for postdischarge surgical recovery from laparoscopic sacrocolpopexy for the preoperative consultative visit to answer the "what is my recovery time?" question. METHODS Study participants (N = 171) with stage 2 or worse pelvic organ prolapse undergoing laparoscopic sacrocolpopexy who completed postoperative surveys at 4 time points. Postdischarge Surgical Recovery 13 (PSR13) scores were anchored to a Global Surgical Recovery (GSR) tool (if 100% recovery is back to your usual health, what percentage of recovery are you now?). Weighted mean PSR13 scores were calculated as a sum of the products variable when patients considered themselves 80 to less than 85, 85 to less than 90, 90 to less than 95, or 95 to 100 percent recovered on the GSR tool. The percentage of study participants recovered at postdischarge day 7, 14, 42, and 90 was calculated based on a comparison between the GSR scores and weighted mean PSR13 scores. RESULTS A PSR13 score of 80 or greater, corresponding to 85% or greater recovery, was seen in 55.6% (42 days) and 50.9% (90 days) of study participants, respectively, establishing this numeric threshold as representing "significant" postdischarge recovery after laparoscopic sacrocolpopexy. At 14 days after discharge, only 16.4% of the study population achieved this PSR13 score. CONCLUSIONS Most study subjects were "significantly" recovered at 42 days after laparoscopic sacrocolpopexy using a PSR13 score of 80 or greater as a numeric threshold. There is a need to determine the population percentage of recovered study subjects at 30, 60, and beyond 90 days from laparoscopic sacrocolpopexy.
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Affiliation(s)
- Michael Heit
- From the Department of Obstetrics and Gynecology, School of Medicine
| | | | - Chen X Chen
- Department of Community and Health Systems, School of Nursing, Indiana University
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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20
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Johns SA, Tarver WL, Secinti E, Mosher CE, Stutz PV, Carnahan JL, Talib TL, Shanahan ML, Faidley MT, Kidwell KM, Rand KL. Effects of mindfulness-based interventions on fatigue in cancer survivors: A systematic review and meta-analysis of randomized controlled trials. Crit Rev Oncol Hematol 2021; 160:103290. [PMID: 33675902 PMCID: PMC8200642 DOI: 10.1016/j.critrevonc.2021.103290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/03/2020] [Accepted: 02/27/2021] [Indexed: 12/11/2022] Open
Abstract
This systematic review and meta-analysis was designed to determine the efficacy of mindfulness-based interventions (MBIs) in improving fatigue-related outcomes in adult cancer survivors. Randomized controlled trials (RCTs) were identified from PubMed, MEDLINE, PsycINFO, CINAHL, Web of Science, and EMBASE databases and reference lists of included studies. Separate random-effects meta-analyses were conducted for fatigue and vitality/vigor. Twenty-three studies reporting on 21 RCTs (N = 2239) met inclusion criteria. MBIs significantly reduced fatigue compared to controls at post-intervention (g = 0.60, 95 % CI [0.36, 0.83]) and first follow-up (g = 0.42, 95 % CI [0.20, 0.64]). Likewise, MBIs significantly improved vitality/vigor at post-intervention (g = 0.39, 95 % CI [0.25, 0.52]) and first follow-up (g = 0.35, 95 % CI [0.03, 0.67]). The evidence grade was low due to risk of bias, substantial heterogeneity, and publication bias among studies. MBIs show promise in improving fatigue and vitality/vigor in cancer survivors. More rigorous trials are needed to address current gaps in the evidence base.
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Affiliation(s)
- Shelley A Johns
- Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA.
| | - Will L Tarver
- Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Patrick V Stutz
- Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA
| | - Jennifer L Carnahan
- Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA
| | | | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Micah T Faidley
- Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA
| | - Kelley M Kidwell
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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21
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Procento PM, Rand KL, Stewart JC, Hirsh AT. Pain Catastrophizing Mediates and Moderates the Link Between Acute Pain and Working Memory. J Pain 2021; 22:981-995. [PMID: 33727160 DOI: 10.1016/j.jpain.2021.03.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
The bidirectional relationship between pain and working memory (WM) deficits is well-documented but poorly understood. Pain catastrophizing-exaggerated, negative cognitive and emotional responses toward pain-may contribute to WM deficits by occupying finite, shared cognitive resources. The present study assessed the role of pain catastrophizing as both a state-level process and trait-level disposition in the link between acute pain and WM. Healthy, young adults were randomized to an experimentally-induced ischemic pain or control task, during which they completed verbal and non-verbal WM tests. Participants also completed measures of state- and trait-level pain catastrophizing. Simple mediation analyses indicated that participants in the pain group (vs. control) engaged in more state-level catastrophizing about pain, which led to worse verbal and non-verbal WM. Moderated mediation analyses indicated that the indirect (mediation) effect of state-level pain catastrophizing was moderated by trait-level pain catastrophizing for both verbal and non-verbal WM. Participants in the pain group who reported a greater trait-level tendency to catastrophize about pain experienced greater state-level catastrophizing about pain during the ischemic task, which led to worse verbal and non-verbal WM performance. These results provide evidence for pain catastrophizing as an important mechanism and moderating factor of WM deficits in acute pain. Future research should replicate these results in chronic pain samples, investigate other potential mechanisms (e.g., sleep disturbances), and determine if interventions that target pain catastrophizing directly can ameliorate cognitive deficits in people with pain. PERSPECTIVE: This article presents a laboratory study examining the relationships among pain, pain catastrophizing, and working memory in healthy participants. The results shed new light on these relationships and raise the possibility that interventions that reduce catastrophizing may lead to improved cognitive function among people with pain.
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Affiliation(s)
- Philip M Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana.
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22
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Rivers AS, Sanford K, Elkins G, Carpenter JS, Rand KL, Bartlett Ellis RJ. Attitudinal and social predictors of adherence to oral endocrine therapy: A psychometrically-informed model. J Health Psychol 2020; 27:913-922. [PMID: 33339482 DOI: 10.1177/1359105320982039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There is a need for a psychometrically-informed model identifying attitudinal and social factors explaining adherence to oral endocrine therapy (OET) for women with hormone receptor positive breast cancer. This study tested a model with variables selected by stringent psychometric criteria, including attitudes about benefit and burden, patient-practitioner alliance and confusion, and positive and negative interpersonal interactions. Self-report scales were completed by 150 current or past OET users. Fourteen correlations and six mediated pathways implied by the model were tested. All hypothesized associations were significant. This preliminary study suggests the model is a valuable framework for OET adherence research and intervention.
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Affiliation(s)
| | | | | | | | - Kevin L Rand
- Indiana University-Purdue University Indianapolis, USA
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Fischer IC, Shanahan ML, Hirsh AT, Stewart JC, Rand KL. The relationship between meaning in life and post-traumatic stress symptoms in US military personnel: A meta-analysis. J Affect Disord 2020; 277:658-670. [PMID: 32911216 DOI: 10.1016/j.jad.2020.08.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/18/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Subjective meaning in life has been theorized to play a critical role in the adjustment to traumatic events. However, its association with post-traumatic stress symptoms has not been quantitatively reviewed. METHODS Informed by Park's integrated meaning-making model and evidenced-based psychological treatments for post-traumatic stress disorder, the goals of this meta-analysis were to: (1) to determine the direction and magnitude of the association between meaning in life and post-traumatic stress symptoms; and (2) to examine potential moderators of this association (i.e., age, sex, race, marital status, type of trauma, and meaning in life conceptualization). CINAHL, Embase, PILOT, PsycINFO, PubMed, and Web of Science core collection databases were searched. RESULTS A random-effects meta-analysis was conducted on 26 associations (N = 9,751). A significant, moderate, negative relationship was found between meaning in life and post-traumatic stress symptoms (r = -0.41; 95% CI: -0.47 to -0.35, k = 25). No significant moderators were detected. CONCLUSIONS Findings suggest that meaning in life plays a crucial role in adjustment to traumatic events. Development and testing of randomized controlled trials to determine whether increases in meaning in life result in reductions of post-traumatic stress in US military personnel may facilitate ongoing efforts aimed at recovery from trauma.
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Affiliation(s)
- Ian C Fischer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA.
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Jesse C Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
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Heit M, Chen CX, Pan C, Rand KL. Recovery expectancies impact postdischarge recovery 42 days after laparoscopic sacrocolpopexy. Int Urogynecol J 2020; 32:1527-1532. [PMID: 33175228 DOI: 10.1007/s00192-020-04586-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this retrospective cohort study was to determine if recovery expectancies were associated with actual postdischarge recovery after laparoscopic sacrocolpopexy. METHODS Study subjects (N = 167) undergoing laparoscopic sacrocolpopexy were asked to preoperatively predict the likelihood of a prolonged postdischarge recovery (> 42 days). Low, medium, and high recovery expectancy groups were created from responses to the likelihood of prolonged postdischarge recovery question. Previously established predictors of actual recovery 42 days after laparoscopic sacrocolpopexy included age, body mass index, Charlson co-morbidity index, short form (SF)-36 bodily pain scores, doctors' and others' health locus of control, and sick role investment. One parsimonious hierarchical linear and logistic regression model was constructed to determine if preoperative recovery expectancies were independently associated with PSR13 scores and "significant" postdischarge recovery after controlling for previously established predictors. RESULTS Study subjects with high recovery expectancies had higher PSR13 scores than subjects with low recovery expectancies (82.32 ± 15.34 vs 73.30 ± 15.30, mean difference 9.01, 95%CI 1.08-16.94). Study subjects with low recovery expectancies scored 7.7 points lower on the PSR13 scale (minimally important difference = 5), which translated into a 73% reduction in the likelihood of being "significantly" recovered 42 days after surgery, after controlling for previously established predictors. CONCLUSIONS A low recovery expectancy has a negative impact on actual recovery 42 days after laparoscopic sacrocolpopexy. Our findings are important because preoperative recovery expectancies are modifiable predictors, making them a candidate for an expectancy manipulation intervention designed to optimize recovery after pelvic reconstructive surgery.
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Affiliation(s)
- Michael Heit
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, 11725 North Illinois Street, K140, Indianapolis, IN, 46032, USA.
| | - Chen X Chen
- Department of Community and Health Systems, School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Christine Pan
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University, 11725 North Illinois Street, K140, Indianapolis, IN, 46032, USA
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University, Indianapolis, IN, USA
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Rand KL, Shanahan ML, Fischer IC, Fortney SK. Hope and optimism as predictors of academic performance and subjective well-being in college students. Learning and Individual Differences 2020. [DOI: 10.1016/j.lindif.2020.101906] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Shanahan ML, Fischer IC, Rand KL. Hope, optimism, and affect as predictors and consequences of expectancies: The potential moderating roles of perceived control and success. Journal of Research in Personality 2020. [DOI: 10.1016/j.jrp.2019.103903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Background: Numerous studies have investigated injuries and treatments in the baseball athlete. The majority of these studies have focused on the throwing shoulder and elbow. However, more recent literature is reporting injuries to other regions in this cohort, including the knee, head, hip, and hamstring. Purpose/Hypothesis: The purpose of the current study was to determine the number and type of injuries in Major League Baseball (MLB) and Minor League Baseball (MiLB) players that do not occur during the actual game but are related to baseball participation. Our hypothesis was that there would be a substantial number of injuries that occurred in professional baseball players during non-game situations. Study Design: Descriptive epidemiological study. Methods: Deidentified, anonymous data were collected from the 2011 through 2016 seasons from the MLB Health and Injury Tracking System (HITS) medical record database. All injuries that were identified as a primary diagnosis and resulted in at least 1 day out of play from both MLB and MiLB were examined. Injuries were categorized as occurring during the game (“game” injuries) or not during the game. A “non-game” injury was defined as occurring at any time other than during the scheduled game from the first to last pitch. Results: There were 51,548 total injuries in MLB and MiLB players from 2011 to 2016, almost 40% of which were attributed to non–game-related injuries (n = 19,201; 37.2%). The remainder occurred during a game (n = 32,347; 62.8%). A significantly greater percentage of non-game injuries were season ending (10.8%) compared with the percentage of game-related season-ending injuries (8.4%) (P < .0001). Pitchers had significantly more non–game-related injuries than game-related injuries (P < .0001). Conclusion: A large number of injuries occur in professional baseball outside of actual games. MiLB players, specifically pitchers, are particularly at risk for these types of injuries. It is feasible that the overall injury rate in professional baseball players could be reduced by analyzing these injuries in more detail to develop prevention strategies.
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Affiliation(s)
- Amanda Esquivel
- Department of Mechanical Engineering, College of Engineering and Computer Science, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Stan Conte
- Conte Sport Performance Therapy, Phoenix, Arizona, USA
| | - Thomas Tedeschi
- Detroit Medical Center Sports Medicine, Detroit, Michigan, USA
| | - Stephen E Lemos
- Detroit Medical Center Sports Medicine, Detroit, Michigan, USA
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Patel JS, Oh Y, Rand KL, Wu W, Cyders MA, Kroenke K, Stewart JC. Measurement invariance of the patient health questionnaire-9 (PHQ-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: NHANES 2005-2016. Depress Anxiety 2019; 36:813-823. [PMID: 31356710 PMCID: PMC6736700 DOI: 10.1002/da.22940] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite its popularity, little is known about the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9) across U.S. sociodemographic groups. Use of a screener shown not to possess measurement invariance could result in under/over-detection of depression, potentially exacerbating sociodemographic disparities in depression. Therefore, we assessed the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups. METHODS U.S. population representative data came from the 2005-2016 National Health and Nutrition Examination Survey (NHANES) cohorts. We conducted a measurement invariance analysis of 31,366 respondents across sociodemographic factors of sex, race/ethnicity, and education level. RESULTS Considering results of single-group confirmatory factor analyses (CFAs), depression theory, and research utility, we justify a two-factor structure for the PHQ-9 consisting of a cognitive/affective factor and a somatic factor (RMSEA = 0.034, TLI = 0.985, CFI = 0.989). On the basis of multiple-group CFAs testing configural, scalar, and strict factorial invariance, we determined that invariance held for sex, race/ethnicity, and education level groups, as all models demonstrated close model fit (RMSEA = 0.025-0.025, TLI = 0.985-0.992, CFI = 0.986-0.991). Finally, for all steps ΔCFI was <-0.004, and ΔRMSEA was <0.01. CONCLUSIONS We demonstrate that the PHQ-9 is acceptable to use in major U.S. sociodemographic groups and allows for meaningful comparisons in total, cognitive/affective, and somatic depressive symptoms across these groups, extending its use to the community. This knowledge is timely as medicine moves towards alternative payment models emphasizing high-quality and cost-efficient care, which will likely incentivize behavioral and population health efforts. We also provide a consistent, evidence-based approach for calculating PHQ-9 subscale scores.
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Affiliation(s)
- Jay S. Patel
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Youngha Oh
- Educational Psychology, Research, Evaluation, Measurement, and Statistics (REMS), Texas Tech University, Lubbock, TX
| | - Kevin L. Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Wei Wu
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Melissa A. Cyders
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
| | - Kurt Kroenke
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Jesse C. Stewart
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN
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Abstract
OBJECTIVE The aim of this study was to obtain public survey reactions to concept art for an exhibit about menopausal hot flashes designed to stimulate learning, dispel myths, spur dialogue, and increase empathy. METHODS Immediately before viewing the art, participants provided demographic information and answered one open-ended question. Immediately after viewing the art, participants answered the same open-ended question, one additional open-ended question, and completed quantitative survey questions. RESULTS Overall, public reactions to the concept art were positive. Qualitative and quantitative data indicated that the public thought the exhibit was appealing, stimulated learning, dispelled myths, spurred desire to have conversations about hot flashes, and increased empathy for women with menopausal hot flashes. CONCLUSIONS The exhibit concept art was appealing and was reported to have a positive impact on the public. Study findings provide support for building the exhibit full-scale as a traveling educational resource that might change public discourse around menopausal hot flashes.
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Affiliation(s)
| | - Kevin L Rand
- Indiana University-Purdue University, Indianapolis, IN
| | | | - Jennifer L Lapum
- Ryerson University, Daphne Cockwell School of Nursing, Toronto, ON, Canada
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Otte JL, Bakoyannis G, Rand KL, Ensrud KE, Guthrie KA, Joffe H, McCurry SM, Newton KM, Carpenter JS. Confirmatory factor analysis of the Insomnia Severity Index (ISI) and invariance across race: a pooled analysis of MsFLASH data. Menopause 2019; 26:850-855. [PMID: 30994570 PMCID: PMC6663566 DOI: 10.1097/gme.0000000000001343] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Women's sleep at menopause is widely reported to be problematic. The Insomnia Severity Index (ISI) is a commonly used tool for quantifying sleep problems in clinical and research settings, but psychometric properties in postmenopausal women have not been reported. Our study aim was to examine the factor structure of the ISI in a large and diverse sample of midlife women with hot flashes. METHODS Baseline data were from 899 women enrolled in one of the three clinical trials using similar entry criteria conducted by the Menopause Strategies Finding Lasting Answers to Symptoms and Health research network. We conducted confirmatory factor analyses for the total sample and within strata defined by race/ethnicity (black and white women). RESULTS The ISI had two factors in the total sample. The two-factor structure was consistent across black and white women, with the exception of one item "difficulty falling asleep." CONCLUSIONS The ISI in midlife women with hot flashes is composed of two factors that capture dimensions of the insomnia severity and daytime impact. The instrument is a psychometrically sound scale appropriate for use in research and clinical practice to capture the severity and daytime impact of insomnia symptoms in diverse samples of midlife women with hot flashes. An abbreviated screening of two items could be considered to determine if further evaluation is needed of sleep complaints.
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Affiliation(s)
- Julie L. Otte
- School of Nursing, Indiana University, Indianapolis, IN
| | - Giorgos Bakoyannis
- School of Nursing, Indiana University, Indianapolis, IN
- Department of Biostatistics, Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN
| | - Kevin L. Rand
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis
| | - Kristine E. Ensrud
- Medicine and Epidemiology and Community Health, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, MN
| | - Katherine A. Guthrie
- MsFLASH Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hadine Joffe
- Connors Center for Women’s Health and Gender Biology, and Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School
| | - Susan M. McCurry
- Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA
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Rand KL, Cohee AA, Monahan PO, Wagner LI, Shanahan ML, Champion VL. Coping Among Breast Cancer Survivors: A Confirmatory Factor Analysis of the Brief COPE. J Nurs Meas 2019; 27:259-276. [PMID: 31511409 DOI: 10.1891/1061-3749.27.2.259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Cancer survivors continue to cope with significant stressors after completing treatment. The Brief COPE (Carver, 1997) is frequently used to measure coping; however, its factor structure remains unclear. The purpose of this study was to determine the best factor conceptualization of the Brief COPE for use among breast cancer survivors. METHODS Breast cancer survivors (N = 1,127) completed the Brief COPE. We conducted confirmatory factor analyses comparing several a priori models based on research in cancer-relevant populations. RESULTS Of the eight models examined, the 14-factor model of the Brief COPE showed the best fit. CONCLUSIONS Despite efforts to simplify the structure of the Brief COPE, our results suggest coping among breast cancer survivors is best assessed using Carver's (1997) original 14-factor conceptualization.
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Affiliation(s)
- Kevin L Rand
- Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | | | | | - Lynne I Wagner
- Wake Forest University, Wake Forest University Health Sciences, Winston-Salem, North Carolina
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Miller MM, Williams AE, Zapolski TCB, Rand KL, Hirsh AT. Assessment and Treatment Recommendations for Pediatric Pain: The Influence of Patient Race, Patient Gender, and Provider Pain-Related Attitudes. J Pain 2019; 21:225-237. [PMID: 31362065 DOI: 10.1016/j.jpain.2019.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/08/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
Previous studies have documented that racial minorities and women receive poorer pain care than their demographic counterparts. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient groups. Less is known about racial and gender disparities in children with pain or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as "providers"), Virtual Human methodology and a pain-related version of the Implicit Association Test (IAT) were used to examine the effects of patient race/gender on providers' pain assessment/treatment decisions for pediatric chronic abdominal pain, as well as the moderating role of provider implicit pain-related race/gender attitudes. Findings indicated that providers rated Black patients as more distressed (mean difference [MD] = 2.33, P < .01, standard error [SE] = .71, 95% confidence interval [CI] = .92, 3.73) and as experiencing more pain-related interference (MD = 3.14, P < .01, SE = .76, 95% CI = 1.63, 4.64) compared to White patients. Providers were more likely to recommend opioids for Black patients than White patients (MD = 2.41, P < .01, SE = .58, 95% CI = 1.05, 3.76). Female patients were perceived to be more distressed by their pain (MD = 2.14, P < .01, SE = .79, 95% CI = .58, 3.70) than male patients, however there were no gender differences in treatment recommendations. IAT results indicated that providers held implicit attitudes that Black Americans (M = .19, standard deviation [SD] = .29) and males (M = .38, SD = .29) were more pain-tolerant than their demographic counterparts; however, these implicit attitudes did not significantly moderate their pain assessment/treatment decisions. Future studies are needed to elucidate specific paths through which the pain experience and care of children differ across racial and gender groups. PERSPECTIVE: Providers' pain assessment (ie, pain distress/pain interference) and treatment (ie, opioids) of pediatric pain differs across patient race and to a lesser extent, patient gender. This study represents a critical step in research on pain-related disparities in pediatric pain.
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Affiliation(s)
- Megan M Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Amy E Williams
- Department of Psychiatry, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
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Meints SM, Mosher C, Rand KL, Ashburn-Nardo L, Hirsh AT. An experimental investigation of the relationships among race, prayer, and pain. Scand J Pain 2019; 18:545-553. [PMID: 29794272 DOI: 10.1515/sjpain-2018-0040] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/30/2018] [Indexed: 11/15/2022]
Abstract
Background and aims Compared to White individuals, Black individuals demonstrate a lower pain tolerance. Research suggests that differences in pain coping strategies, such as prayer, may mediate this race difference. However, previous research has been cross-sectional and has not determined whether prayer in and of itself or rather the passive nature of prayer is driving the effects on pain tolerance. The aim of this study was to clarify the relationships among race, prayer (both active and passive), and pain tolerance. Methods We randomly assigned 208 pain-free participants (47% Black, 53% White) to one of three groups: active prayer ("God, help me endure the pain"), passive prayer ("God, take the pain away"), or no prayer ("The sky is blue"). Participants first completed a series of questionnaires including the Duke University Religion Index, the Coping Strategies Questionnaire-Revised (CSQ-R), and the Pain Catastrophizing Scale. Participants were then instructed to repeat a specified prayer or distractor coping statement while undergoing a cold pressor task. Cold pain tolerance was measured by the number of seconds that had elapsed while the participant's hand remained in the cold water bath (maximum 180 s). Results Results of independent samples t-tests indicated that Black participants scored higher on the CSQ-R prayer/hoping subscale. However, there were no race differences among other coping strategies, religiosity, or catastrophizing. Results of a 2 (Race: White vs. Black)×3 (Prayer: active vs. passive vs. no prayer) ANCOVA controlling for a general tendency to pray and catastrophizing in response to prayer indicated a main effect of prayer that approached significance (p=0.06). Pairwise comparisons indicated that those in the active prayer condition demonstrated greater pain tolerance than those in the passive (p=0.06) and no prayer (p=0.03) conditions. Those in the passive and no prayer distractor conditions did not significantly differ (p=0.70). There was also a trending main effect of race [p=0.08], with White participants demonstrating greater pain tolerance than Black participants. Conclusions Taken together, these results indicate that Black participants demonstrated a lower pain tolerance than White participants, and those in the active prayer condition demonstrated greater tolerance than those in the passive and no prayer conditions. Furthermore, Black participants in the passive prayer group demonstrated the lowest pain tolerance, while White participants in the active prayer group exhibited the greatest tolerance. Results of this study suggest that passive prayer, like other passive coping strategies, may be related to lower pain tolerance and thus poorer pain outcomes, perhaps especially for Black individuals. On the other hand, results suggest active prayer is associated with greater pain tolerance, especially for White individuals. Implications These results suggest that understanding the influence of prayer on pain may require differentiation between active versus passive prayer strategies. Like other active coping strategies for pain, active prayer may facilitate self-management of pain and thus enhance pain outcomes independent of race. Psychosocial interventions may help religiously-oriented individuals, regardless of race, cultivate a more active style of prayer to improve their quality of life.
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Affiliation(s)
- Samantha M Meints
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 60 Fenwood Road, BTM Ste. 5016, Boston, MA 02115, USA, Phone: (857) 307-5405, Fax: (617) 525-7900
| | - Catherine Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Leslie Ashburn-Nardo
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Secinti E, Rand KL, Johns SA, O'Neil BH, Helft PR, Shahda S, Jalal SI, Mosher CE. Social correlates of mental health in gastrointestinal cancer patients and their family caregivers: Exploring the role of loneliness. Support Care Cancer 2018; 27:2077-2086. [PMID: 30225573 DOI: 10.1007/s00520-018-4467-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The present study examined the degree to which loneliness mediated the influence of negative (social constraints) and positive (emotional support) relationship qualities on the global mental health of advanced gastrointestinal (GI) cancer patients and their family caregivers. METHODS Fifty patient-caregiver dyads completed measures assessing social constraints (e.g., avoidance, criticism) from the other dyad members, emotional support from others, loneliness, and global mental health. Structural equation modeling was used to examine individual models, and Actor-Partner Interdependence Mediation Modeling was used to examine dyadic associations. RESULTS Individual path analyses for patients and caregivers demonstrated that emotional support had a significant indirect effect on mental health through loneliness (Bs = 0.32 and 0.30, respectively), but no associations were found between social constraints and mental health. In dyadic analyses, participants' loneliness and mental health were not significantly related to their partner's emotional support, loneliness, or mental health (Bs = - 0.18 to 0.18). CONCLUSIONS Findings suggest that for advanced GI cancer patients and caregivers, emotional support from others alleviates feelings of loneliness, which may lead to better mental health. However, the benefits of emotional support appear to be primarily intrapersonal rather than interpersonal in nature. Additionally, participants endorsed low levels of social constraints, which might explain their lack of relation to loneliness and mental health. Continued examination of interdependence in social processes between cancer patients and caregivers will inform intervention development.
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Affiliation(s)
- Ekin Secinti
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA.
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Shelley A Johns
- Indiana University School of Medicine, Center for Health Services Research, Regenstrief Institute, 1101 W. 10th Street, RF-226, Indianapolis, IN, 46202, USA
| | - Bert H O'Neil
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Paul R Helft
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Safi Shahda
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Shadia I Jalal
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
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Cheavens JS, Heiy JE, Feldman DB, Benitez C, Rand KL. Hope, goals, and pathways: Further validating the hope scale with observer ratings. The Journal of Positive Psychology 2018. [DOI: 10.1080/17439760.2018.1484937] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Jane E. Heiy
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- VA Portland Health Care System, Portland, OR, USA
| | - David B. Feldman
- Department of Psychology, Santa Clara University, Santa Clara, CA, USA
| | - Cinthia Benitez
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Kevin L. Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Cripe LD, Rand KL, Perkins SM, Tong Y, Schmidt KK, Hedrick DG, Rawl SM. Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use. J Palliat Med 2018; 21:1107-1113. [PMID: 29905496 DOI: 10.1089/jpm.2017.0686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with advanced cancer often face distressing decisions about chemotherapy. There are conflicting data on the relationships among perceived prognosis, psychological characteristics, and chemotherapy use, which impair the refinement of decision support interventions. OBJECTIVE Clarify the relationships among patient and oncologist estimates of life expectancy for 6 and 12 months, chemotherapy use, and patient psychological characteristics. DESIGN Secondary analysis of data from two cross-sectional studies. SETTING/SUBJECTS One hundred sixty-six patients with advanced stage cancer recruited from ambulatory cancer clinics. MEASUREMENTS All data were obtained at study enrollment. Patients completed the Adult Hope Scale, Hospital Anxiety and Depression Scale, and Life Orientation Test-Revised. Patients and their oncologists provided estimates of surviving beyond 6 and 12 months. Chemotherapy use was determined by chart review. RESULTS There were no significant associations between life-expectancy estimates and chemotherapy use nor patient anxiety, depression, hope, or optimism and chemotherapy use. Patients' life expectancy estimates for 12 months and oncologists' for 6 months were associated with higher patient anxiety and depression. Finally, both oncologist and patient estimates of life expectancy for 6 and 12 months were associated with increased levels of trait hope. CONCLUSION Advanced cancer patients who provide less optimistic estimates of life expectancy have increased anxiety and depression, but do not use chemotherapy more often. Increased patient trait hope is associated with more favorable oncologist estimates. These findings highlight the need for interventions to support both patients and oncologists as they clarify prognostic expectations and patients cope with the psychological distress of a limited life expectancy.
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Affiliation(s)
- Larry D Cripe
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Kevin L Rand
- 2 Department of Psychology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Susan M Perkins
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yan Tong
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Karen Krall Schmidt
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - David G Hedrick
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Susan M Rawl
- 3 Indiana University School of Nursing , Indianapolis, Indiana
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Tometich DB, Mosher CE, Hirsh AT, Rand KL, Johns SA, Matthias MS, Outcalt SD, Schneider BP, Mina L, Storniolo AMV, Newton EV, Miller KD. Metastatic breast cancer patients' expectations and priorities for symptom improvement. Support Care Cancer 2018; 26:3781-3788. [PMID: 29736866 DOI: 10.1007/s00520-018-4244-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/30/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Little research has examined cancer patients' expectations, goals, and priorities for symptom improvement. Thus, we examined these outcomes in metastatic breast cancer patients to provide patients' perspectives on clinically meaningful symptom improvement and priorities for symptom management. METHODS Eighty women with metastatic breast cancer participated in a survey with measures of comorbidity, functional status, engagement in roles and activities, distress, quality of life, and the modified Patient-Centered Outcomes Questionnaire that focused on 10 common symptoms in cancer patients. RESULTS On average, patients reported low to moderate severity across the 10 symptoms and expected symptom treatment to be successful. Patients indicated that a 49% reduction in fatigue, 48% reduction in thinking problems, and 43% reduction in sleep problems would represent successful symptom treatment. Cluster analysis based on ratings of the importance of symptom improvement yielded three clusters of patients: (1) those who rated thinking problems, sleep problems, and fatigue as highly important, (2) those who rated pain as moderately important, and (3) those who rated all symptoms as highly important. The first patient cluster differed from other subgroups in severity of thinking problems and education. CONCLUSIONS Metastatic breast cancer patients report differing symptom treatment priorities and criteria for treatment success across symptoms. Considering cancer patients' perspectives on clinically meaningful symptom improvement and priorities for symptom management will ensure that treatment is consistent with their values and goals.
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Affiliation(s)
- Danielle B Tometich
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA.
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Shelley A Johns
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.,Center for Health Services Research, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, USA
| | - Marianne S Matthias
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.,Center for Health Services Research, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN, 46202, USA.,Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd, Indianapolis, IN, 46202, USA
| | - Samantha D Outcalt
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA.,Center for Health Services Research, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN, 46202, USA.,Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN, 46202, USA
| | - Bryan P Schneider
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Lida Mina
- Banner MD Anderson Cancer Center, 2946 E Banner Gateway Dr, Gilbert, AZ, 85234, USA
| | - Anna Maria V Storniolo
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Erin V Newton
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Kathy D Miller
- Indiana University School of Medicine, Indiana University Melvin and Bren Simon Cancer Center, 535 Barnhill Dr, Indianapolis, IN, 46202, USA
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Winger JG, Rand KL, Hanna N, Jalal SI, Einhorn LH, Birdas TJ, Ceppa DP, Kesler KA, Champion VL, Mosher CE. Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and Their Family Caregivers. J Pain Symptom Manage 2018; 55:1341-1349.e4. [PMID: 29366911 PMCID: PMC5899922 DOI: 10.1016/j.jpainsymman.2018.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 02/05/2023]
Abstract
CONTEXT Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. OBJECTIVES To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. METHODS This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n = 51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patients' and caregivers' psychological distress and patients' pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at six weeks after the intervention. RESULTS For patients, greater practice of assertive communication was associated with less pain interference (β = -0.45, P = 0.02) and psychological distress (β = -0.36, P = 0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β = -0.30, P = 0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β = 0.47, P = 0.07) and fatigue interference (β = 0.49, P = 0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β = 0.56, P = 0.01) and psychological distress (β = 0.36, P = 0.08). CONCLUSION Findings suggest that the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.
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Affiliation(s)
- Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA.
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Nasser Hanna
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shadia I Jalal
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Lawrence H Einhorn
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas J Birdas
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - DuyKhanh P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kenneth A Kesler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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Abstract
OBJECTIVES Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients' efforts to live in the present and plan for the future. METHODS Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion-crystallization, a qualitative research technique. RESULTS Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported. SIGNIFICANCE OF RESULTS These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) "What is important to you now, knowing that you will die sooner than you want or expected?" (2) "Tell me about yourself." (3) "Tell me in your own words about your experience with cancer care and treatment." (4) "What impact has your illness had on others?" In honoring patients' lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients' priorities for life.
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Affiliation(s)
- Ann H Cottingham
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Department of Medicine and Psychology, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Larry D Cripe
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,3 Department of Medicine and Psychology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Kevin L Rand
- 4 Department of Medicine and Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Richard M Frankel
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,5 Department of Medicine and Psychology, Cleveland Clinic, Cleveland, OH, USA
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Adams RN, Mosher CE, Rand KL, Hirsh AT, Monahan PO, Abonour R, Kroenke K. The Cancer Loneliness Scale and Cancer-related Negative Social Expectations Scale: development and validation. Qual Life Res 2017; 26:1901-1913. [PMID: 28236266 DOI: 10.1007/s11136-017-1518-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE Loneliness is a known risk factor for poor mental and physical health outcomes and quality of life in the general population, and preliminary research suggests that loneliness is linked to poorer health outcomes in cancer patients as well. Various aspects of the cancer experience contribute to patients feeling alone and misunderstood. Furthermore, loneliness theory suggests that negative social expectations, which may specifically relate to the cancer experience, precipitate and sustain loneliness. Cancer-specific tools are needed to assess key constructs of this theory. In the current study, we developed and tested measures of (1) loneliness attributed to cancer (i.e., cancer-related loneliness) and (2) negative social expectations related to cancer. METHODS First, we developed the items for the measures based on theory, prior research, and expert feedback. Next, we assessed the measures' psychometric properties (i.e., internal consistency and construct validity) in a diverse sample of cancer patients. RESULTS The final products included a 7-item unidimensional Cancer Loneliness Scale and a 5-item unidimensional Cancer-related Negative Social Expectations Scale. Evidence of excellent reliability and validity was found for both measures. CONCLUSIONS The resulting measures have both clinical and research utility.
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Affiliation(s)
- Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, 780 Welch Road, MC 5776, Palo Alto, CA, 94304, USA.
| | - Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, 410 W. Tenth St., Suite 3000, Indianapolis, IN, 46202, USA
| | - Rafat Abonour
- Department of Medicine, Indiana University School of Medicine, 535 Barnhill Drive, Indiana Cancer Pavilion, Suite 446, Indianapolis, IN, 46202, USA
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA.,VA HSR&D Center for Health Information and Communication, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Inc. (RF), 1101 West Tenth Street, RF 221, Indianapolis, IN, 46202, USA
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Mosher CE, Tometich DB, Hirsh A, Rand KL, Johns SA, Matthias MS, Outcalt SD, Bricker J, Schneider B, Mina L, Storniolo AM, Newton E, Miller K. Symptom experiences in metastatic breast cancer patients: relationships to activity engagement, value-based living, and psychological inflexibility. Psychooncology 2016; 26:1944-1951. [PMID: 27648927 DOI: 10.1002/pon.4283] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study examined symptom-based subgroups of metastatic breast cancer (MBC) patients and the extent to which they differed across key constructs of acceptance and commitment therapy (ACT). METHODS Eighty women with MBC completed self-report surveys assessing 10 common symptoms and several ACT variables (ie, activity engagement, psychological inflexibility, value obstruction, and value progress) during a single time point. RESULTS A cluster analysis yielded 3 patient subgroups: low symptoms, low-moderate symptoms, and moderate-high symptoms. Relative to the subgroup with low symptoms, the other subgroups reported less activity engagement. In addition, compared with patients with low symptoms, the subgroup with moderate-high symptoms reported greater psychological inflexibility (ie, avoidance of unwanted internal experiences) and greater difficulty living consistently with their values. CONCLUSIONS Women with MBC show heterogeneity in their symptom profiles, and those with higher symptom burden are more likely to disengage from valued activities and avoid unwanted experiences (eg, thoughts, feelings, and bodily sensations). Findings are largely consistent with the ACT model and provide strong justification for testing ACT to address symptom interference in MBC patients.
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Affiliation(s)
- Catherine E Mosher
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Danielle B Tometich
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Adam Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Shelley A Johns
- Indiana University School of Medicine, Indianapolis, IN, USA.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Marianne S Matthias
- Indiana University School of Medicine, Indianapolis, IN, USA.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.,VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Samantha D Outcalt
- Indiana University School of Medicine, Indianapolis, IN, USA.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA.,VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Psychology, University of Washington, Seattle, WA, USA
| | - Bryan Schneider
- Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA
| | - Lida Mina
- Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA
| | - Anna Maria Storniolo
- Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA
| | - Erin Newton
- Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA
| | - Kathy Miller
- Indiana University School of Medicine, Indiana Cancer Pavilion, Indianapolis, IN, USA
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Carpenter JS, Heit M, Rand KL. Development and psychometric properties of a measure of catheter burden with bladder drainage after pelvic reconstructive surgery. Neurourol Urodyn 2016; 36:1140-1146. [PMID: 27460055 DOI: 10.1002/nau.23077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 07/05/2016] [Indexed: 11/09/2022]
Abstract
AIMS Catheter burden after pelvic reconstructive surgery is an important patient-reported quality of life outcome in research and clinical practice. However, existing tools focus on long-term catheter users rather than short-term postoperative patients. The study aim was to evaluate the psychometric properties of a modified version of the intermittent self-catheterization questionnaire (ISC-Q) in postoperative pelvic reconstructive patients. METHODS After experts convened to discuss and modify the ISC-Q items based on their knowledge of women's experiences and clinical practices, 178 women (108 with transurethral and 70 with suprapubic catheters) completed the modified scale and other measures as part of a larger parent study designed to assess health-related quality of life (HRQoL) following pelvic reconstructive surgery requiring bladder drainage. RESULTS During psychometric testing, the modified ISC-Q was reduced to six items encompassing two factors: a three-item difficulty of use factor and a 3-item embarrassment factor. The new scale was named the short-term catheter burden questionnaire (STCBQ). The two-factor model was robust in both subsamples. Only scores within and not between subsamples can be meaningfully compared due to a lack of scalar invariance. Correlations among STCBQ total scores, subscores, and a single satisfaction item indicated good construct validity. Correlations with patient demographics provided further information about the scale. CONCLUSIONS The STCBQ is a short, efficient assessment of short-term catheter burden following pelvic reconstructive surgery. The scale can be used as an important patient reported outcome measure in clinical practice and research. Neurourol. Urodynam. 36:1140-1146, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Janet S Carpenter
- Science of Nursing Care Department, School of Nursing, Indiana University, Indianapolis, Indiana
| | - Michael Heit
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kevin L Rand
- Department of Psychology, School of Science, Indiana University-Purdue University, Indianapolis, Indiana
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Cripe LD, Hedrick DG, Rand KL, Burns D, Banno D, Cottingham A, Litzelman D, Hoffmann ML, Martenyi N, Frankel RM. Medical Students' Professionalism Narratives Reveal That Experiences With Death, Dying, or Palliative Care Are More Positive Than Other Experiences During Their Internal Medicine Clerkship. Am J Hosp Palliat Care 2016; 34:79-84. [PMID: 26430135 DOI: 10.1177/1049909115609296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE More physicians need to acquire the skills of primary palliative care. Medical students' clerkship experiences with death, dying, and palliative care (DDPC), however, may create barriers to learning such skills during residency. Whether professional development is differentially affected by DDPC is unknown. This knowledge gap potentially hinders the development of educational strategies to optimize students' preparedness for primary palliative care. METHOD Third-year students submitted professionalism narratives (N = 4062) during their internal medicine clerkship between 2004 and 2011. We identified DDPC-related narratives and then randomly selected control narratives. Narratives were compared by valence (positive or negative) and professionalism-related themes. RESULTS AND CONCLUSION Less than 10% of the narratives were related to DDPC, but the majority was positive. There was a significant overlap in professionalism themes between DDPC and control narratives. The results suggest student preparedness for primary palliative care may be improved by addressing the common professionalism challenges of clinical clerkships.
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Affiliation(s)
- Larry D Cripe
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,2 IU Simon Cancer Center, Indianapolis, IN, USA
| | - David G Hedrick
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,2 IU Simon Cancer Center, Indianapolis, IN, USA
| | - Kevin L Rand
- 2 IU Simon Cancer Center, Indianapolis, IN, USA.,3 Department of Psychology, IUPUI School of Science, Indianapolis, IN, USA
| | - Debra Burns
- 2 IU Simon Cancer Center, Indianapolis, IN, USA.,4 Department of Music and Arts Technology, Purdue School of Engineering and Technology at IUPUI, Indianapolis, IN, USA
| | - Daniella Banno
- 3 Department of Psychology, IUPUI School of Science, Indianapolis, IN, USA
| | - Ann Cottingham
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA
| | - Debra Litzelman
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,5 Regenstrief Institute, Indianapolis, IN, USA
| | - Mary L Hoffmann
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA
| | | | - Richard M Frankel
- 1 Department of Medicine, IU School of Medicine, Indianapolis, IN, USA.,5 Regenstrief Institute, Indianapolis, IN, USA.,6 Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
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Rand KL, Banno DA, Shea AM, Cripe LD. Life and treatment goals of patients with advanced, incurable cancer. Support Care Cancer 2016; 24:2953-62. [PMID: 26864986 DOI: 10.1007/s00520-016-3113-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment. METHODS Patients with advanced lung cancer, gastrointestinal cancer, or melanoma (N = 84) completed measures of prognosis for 12-month survival, hope, optimism, depression, and anxiety. Oncologists provided patient performance status and prognosis for 12-month survival. We conducted interviews with a subset of patients (N = 63), eliciting life and treatment goals, values, and expectancies. RESULTS Patient life goals resembled goals among healthy populations; whereas, treatment goals were perceived as separate and more important. Cure and fight cancer emerged as the most important goals. Patients who valued cure the most had worse performance status (M = 1.46 vs. 0.78) and more depressive symptoms (M = 6.30 vs. 3.50). Patients who valued fight cancer the most had worse self-prognosis (M = 69.23 % vs. 86.11 %), fewer treatment goals (M = 2.08 vs. 3.16), and lower optimism (M = 15.00 vs. 18.32). CONCLUSIONS Patients with advanced cancer perceive treatment goals as separate from and more important than life goals. They hold optimistic expectancies for achieving their goals and for survival. Valuing cure highly may put patients at risk for experiencing psychological maladjustment.
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Affiliation(s)
- Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA. .,Indiana University Simon Cancer Center, Indianapolis, IN, USA. .,Walther Program in Palliative Care Research, Indianapolis, IN, USA. .,Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA.
| | - Daniella A Banno
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA
| | - Amanda M Shea
- Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA
| | - Larry D Cripe
- School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA.,Walther Program in Palliative Care Research, Indianapolis, IN, USA.,Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA
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Luther L, Firmin RL, Vohs JL, Buck KD, Rand KL, Lysaker PH. Intrinsic motivation as a mediator between metacognition deficits and impaired functioning in psychosis. Br J Clin Psychol 2016; 55:332-47. [PMID: 26756621 DOI: 10.1111/bjc.12104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Poor functioning has long been observed in individuals with psychosis. Recent studies have identified metacognition - one's ability to form complex ideas about oneself and others and to use that information to respond to psychological and social challenges-as being an important determinant of functioning. However, the exact process by which deficits in metacognition lead to impaired functioning remains unclear. This study first examined whether low intrinsic motivation, or the tendency to pursue novel experiences and to engage in self-improvement, mediates the relationship between deficits in metacognition and impaired functioning. We then examined whether intrinsic motivation significantly mediated the relationship when controlling for age, education, symptoms, executive functioning, and social cognition. DESIGN Mediation models were examined in a cross-sectional data set. METHODS One hundred and seventy-five individuals with a psychotic disorder completed interview-based measures of metacognition, intrinsic motivation, symptoms, and functioning and performance-based measures of executive functioning and social cognition. RESULTS Analyses revealed that intrinsic motivation mediated the relationship between metacognition deficits and impaired functioning (95% CI of indirect effect [0.12-0.43]), even after controlling for the aforesaid variables (95% CI of indirect effect [0.04-0.29]). CONCLUSIONS Results suggest that intrinsic motivation may be a mechanism that underlies the link between deficits in metacognition and impaired functioning and indicate that metacognition and intrinsic motivation may be important treatment targets to improve functioning in individuals with psychosis. PRACTITIONER POINTS The findings of this study suggest that deficits in metacognition may indirectly lead to impaired functioning through their effect on intrinsic motivation in individuals with psychosis. Psychological treatments that target deficits in both metacognition and intrinsic motivation may help to alleviate impaired functioning in individuals with psychosis. LIMITATIONS The cross-sectional design of this study is a limitation, and additional longitudinal studies are needed to confirm the direction of the findings and rule out rival hypotheses. Generalization of the findings may be limited by the sample composition. It may be that different relationships exist between metacognition, intrinsic motivation, and functioning in those with early psychosis or among those in an acute phase or who decline treatment.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Ruth L Firmin
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Eskenazi Hospital, Indianapolis, Indiana, USA.,Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Research Program, Indianapolis, Indiana, USA
| | - Kelly D Buck
- Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Otte JL, Rand KL, Landis CA, Paudel ML, Newton KM, Woods N, Carpenter JS. Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in women with hot flashes. Menopause 2015; 22:1190-6. [PMID: 25944520 PMCID: PMC4624473 DOI: 10.1097/gme.0000000000000459] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Women, especially those with hot flashes, report poor sleep quality during various stages of the menopausal transition and postmenopause. Sleep measurements vary widely because of the copious instruments available. The Pittsburgh Sleep Quality Index (PSQI) is a frequently used questionnaire that produces a single score for sleep quality. This one-factor structure has not received consistent support in the literature. The goal of this analysis was to determine the best factor structure of the PSQI in women with hot flashes. METHODS A confirmatory factor analysis was conducted on PSQI baseline data from three randomized controlled clinical trials enrolling perimenopausal and postmenopausal women with hot flashes (N = 849) from the Menopause Strategies: Finding Lasting Answers for Symptoms and Health network. Several a priori factor models were compared. RESULTS One-factor and two-factor models did not fit the data. A three-factor model comprising sleep efficiency, perceived sleep quality, and daily disturbance showed good fit; however, the sleep medication item was dropped because of poor fit and low rates of sleep medication use. The three-factor model was examined in African-American and white subsamples and was found to be similar in both groups; however, two items showed small group differences in strength as indicators. CONCLUSIONS Sleep quality in midlife women with hot flashes, as measured by the PSQI, seems to comprise three correlated factors. Minor measurement differences detected between groups are of research interest but do not necessitate different scoring practices. Additional research is needed to further define sleep quality and its associations with health-related outcomes.
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Affiliation(s)
- Julie L Otte
- 1School of Nursing, Indiana University, Indianapolis, IN 2Department of Psychology, Indiana University-Purdue University, Indianapolis, IN 3University of Washington School of Nursing, Seattle, WA 4University of Minnesota School of Public Health and Epidemiology, Minneapolis, MN 5Harvard Medical School, Boston, MA 6Group Health Research Institute, Seattle, WA
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Oles SK, Fukui S, Rand KL, Salyers MP. The relationship between hope and patient activation in consumers with schizophrenia: Results from longitudinal analyses. Psychiatry Res 2015; 228:272-6. [PMID: 26165962 DOI: 10.1016/j.psychres.2015.05.100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 02/21/2015] [Accepted: 05/24/2015] [Indexed: 11/29/2022]
Abstract
Hope (goal-directed thinking) and patient activation (knowledge and skills to manage one's illness) are both important in managing chronic conditions like schizophrenia. The relationship between hope and patient activation has not been clearly defined. However, hope may be viewed as a foundational, motivating factor that can lead to greater involvement in care and feelings of efficacy. The purpose of the present study was to understand the prospective relationship between hope and patient activation in a sample of adults with schizophrenia (N=118). This study was a secondary data analysis from a study on Illness Management and Recovery (IMR) - a curriculum-based approach to schizophrenia self-management. Data were collected at baseline (prior to any intervention), and at 9 and 18-month follow-up. As predicted, hope and patient activation were significantly related with each other, showing large positive concurrent correlations. Demographics and background characteristics were not significantly related to patient activation or hope. Longitudinal analyses found no specific directional effect, yet suggested that hope and patient activation mutually influence each other over time. Our findings add flexibility in designing recovery-based interventions - fostering hope may not be a pre-requisite for activating consumers to be more involved in their own care.
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Affiliation(s)
- Sylwia K Oles
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA.
| | - Sadaaki Fukui
- School of Social Welfare Center for Mental Health Research and Innovation, University of Kansas, Lawrence, KS, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, US
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, US
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Hullmann SE, Robb SL, Rand KL. Life goals in patients with cancer: a systematic review of the literature. Psychooncology 2015; 25:387-99. [PMID: 25990641 DOI: 10.1002/pon.3852] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 03/16/2015] [Accepted: 04/14/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Purposes of this systematic review of life goal research in cancer patients were to (1) identify life goal characteristics and processes being examined, (2) describe instruments used to assess life goal constructs, (3) identify theoretical models being used to guide research, and (4) summarize what is known about the impact of the cancer experience on life goal characteristics, processes, and psychological outcomes. METHODS We conducted this systematic review using MEDLINE, PubMed, CINAHL, and PsycINFO databases. Inclusion criteria were as follows: (1) published between 1993 and 2014, (2) English language, (3) cancer patient population, and (4) original research articles that assessed life goal characteristics and/or goal processes. One hundred ninety-seven articles were screened and 27 included in the final review. RESULTS Seven life goal characteristics and seven life goal processes were identified, and less than half of studies investigated associations between goal characteristics and processes. Conceptual definitions were not provided for about half of the identified life goal constructs. Studies used both validated and author-developed instruments to assess goal constructs. Twenty-four different theoretical models were identified, with self-regulation theory most frequently cited. Overall, the literature suggests that cancer impacts patients' life goal characteristics and processes, and life goal disturbance is related to poorer psychological outcomes. CONCLUSIONS The impact of the cancer experience on life goals is an important and emerging area of research that would benefit from conceptual and theoretical clarity and measurement consistency.
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Affiliation(s)
| | - Sheri L Robb
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Kevin L Rand
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Otte JL, Carpenter JS, Manchanda S, Rand KL, Skaar TC, Weaver M, Chernyak Y, Zhong X, Igega C, Landis C. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained? Cancer Med 2014; 4:183-200. [PMID: 25449319 PMCID: PMC4329003 DOI: 10.1002/cam4.356] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/26/2014] [Accepted: 09/07/2014] [Indexed: 11/13/2022] Open
Abstract
Although sleep is vital to all human functioning and poor sleep is a known problem in cancer, it is unclear whether the overall prevalence of the various types of sleep disorders in cancer is known. The purpose of this systematic literature review was to evaluate if the prevalence of sleep disorders could be ascertained from the current body of literature regarding sleep in cancer. This was a critical and systematic review of peer-reviewed, English-language, original articles published from 1980 through 15 October 2013, identified using electronic search engines, a set of key words, and prespecified inclusion and exclusion criteria. Information from 254 full-text, English-language articles was abstracted onto a paper checklist by one reviewer, with a second reviewer randomly verifying 50% (k = 99%). All abstracted data were entered into an electronic database, verified for accuracy, and analyzed using descriptive statistics and frequencies in SPSS (v.20) (North Castle, NY). Studies of sleep and cancer focus on specific types of symptoms of poor sleep, and there are no published prevalence studies that focus on underlying sleep disorders. Challenging the current paradigm of the way sleep is studied in cancer could produce better clinical screening tools for use in oncology clinics leading to better triaging of patients with sleep complaints to sleep specialists, and overall improvement in sleep quality.
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Affiliation(s)
- Julie L Otte
- Indiana University School of Nursing, Indianapolis, Indiana
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Winger JG, Mosher CE, Rand KL, Morey MC, Snyder DC, Demark-Wahnefried W. Diet and exercise intervention adherence and health-related outcomes among older long-term breast, prostate, and colorectal cancer survivors. Ann Behav Med 2014; 48:235-45. [PMID: 24648018 PMCID: PMC4156898 DOI: 10.1007/s12160-014-9598-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence. PURPOSE We examined associations between adherence to components of a diet-exercise intervention and survivors' physical and mental health. METHODS A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention. RESULTS Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β = 0.11, p < 0.05), basic and advanced lower extremity function (β = 0.10, p < 0.05/β = 0.09, p < 0.05), and mental health (β = 0.05, p < 0.05), and a negative indirect relationship with body mass index (β = -0.06, p < 0.05). CONCLUSIONS Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).
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Affiliation(s)
- Joseph G Winger
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 134, Indianapolis, IN, 46202, USA,
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