Studies of sexuality or sexual behavior in childhood cancer survivors tend to examine relationships or achievement of developmental milestones but not physiological response to cancer or treatment. The purpose of this study is to (1) identify prevalence and risk factors for sexual dysfunction in childhood cancer survivors, and (2) examine the extent to which sexual dysfunction may be associated with health-related quality of life (HRQOL) and psychosocial outcomes.
Five hundred ninety-nine survivors age 18-39 years completed standardized measures of sexual functioning, HRQOL, psychological distress and life satisfaction. Descriptive statistics assessed prevalence of sexual symptoms. Bivariate analyses identified correlates of sexual symptoms and examined associations between symptoms and HRQOL/psychosocial outcomes.
Most survivors appear to be doing well, although 52% of female survivors and 32% of male survivors reported at least “a little of a problem” in one or more areas of sexual functioning. Mean symptom score for females was more than twice that of males. Sexual symptoms were associated with reporting health problems. Significant associations between sexual functioning and HRQOL outcomes were observed, with gender differences in strengths of association suggesting that males find sexual symptoms more distressing than do females.
While most survivors appear to be doing well in this important life domain, some young adult survivors report sexual concerns. While female survivors may report more sexual symptoms than male survivors, males may experience more distress associated with sexual difficulties. Better specified measures of sexual function, behavior and outcomes are needed for this young adult population.
Sexual functioning; cancer survivor; childhood cancer; quality of life; psychosocial; gender
The purpose of this study was to compare adolescent and young adult (AYA) pediatric cancer survivors and peers without a history of serious illness on psychological distress, health-related quality of life (HRQOL), health beliefs; examine age at diagnosis and cancer treatment intensity on these outcomes; and examine relationships between number of health problems and the outcomes.
Patients and Methods
AYA cancer survivors (n = 167) and controls (n = 170), recruited during visits to a cancer survivorship clinic and primary care, completed self-report questionnaires of distress, health problems, and health beliefs. For survivors, providers rated treatment intensity and health problems.
There were no statistically significant differences between survivors and controls in psychological distress or HRQOL. Cancer survivors had less positive health beliefs. Survivors diagnosed as adolescents had significantly greater psychological distress and fewer positive health beliefs than those diagnosed earlier. Survivors with the highest level of treatment intensity had greater anxiety and fewer positive health beliefs than those with less intense treatments. Provider report of current health problems related to survivors' beliefs and mental HRQOL only, whereas patient report of health problems correlated significantly with most psychosocial outcomes and beliefs.
AYA cancer survivors did not differ from peers in psychological adjustment but did endorse less adaptive health beliefs. Survivors diagnosed during adolescence and who had more intensive cancer treatments evidenced poorer psychosocial outcomes. Beliefs about health may be identified and targeted for intervention to improve quality of life, particularly when patient perceptions of current health problems are considered.
Cancer survivorship is increasingly a situation of chronic disease management that needs to be integrated with the context of broader health and well-being. This perspective paper combines personal experiences and a professional research program to address the complexities of long-term management of cancer and integrated care and the importance of psychological distress and psychological growth expressed in diverse pathways of survivorship. The role of age is addressed as partially defining the extent and nature of long-term psychological effects. General internists are in a unique position to play a central role in enabling cancer survivors to integrate the cancer experience into their lives and their overall health and well-being.
cancer; survivorship; aging; psychology; well-being; chronic illness management
We examined racial disparities (White, African American, and other race) in health status (self-rated health, lower-body functional limitations, psychological distress, and body mass index [BMI]) and behaviors (smoking, alcohol use, and physical activity) of long-term cancer survivors (≥5 years) when compared to non-cancer controls.
Using 2005–2007 National Health Interview Survey data, we computed adjusted prevalence estimates of health status and behaviors for all six groups, controlling for sociodemographic factors, medical-care access, or presence of other chronic conditions.
The sample included 2,762 (3.6%) survivors and 73,059 controls. Adjusted prevalence estimates for each race were higher for long-term survivors than controls in terms of having fair-poor self-rated health, ≥1 limitation, psychological distress, and higher BMI but were similar between survivors and controls in terms of physical activity, smoking, and alcohol use. Adjusted prevalence estimates for having fair-poor self-rated health were higher for African American survivors than white survivors, lower for psychological distress, physical activity and alcohol use, and similar for smoking and BMI.
With the exception of smoking and limitations, racial differences existed among survivors for all health-status and behavioral measures. Clinicians may play a key role in helping to reduce disparities.
Disparity; Race; Cancer survivor; Behavior; Quality of life
Research into the psychological sequelae of spinal cord injury (SCI) has focused on reports of psychological distress, despite the low prevalence rates of mental health difficulties. Positive psychological frameworks have begun to explore how some individuals do not report psychological distress, while appraisals have been posited as possible mediators of psychological outcome. Research into positive psychological outcomes in people with SCI is still in its infancy.
To provide a description of the positive psychological outcomes experienced by people reporting low levels of psychological distress, to generate an understanding of how these individuals explain their positive outcomes, and to consider the implications for research, theory, and practice.
Six participants (2 female, 4 male) reporting low levels of psychological distress were interviewed using a semi-structured interview schedule exploring their experiences. Interpretative phenomenological analysis was used to analyze data.
Three superordinate themes were identified: “living a normal life, just doing things differently,” “overcoming challenges: determination to succeed,” and “using the resources available to me.” The description and explanation of a positive psychological outcome was complex. For participants, positive psychological outcomes did not exclude experiencing psychological difficulty; moreover, they described an ability to overcome difficulty. Challenge-focused appraisals, social support, and meaningful activity were identified by participants as being important to psychological outcome.
Positive psychological outcomes following SCI are complex, and research and theory need to better understand the experience of individuals following SCI in order to inform clinical practice.
appraisals; posttraumatic growth; psychosocial outcomes; resilience; spinal cord injury
This study uses a risk and resilience framework for conceptualizing the long-term effects of childhood family violence on mental health. It examines sense of community as a protective factor against adult psychological distress associated with experiences of physical or psychological violence in childhood from parents. Regression models are estimated using data from the 1995 National Survey of Midlife Development in the U.S. and from the 1996–97 National Study of Daily Experiences. Reported experiences of frequent psychological violence, regardless of the frequency of physical violence, is found to be positively associated with adult psychological distress. Adults’ sense of community is found to moderate the association between reports of both frequent psychological and frequent physical violence in childhood from parents and adult psychological distress.
The goal of this research was to examine the extent to which 10-year breast cancer survivors integrated cancer into their self-concept (i.e., survivor centrality), identify predictors of survivor centrality, and determine the relation of survivor centrality to well-being.
Breast cancer survivors (n = 240) were interviewed 10 years following the initial diagnosis. They completed measures of survivor centrality, illness valence (i.e., positive or negative views of illness), and well-being (positive and negative affect, mental and physical functioning, psychological distress, benefit-finding).
There were few predictors of the kinds of women who were more likely to integrate breast cancer into their self-concepts, but survivor centrality was related to engaging in behaviors that suggested survivorship was relevant to women’s daily lives, such as becoming involved in breast cancer activities. Survivor centrality was related to three markers of negative psychological well-being: more negative affect, poorer mental functioning, and greater psychological distress. However, in the case of negative affect and psychological distress, this relation was moderated by illness valence, such that survivor centrality was only related to negative psychological well-being when the illness was viewed in less positive terms.
Women vary in the extent to which they define themselves in terms of the breast cancer experience. Survivor centrality in and of itself is not always indicative of adjustment to disease. When women have a more negative view of being a breast cancer survivor, survivor centrality is more likely to signify potential problems.
breast cancer; survivorship; self-concept; well-being
Cancer survivors employ distinct sets of coping behaviors that vary in their associations with psychological health and quality of life. However, existing research has largely focused on white and middle class subjects.
This study explores whether clusters with differing coping profiles could be identified among older African American cancer survivors and whether these profiles varied on cultural factors and physical, psychological, and relationship well-being.
Four hundred forty-nine older African American cancer survivors recruited from outpatient oncology clinics completed a questionnaire booklet containing the Ways of Helping Questionnaire (WHQ), the Brief Index of Race-Related Stress (IRRS), the Religious Involvement Scale, Mutuality Scale, and the Short Form 12 Health Survey Questionnaire (SF-12). A k-means cluster analysis was conducted using the WHQ.
Four distinct coping profiles were identified and labeled High Coping, Low Encouraging Healthy Behaviors, Low Coping and Strong/Distracting Behaviors. Coping profiles were associated with participant’s gender, age, and living alone. Controlling for these demographic differences, coping profiles were associated with religiosity, experiences with racism, and physical, psychological and relationship well-being.
The findings from this study lend support for examining coping profiles and health outcomes among African American cancer survivors. This research also suggests that these profiles vary on cultural factors. This information should prove useful to researchers as they develop culturally appropriate interventions for this underserved population.
cancer; African Americans; coping profiles; cluster analysis; religious involvement; experienced racism; quality of life
This study examined barriers to mental health service use and their demographic, medical, and psychosocial correlates among hematopoietic stem cell transplant (HSCT) survivors. A sample of 253 HSCT survivors who were 1- to 3-years post-transplant completed measures of demographic, physical, psychological, and social characteristics as well as a newly modified measure of barriers to mental health service use. Only 50% of distressed HSCT survivors had received mental health services. An exploratory factor analysis of the barriers to mental health service use scale yielded four factors: Scheduling Barriers, Knowledge Barriers, Emotional Barriers, and Illness-related Barriers. Patients with higher social constraints (perceived problems discussing the illness experience with significant others) reported higher levels of all four types of barriers. General distress and transplant-related posttraumatic stress symptoms were positively associated with emotional, knowledge, and illness-related barriers to mental health service use, whereas physical and functional well-being were inversely associated with these barriers. Having more knowledge barriers and more emotional barriers predicted a lower likelihood of receiving mental health services, as did lower levels of education and general distress. Results suggest that a significant number of HSCT survivors may benefit from education about mental health services that is tailored to individual barriers.
hematopoietic stem cell transplantation; cancer survivorship; barriers; mental health services; psychological
The current study examined whether cancer survivors showed impairment, resilience, or growth responses relative to a sociodemographically matched sample in four domains: mental health and mood, psychological well-being, social well-being, and spirituality. The impact of aging on psychosocial adjustment was also investigated.
Participants were 398 cancer survivors who were participants in the MIDUS survey (Midlife in the United States) and 796 matched respondents with no cancer history. Psychosocial assessments were completed in 1995-96 and 2004-06.
Findings indicated that cancer survivors demonstrated impairment relative to the comparison group in mental health, mood, and some aspects of psychological well-being. Longitudinal analyses spanning pre- and post-diagnosis clarified that while mental health declined after a cancer diagnosis, poorer functioning in other domains existed prior to diagnosis. However, survivors exhibited resilient social well-being, spirituality, and personal growth. Moreover, age appeared to confer resiliency; older survivors were more likely than younger adults to show psychosocial functioning equivalent to their peers.
While younger survivors may be at risk for disturbances in mental health and mood, cancer survivors show resilience in other important domains of psychosocial adjustment.
cancer; mental health; mood; resilience; aging
We examined potential reasons (sociodemographics, psychological distress, health behavior, chronic health conditions, access to medical care) for increased prevalence of lower-body functional limitations (LBFL) among long-term (≥5 years) cancer survivors.
Using 2005-2007 National Health Interview Survey data, we defined LBFL as reporting difficulty/inability to perform at least 1 of 5 activities (walking 1/4 of a mile; walking up and down 10 steps without rest; standing for 2 hours; stooping, crouching, or kneeling; and lifting 10 lbs). Increased prevalence of LBFL was compared between long-term survivors of each of 11 cancer types reported by ≥50 respondents (n=2,143) and persons without cancer history (controls; n=72,618).
Among cancer survivors, 57.0% had a LBFL versus 26.6% of controls. The unadjusted prevalence of LBFL varied by cancer type, ranging from 44.9% (lymphoma survivors) to 88.8% (lung cancer survivors). Long-term lung (odds ratio [OR]:7.91), uterine (OR:2.41), thyroid (OR:2.27), cervical (OR:1.76), ovarian (OR:1.75), and breast (OR:1.35) cancer survivors had increased odds of reporting a LBFL than controls after adjusting for sociodemographic factors (all p<0.05). Differences in prevalence of arthritis and lower-back pain and in access to medical care explained differences in LBFL prevalence between controls and long-term breast, cervical, ovarian, and uterine cancer survivors. Long-term bladder, colorectal, lymphoma, melanoma, and prostate cancer survivors were equally likely to report a LBFL as controls.
Treatment of arthritis and lower back pain and increasing access to medical care might help reduce the risk of LBFL and improve quality of life among specific long-term cancer survivors.
dysfunction; arthritis; low-back pain; survivors
Globally, mental health promotion related to psychological distress in the workplace has become a great concern, and a focus of much research attention. However, a sense of contribution to society and sense of bonding with the workplace have not been examined in relation to psychological distress. Thus, the purpose of this study is to examine whether these two factors are associated with psychological distress.
We conducted a cross-sectional survey of 1137 full-time employees who worked in systems engineering, sales, or administration at a Japanese company. Participant's sense of contribution to society, sense of bonding with the workplace, psychological distress, and qualitative job stress (quantitative and qualitative workloads, job-control latitude, and support from supervisors, co-workers and family) were assessed with a questionnaire. We performed multiple logistic regression analyses to examine associations between psychological distress and sense of contribution to society and of bonding with the workplace.
A high sense of contribution to society was significantly associated with a high sense of bonding with the workplace (Spearman's ρ = 0.47, p < 0.01). A sense of contribution to society was negatively associated with psychological distress after adjusting for job stress factors (OR = 2.05, 95% CI 0.99-4.23) or sociodemographic characteristics of participants (OR = 2.92, 1.53-5.59). After adjusting for job stress factors as well as sociodemographic characteristics, the association became weaker. A sense of bonding with the workplace was negatively associated with psychological distress after adjusting for sociodemographic characteristics (OR = 2.49, 1.29-4.79). However, this association was not observed after adjusting for job stress factors.
Psychological distress in the workplace was associated with sense of contribution to society. Therefore, workplace mental health promotion should consider the workers' sense of contribution to society.
mental health; job stress; psychological distress; contribution to society; bonding with workplace; meaning of work
Childhood cancer has long-term implications for survivors and their family members. While the impact of cancer on the family continues into adulthood, little research exists on family-related issues during this important developmental period. In order to advance our understanding of families of adolescent and young adult (AYA) childhood cancer survivors, a measure of health-related beliefs for parents of AYA cancer survivors was developed. Exploratory factor analysis based on the mothers' data was used to identify four factors among 23 items: Social Competence, Satisfaction with Healthcare, Health Perceptions, and Health Apprehension. The scales are associated with psychological distress, quality of life, and posttraumatic stress symptoms but unrelated to age of the child at diagnosis and cancer treatment intensity. The beliefs identified in this study are consistent with clinical observations of families of young adult survivors and provide indications for the importance of ongoing attention to the families of childhood cancer survivors.
beliefs; childhood cancer; survivors; families; parents; adolescents; young adults
Spouses of cancer patients are at-risk for poor psychological and physical health as they cope with the complex nature of the disease and fears of losing their partner. Moreover, spouses often serve as patients' primary informal caregivers, a group that evidences poor outcomes across a variety of domains. The present study examines the relative contributions of cancer recurrence – a cancer-specific stressful event – and the subjective experience of cancer-specific stress (IES) in a sample of male spouses of breast cancer survivors. We hypothesized that stress would contribute to poorer physical health and compromised immune function. Spouses (recurrence; n=16) of patients who were coping with their first recurrence were matched to spouses of patients with no evidence of disease (disease-free; n=16). Self-reported physical health (physical symptoms and fatigue) and immune function [T-cell blastogenic response to the mitogens Concanavalin A (ConA) and phytohemagglutanin (PHA) and T3 monoclonal antibody (T3 Mab)] were included as outcomes. Results indicated that patient recurrence status was not a significant unique predictor of physical health or immune function; rather, among all spouses, cancer-specific stress symptoms were associated with increased physical symptoms and altered T-cell blastogenesis. These data suggest that the health implications of caregiving for spouses of cancer survivors is more strongly linked to their subjective experience of cancer as stressful, rather than simply the patients' disease status.
cancer recurrence; stress; immune function; spouses; breast cancer
This study used a cross-sectional design to examine the role of religious involvement within a stress-process framework. Participants were 252 urban, low-income HIV-seropositive African American mothers. The relationships among religious involvement, stress, coping responses, social support, and psychological distress were examined using structural equation modeling. The number of stressors reported by the mother was related to greater religious involvement, which in turn was negatively related to psychological distress. Furthermore, the results suggest that social support, active coping, and avoidant coping responses mediated the relationship between religious involvement and psychological distress. According to the present results, interventions to attenuate psychological distress in HIV-seropositive African American mothers might focus on increasing social support, promoting active coping, and decreasing avoidant coping. The present findings suggest that this may be accomplished, in part, by promoting involvement in religious institutions and practices. However, in light of the cross-sectional design used in the present study, and given that religion may have both positive and negative consequences further research is needed to determine the extent to which promoting religiosity may increase or alleviate distress.
religion; HIV/AIDS; African Americans; coping; social support; psychological distress; stress-process model
To identify risk factors for adverse psychological outcomes among adult siblings of long-term survivors of childhood cancer.
Cross-sectional, self-report data from 3,083 adult siblings (mean age 29 years, range 18-56 years) of 5+ year survivors of childhood cancer were analyzed to assess psychological outcomes as measured by the Brief Symptom Inventory-18 (BSI-18). Sociodemographic and health data, reported by both the siblings and their matched cancer survivors were explored as risk factors for adverse sibling psychological outcomes through multivariable logistic regression.
Self-reported symptoms of psychological distress, as measured by the global severity index of the BSI-18, were reported by 3.8% of the sibling sample. Less than 1.5% of siblings reported elevated scores on two or more of the subscales of the BSI-18. Risk factors for sibling depression included having a survivor brother (OR 2.22, 95% CI 1.42-3.55), and having a survivor with impaired general health (OR 2.15, 95% CI 1.18-3.78). Siblings who were younger than the survivor reported increased global psychological distress (OR 1.81, 95% CI 1.05-3.12), as did siblings of survivors reporting global psychological distress (OR 2.32, 95% CI 1.08-4.59). Siblings of sarcoma survivors reported more somatization than did siblings of leukemia survivors (OR 2.07, 95% CI 1.05-3.98).
These findings suggest that siblings of long-term childhood cancer survivors are psychologically healthy in general. There are, however, small subgroups of siblings at risk for long-term psychological impairment who may benefit from preventive risk-reduction strategies during childhood while their sibling with cancer is undergoing treatment.
Psychological quality of life (QOL), health-related QOL (HRQOL), and life satisfaction outcomes and their associated risk factors are reviewed for the large cohort of survivors and siblings in the Childhood Cancer Survivor Study (CCSS). This review includes previously published manuscripts that used CCSS data focused on psychological outcome measures, including the Brief Symptom Inventory (BSI-18), the Medical Outcomes Survey Short Form-36 (SF-36), the Cantril Ladder of Life, and other self-report questionnaires. Comparisons and contrasts are made between siblings and survivors, and to normative data when available, in light of demographic/health information and abstracted data from the medical record. These studies demonstrate that a significant proportion of survivors report more symptoms of global distress and poorer physical, but not emotional, domains of HRQOL. Other than brain tumor survivors, most survivors report both good present and expected future life satisfaction. Risk factors for psychological distress and poor HRQOL are female sex, lower educational attainment, unmarried status, annual household income less than $20,000, unemployment, lack of health insurance, presence of a major medical condition, and treatment with cranial radiation and/or surgery. Cranial irradiation impacted neurocognitive outcomes, especially in brain tumor survivors. Psychological distress also predicted poor health behaviors, including smoking, alcohol use, fatigue, and altered sleep. Psychological distress and pain predicted use of complementary and alternative medicine. Overall, most survivors are psychologically healthy and report satisfaction with their lives. However, certain groups of childhood cancer survivors are at high risk for psychological distress, neurocognitive dysfunction, and poor HRQOL, especially in physical domains. These findings suggest targeting interventions for groups at highest risk for adverse outcomes and examining the positive growth that remains despite the trauma of childhood cancer.
Spirituality is a multidimensional construct, and little is known about how its distinct dimensions jointly affect well-being. In longitudinal studies (Study 1, N = 418 breast cancer patients; Study 2, N = 165 cancer survivors), we examined two components of spiritual well-being (i.e., meaning/peace and faith) and their interaction, as well as change scores on those variables, as predictors of psychological adjustment. In Study 1, higher baseline meaning/peace, as well as an increase in meaning/peace over six months, predicted a decline in depressive symptoms and an increase in vitality across 12 months in breast cancer patients. Baseline faith predicted an increase in perceived cancer-related growth. Study 2 revealed that an increase in meaning/peace was related to improved mental health and lower cancer-related distress. An increase in faith was related to increased cancer-related growth. Both studies revealed significant interactions between meaning/peace and faith in predicting adjustment. Findings suggest that the ability to find meaning and peace in life is the more influential contributor to favorable adjustment during cancer survivorship, although faith appears to be uniquely related to perceived cancer-related growth.
Cancer; spirituality; psychological adjustment; chronic disease
Mental health disorders account for 13% of the global burden of disease, a burden that low-income countries are generally ill-equipped to handle. Research evaluating the association between mental health and employment in low-income countries, particularly in sub-Saharan Africa, is limited. We address this gap by examining the association between employment and psychological distress.
We analyzed data from the Ghana Socioeconomic Panel Survey using logistic regression (N = 5,391 adults). In multivariable analysis, we estimated the association between employment status and psychological distress, adjusted for covariates. We calculated lost productivity from unemployment and from excess absence from work that respondents reported was because of their feelings of psychological distress.
Approximately 21% of adults surveyed had moderate or severe psychological distress. Increased psychological distress was associated with increased odds of being unemployed. Men and women with moderate versus mild or no psychological distress had more than twice the odds of being unemployed. The association of severe versus mild or no distress with unemployment differed significantly by sex (P-value for interaction 0.004). Among men, the adjusted OR was 12.4 (95% CI: 7.2, 21.3), whereas the association was much smaller for women (adjusted OR = 3.8, 95% CI: 2.5, 6.0). Extrapolating these figures to the country, the lost productivity associated with moderate or severe distress translates to approximately 7% of the gross domestic product of Ghana.
Psychological distress is strongly associated with unemployment in Ghana. The findings underscore the importance of addressing mental health issues, particularly in low-income countries.
Employment; Mental health; Low-income countries
Objective Study examined content of personal goals, health-related hindrance (HRH; i.e., impact of health on goals), and relationship of HRH to health status and psychological well-being in young adults with cystic fibrosis (CF; n = 48), who survived childhood cancer (n = 57), and without history of chronic illness (n = 105). Methods Participants completed measures of life events, quality of life, psychological well-being, and goals. Results No group differences were found on goal content. HRH significantly related to subjective well-being and distress after controlling for demographics, negative life events, physical health-related quality of life, disease status, and self-efficacy. HRH related to health status variables. Cancer survivors without cancer late effects had significantly less HRH than the other groups. Conclusions Health status may affect pursuit of personal goals and relate to well-being of young adults. The assessment of HRH has potential clinical utility for targeting interventions and warrants further research.
cancer survivors; cystic fibrosis; goals; hindrance; pediatric; well-being; young adults
In this study, women’s levels of ego development and their psychological difficulties were examined in relation to feelings in the maternal role. The sample consisted of 91 mothers from diverse socioeconomic backgrounds. Ego development was assessed by the Washington University Sentence Completion Test, and psychological difficulties were operationalized by self-reported global symptomatology, maternal substance abuse, and expressed anger. Outcome variables included feelings of satisfaction, distress, and support in the maternal role, as well as the degree to which negative and positive emotions were integrated in response to hypothetical vignettes of challenging everyday child-rearing experiences. Hypotheses were that women at high levels of ego development would show greater deterioration in the presence versus absence of self-reported adjustment problems than would those at lower levels. A series of interaction effects each indicated trends consistent with the hypotheses. These results add to accumulating evidence that tendencies toward self-examination, characteristic of high developmental levels, do not inevitably serve protective functions but may be linked with heightened reactivity to negative intrapsychic forces.
Long-term survivors of head and neck cancer may suffer from psychological distress and reduced quality of life because of late side-effects of the treatment. In a follow-up study of patients randomised to two different radiation fractionating regimens, 204 patients filled in a mailed questionnaire 7-11 years after treatment. The questionnaire consisted of the General Health Questionnaire, 20-item version (GHQ-20), and the EORTC Core Quality of Life Questionnaire (EORTC QLQ-C30). There were no differences in psychological distress between patients receiving conventional radiotherapy and those receiving a slightly hypofractionated regimen. A high prevalence of psychological distress was found in both treatment groups (30% of 'cases' according to the GHQ-20), especially in patients with impaired cognitive or social function, or with pain. Clinicians need to be aware of this morbidity, and their ability to detect patients with psychological problems needs to be improved. The GHQ-20 can facilitate the communication process in a clinical setting. With an increased awareness of these problems and by using valid instruments for identification of patients at risk, the clinicians may intervene and help the patients to reduce their psychological distress.
Introduction and Purpose
Abdominal obesity, the central distribution of adipose tissue, is a well established cardiometabolic disease risk factor. The prevalence has steadily increased since 1988, and now more than 50% of adults have abdominal obesity. Psychological distress coupled with increased dietary energy density (ED) may contribute to abdominal obesity. Guided by the stress and coping model, this study examined the relationship between psychological factors (perceived stress and depressive symptoms) and dietary ED in overweight, working adults. The first hypothesis tested if psychological factors explained a significant amount of food and beverage ED variance above that accounted for by demographic factors. The second hypothesis tested if psychological factors explained a significant amount of food and non-alcoholic beverage ED variance above that accounted for by demographic factors. Post hoc analyses compared macronutrient composition and food group pattern between overweight, working adults with and without depressive symptoms.
This descriptive, cross sectional, correlation study was comprised of 87 overweight, working adults; mean age, 41.3 (SD 10.2) years; mean body mass index (BMI), 32.1 (SD 6.1) kg/m2; 73.6% women; 50.6% African-American. Participants completed the Beck Depression Inventory-II (BDI-II) and Perceived Stress Scale (PSS); weighed three day food record analyzed for caloric intake (kilocalories) and weight (grams) of consumed foods and beverages which were used to calculate ED (kilocalories/gram). Height and weight were measured to calculate BMI. Descriptive statistics, Mann-Whitney U and sequential regression modeling were used for data analysis.
Depressive symptoms were reported by 21.9% of participants, and explained variance in food and beverage ED above that accounted for by African-American race and reporting adequate caloric intake. Depressive symptoms explained variance in food and non-alcoholic beverage ED above that accounted for male gender, African-American race and reporting adequate caloric intake. Perceived stress and depressive symptoms were positively correlated; however, perceived stress was not a significant predictor of food and beverage ED.
Depressive symptoms, potentially modifiable, were four times that found in the general population, and independently predicted increased food and beverage ED. Further research is needed to determine if improvements in depressive symptoms alter dietary ED, potentially reducing cardiometabolic disease risk.
Psychological distress; depressive symptoms; dietary energy density; overweight
Despite encouraging preliminary findings regarding the efficacy of mindfulness and acceptance-based treatments for a range of psychological presentations, we have yet to elucidate mechanisms of action within these treatments. One mechanism through which mindfulness may reduce psychological symptoms and promote functioning is through enhancing emotional responding and regulation. In this study, we used multimodal assessment to examine the effects of a brief mindfulness intervention in a laboratory setting on emotional experiences and regulation in response to distressing, positive, and affectively mixed film clips. Although there were no condition (mindfulness versus control) effects on reports of difficulties in emotional response or regulation after the distressing film clip, participants in the mindfulness condition reported significantly greater positive affect in response to the positive film. Additionally, participants in the mindfulness condition reported more adaptive regulation (approaching significance, medium to large effect size) in response to the affectively mixed clip, and also reported significantly less negative affect immediately following this clip, although not after a recovery period. No significant differences emerged between conditions on physiological measures (skin conductance and heart rate) throughout the study.
Mindfulness; Emotion Regulation. Acceptance; Positive Emotions
Although the general trauma literature links disclosure of abuse to positive psychological and physical health outcomes, findings for sexual assault survivors are mixed. Supportive responses can reaffirm self-worth; however, negative responses can increase feelings of shame and isolation. This study examined the effects of disclosure in a community sample of Caucasian and African American sexual assault survivors who completed computer-assisted self-interviews. Among the 58.6% of survivors who had disclosed to someone (n = 136), 96% had disclosed to at least 1 informal and 24% at least 1 formal support provider. The experiences of African American and Caucasian survivors were similar in many ways. Participants received more positive than negative responses from others, although only negative responses were related to posttraumatic stress disorder symptoms, and particularly so for African American participants. Regretting disclosure and disclosure to formal providers were also related to posttraumatic stress disorder symptoms. Suggestions are made for programs to decrease negative responses to disclosure.
sexual assault; disclosure; posttraumatic stress disorder; social reactions; ethnicity