银屑病患者的心理社会因素研究

目的研究银屑病患者心理社会因素的特征。方法运用临床心理测定工具(LES,CS,SSS,SAS,SDS)测定30例银屑病患者及30例正常对照组病前遭遇的生活事件、应付方式、社会支持、患病后的心身健康状况及其影响因素。结果银屑病患者本次患病前所经历的生活事件频数及紧张值,消极应付方式评分,抑郁及焦虑分值均显著高于对照组。积极应付评分,社会支持总分减低。发现家族史、生活事件紧张总值和抑郁为银屑病的危险因素,而积极应付方式和社会支持为疾病的有利的保护因素。结论银屑病患者具有一定的心理社会特征,可对病人进行一定的社会心理干预措施。     

Neuropathic pain,cognitive fusion,and alexithymia in patients with multiple sclerosis: Cross-sectional evidence for an explanatory model of anxiety symptoms

Multiple sclerosis (MS) presents a high prevalence, a marked increase worldwide, and a relevant impact on patients, public health, and society. Anxiety often cooccurs with MS and can contribute to the worsening of MS symptoms. However, knowledge about predictors of anxiety in Patients with MS (PwMS) is scarce.

Objective

This preliminary study explored a novel model for anxiety symptoms in PwMS, including neuropathic pain (NeP), cognitive fusion (CF), experiential avoidance (EA), and alexithymia as explanatory factors.

Method

This cross-sectional study integrated two independent convenience samples: 107 PwMS recruited from the Portuguese Society for Multiple Sclerosis and 97 age- and gender-matched participants without the MS diagnosis (no-MS sample) recruited from the Portuguese general population. Self-report questionnaires that measured the constructs included in the model were administered to both groups.

Results

PwMS showed significantly higher values regarding anxiety symptoms and their explanatory variables (NeP, CF, EA, alexithymia) in comparison to non-MS participants. In the MS sample, no correlations were found between anxiety symptoms and sociodemographic and clinical characteristics. NeP, CF, and alexithymia showed significant correlations with anxiety symptoms and significantly explained this symptomatology in simple linear regression models. Thus, these variables were retained in the multiple linear regression model and emerged as significant regressors that together explained 38% of the variance in anxious symptomatology in PwMS.

Conclusions

This preliminary study provides novel evidence on NeP and some maladaptive emotion regulation strategies related to EA/psychological inflexibility, as vulnerability to anxiety in PwMS can be considerably increased by CF and alexithymia. Clinical implications were discussed.     

精神分裂症照料者相关社会心理因素

目的研究精神分裂症照料者社会心理因素的特点及影响因素。方法应用生活事件量表、多伦多述情障碍量表、焦虑自评量表、抑郁自评量表、应付方式问卷及社会支持问卷,测定48例精神分裂症照料者遭遇的生活事件及其身心健康状况,了解其采取的应付方式,现有的社会支持及其影响因素,同时选取健康对照组50例相同量表评定。结果精神分裂症照料者所经历的生活事件总频数,负性生活事件频数,精神紧张总值及负性紧张值均显著高于对照组(t=3.978,5.064,6.694,9.282;P0.01),消极应付方式评分,抑郁及焦虑分值均显著高于对照组(t=8.195,9.815,7.174;P0.01)。积极应付评分,社会支持总分减低(t=-2.394,P0.05;t=3.616,P0.01);消极应付方式明显高于对照组(t=8.394,P0.01)。结果显示精神分裂症照料者生活事件频数,生活事件紧张总值,抑郁等因子维度与对照组均存在显著差异,在社会支持及应付方式上研究组与对照组也存在明显差异。结论精神分裂症照料者心理健康状况不容乐观,需要进一步关注,必要时应采取积极的干预措施。     

Stress,psychological distress,psychosocial factors,menopause symptoms and physical health in women

Objectives

Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women.

Methods

One hundred and sixteen women aged 45–55 years were recruited through women's health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health.

Results

Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping.

Conclusions

Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.     

Unique genetic and environmental determinants of prolonged fatigue: a twin study

BACKGROUND: Prolonged fatigue syndromes have been proposed as prevalent and disabling forms of distress that occur independently of conventional notions of anxiety and depression. METHODS: To investigate the genetic and environmental antecedents of common forms of psychological and somatic distress, we measured fatigue, anxiety, depression and psychological distress in 1004 normal adult twin pairs (533 monozygotic (MZ), 471 dizygotic (DZ)) over 50 years of age. RESULTS: Familial aggregation of psychological distress, anxiety and fatigue appeared to be due largely to additive genetic factors (MZ:DZ ratios of 2.12-2.69). The phenotypic correlations between the psychological measures (distress, anxiety and depression) were moderate (0.67-0.79) and higher than that between fatigue and psychological distress (0.38). Multivariate genetic modelling revealed a common genetic factor contributing to the development of all the observed phenotypes (though most strongly for the psychological forms), a second independent genetic factor also influenced anxiety and depression and a third independent genetic factor made a major contribution to fatigue alone. In total, 44% (95% CI 25-60%) of the genetic variance for fatigue was not shared by the other forms of distress. Similarly, the environmental factor determining psychological distress made negligible contributions to fatigue, which was underpinned largely by its own independent environmental factor. CONCLUSION: This study supports the aetiological independence of prolonged fatigue and, therefore, argues strongly for its inclusion in classification systems in psychiatry.     

Psychological well‐being across 1 year with rheumatoid arthritis: Coping resources as buffers of perceived stress

Objectives. Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well‐being among rheumatoid arthritis (RA) patients. Design. A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year. Methods. Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well‐being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for. Results. Perceived stress had the strongest relationship with psychological well‐being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well‐being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months. Conclusion. Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.     

Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions

Aims were to identify the demographic, psychopathology, and psychosocial factors predicting time to major depressive disorder (MDD) recovery and moderators of treatment among 114 depressed adolescents recruited from a juvenile justice center and randomized to a cognitive behavioral treatment (CBT) condition or a life skills-tutoring control condition. Nine variables predicted time to recovery over 1-year follow-up (e.g., earlier MDD onset, attention-deficit/hyperactivity disorder, functional impairment, hopelessness, negative thoughts, low family cohesion, coping skills); suicidal ideation and parental report of problem behaviors were the best predictors. CBT resulted in faster recovery time relative to control treatment, specifically among adolescents of White ethnicity, with recurrent MDD, and with good coping skills. Results suggest that psychopathology plays a more prominent role in maintaining adolescent depression than demographic or psychosocial factors.     

急性心肌梗塞患者与正常人生活事件、生活方式和负性情绪的对照研究

目的：探寻生活事件、生活方式、负性情绪与急性心肌梗塞（Acute Myocardial Infarction，简AMI）的病因学联系。方法：对91例AMI病人和90位正常人应用LES、SSRS、HAMD、HAMA等量表和生活方式问卷、一般状况测查表进行对照调查。结果：与正常人对照，AMI组发作前有明显心理刺激因素的有72例（79．12％）；AMI组负性生活事件分更高（P〈0．01）；AMI组的客观支持和主观支持和对支持利用度均明显低于正常组（P〈0．01）；生活方式方面，AMI组在饮食不良习惯、业余生活单调、缺乏锻炼，嗜烟酒，睡眠无规律等均明显高于对照组（P〈0．01）；负性情绪方面，AMI组在焦虑／躯体化、认知障碍、阻滞、绝望、睡眠障碍和焦虑抑郁总分均明显高于对照组（P〈0．01）。结论：负性事件多发，缺乏亲人和社会支持．不良的生活方式和负性情绪可能是AMI的发病危险因素。     

Determinants of Psychological Distress and Its Course in the First Year After Diagnosis in Rheumatoid Arthritis Patients

In order to examine determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients, self-report data and clinical and laboratory measures were collected in 91 patients (70% female, mean age 57 years) shortly after diagnosis and 1 year later. Multiple regression analysis indicated that sex, pain and functional status, disease impact on daily life, life events, and perceived social support were related to psychological distress (anxiety and depressed mood) shortly after diagnosis. Coping strategies were related to distress levels only 1 year later. Multiple regression analysis of change in anxiety and depressed mood revealed that a decrease of psychological distress after 1 year could be predicted by male sex, an initially less severe inflammatory activity and an initially more extended social network. In addition, a decrease in distress was related to parallel improvements in clinical status. Results indicate the importance of a multimodal assessment of demographic variables, clinical and life stressors and social resources for the understanding of distress and the identification of risk factors in the first stage of the disease. Personal coping resources appear to become more important predictors of distress in a later phase of the disease.     

Attributions, Coping and, Adjustment in Children with Cancer

Assessed the influence of children's attribution style, copingstyle, social competence, parent coping, and demographic variableson the psychosocial adjustment of 86 pediatric oncology patients.Utilizing hierarchical multiple regression procedures, nearlyone half of the variance in child depression was predicted bychildren's avoidance coping, depressive attributional style,and social competence. Child anxiety was predicted by a depressiveattributional style, avoidance coping, and age at diagnosis.Child externalizing behavior was predicted by a depressive attributionalstyle, parents' anxiety and SES. Implications for interventionsand future research are discussed     

Psychological distress and visual functioning in relation to vision‐related disability in older individuals with cataracts

Objective. To determine whether demographic, health status and psychological functioning measures, in addition to impaired visual acuity, are related to vision‐related disability. Methods. Participants were 105 individuals (mean age = 73.7 years) with cataracts requiring surgery and corrected visual acuity in the better eye of 6/24 to 6/36 were recruited from waiting lists at three public out‐patient ophthalmology clinics. Visual disability was measured with the Visual Functioning‐14 survey. Visual acuity was assessed using better and worse eye logMAR scores and the Melbourne Edge Test (MET) for edge contrast sensitivity. Data relating to demographic information, depression, anxiety and stress, health care and medication use and numbers of co‐morbid conditions were obtained. Results. Principal component analysis revealed four meaningful factors that accounted for 75% of the variance in visual disability: recreational activities, reading and fine work, activities of daily living and driving behaviour. Multiple regression analyses determined that visual acuity variables were the only significant predictors of overall vision‐related functioning and difficulties with reading and fine work. For the remaining visual disability domains, non‐visual factors were also significant predictors. Difficulties with recreational activities were predicted by stress, as well as worse eye visual acuity, and difficulties with activities of daily living were associated with self‐reported health status, age and depression as well as MET contrast scores. Driving behaviour was associated with sex (with fewer women driving), depression, anxiety and stress scores, and MET contrast scores. Conclusion. Vision‐related disability is common in older individuals with cataracts. In addition to visual acuity, demographic, psychological and health status factors influence the severity of vision‐related disability, affecting recreational activities, activities of daily living and driving.     

Psychological distress in primary care patients with heart failure: a longitudinal study.

BACKGROUND: Psychological distress is a common phenomenon in patients with heart failure. Depressive symptoms are often under-diagnosed or inadequately treated in primary care. AIM: To analyse anxiety and/or depression in primary care patients with heart failure according to psychosocial factors, and to identify protective factors for the resolution of psychological distress. DESIGN OF STUDY: Longitudinal observation study. SETTING: Primary care practices in lower Saxony, Germany. METHOD: In 291 primary care patients with heart failure the following factors were measured using validated questionnaires at baseline and 9 months later: anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), quality of life (Minnesota Living with Heart Failure Questionnaire), coping with illness (Freiburg questionnaire for coping with illness), and social support (social support questionnaire). Severity of heart failure (New York Heart Association [NYHA] classification and Goldman's Specific Activity Scale), and sociodemographic characteristics were documented using self-report instruments. RESULTS: Twenty-six (32.5%) of the 80 patients who were distressed at baseline had normal HADS scores 9 months later, while the remainder stayed distressed. In logistic regression, baseline distress (odds ratios [OR] 5.51; 95% confidence intervals [CI] = 2.56 to 11.62), emotional problems (OR = 1.08; 95% CI = 1.00 to 1.17), social support (OR = 0.54; 95% CI = 0.35 to 0.83), and NYHA classification (OR = 1.70; 95% CI = 1.05 to 2.77) independently predicted distress at follow up. High social support contributed to a resolution of anxiety or depression, while partnership and low levels of emotional problems protected patients who began the study in a good emotional state from psychological distress. CONCLUSION: In everyday practice it is important to consider that a high NYHA classification and emotional problems may contribute to anxiety or depression, while high social support and living in a relationship may positively influence the psychological health of patients with heart failure.     

Psychological consequences of surgery

The purpose of the present study was to assess changes in psychological distress and memory complaint following a wide variety of surgeries. In addition, variables reflecting type of surgery, demographic characteristics, history of mental illness, and health factors were evaluated as predictors of postoperative psychological distress and memory complaint. Using the Brief Symptom Inventory (BSI), it was found that 10.9% of patients had high levels of psychological distress the day before surgery compared to 13.9% of patients three months after surgery. Complaints of memory disturbance also increased significantly. Only the anxiety subscale of the BSI showed a significant decrease at three months postsurgery. Hierarchical multiple regression revealed that younger age, lower social status, being male, having a history of mental illness, higher presurgery BSI, and poorer postsurgery health were significant predictors of postsurgery psychological distress. The results of the study suggest that, although patients become less anxious after surgery, other forms of emotional distress increase, perhaps due to factors such as slower than anticipated recovery. Results also suggest that medical factors may play an indirect rather than a direct role in psychological consequences of surgery.     

Psychological distress of fathers attending an Australian early parenting service for early parenting difficulties

Background: Early parenting centres are in a unique position to identify and provide support to fathers experiencing mental health difficulties. However, the extent to which fathers attending these services experience mental health difficulties is not known. This study aimed to assess fathers' mental health, identify specific clinical profiles based on the severity and pattern of self‐reported symptoms of depression, stress, anxiety, and fatigue and identify factors associated with poorer mental health. Methods: Participants were 144 fathers admitted to a residential programme. Socio‐demographic information and symptoms of depression, anxiety, stress, and fatigue were collected using standardised instruments. Results: The proportion of fathers reporting distress in the clinical ranges for stress, anxiety, and depression were 17%, 6%, and 9%, respectively. Latent class analysis identified two distinct groups or clinical profiles of fathers, representing mild (84%) and high distress (16%). Poor physical health, severity of child's sleep disruption, low socio‐economic position, and poor self‐care were associated with high distress. Conclusions: Fathers attending early parenting services are at risk of experiencing significant levels of distress, anxiety, stress, and fatigue. Early Parenting Services can play a critical role in screening and identifying fathers experiencing poor mental health and link them into appropriate mental health support.     

Complex genetic and environmental relationships between psychological distress, fatigue and immune functioning: a twin study

BACKGROUND: Although there is considerable support for adverse relationships between states of psychological and somatic distress and immune response, there is little evidence in humans of the relative contribution of genetic and environmental factors. METHODS: This study utilized a twin methodology to examine the interplay between psychological distress, fatigue and immune function. We recorded a number of measures of distress, including conventional depression and anxiety as well as the somatic symptom of prolonged fatigue, and immune responsiveness (by delayed-type hypersensitivity skin response) in 124 normal adult twin pairs (79 monozygotic, 45 dizygotic). RESULTS: While there were strong genetic influences on the psychological distress and fatigue factors (only some of which are common to both), familial aggregation of immune responsiveness arose mainly from environmental factors shared by both members of a twin pair. Phenotypic correlations between psychological and immune measures were negligible, but multivariate genetic modelling revealed that these masked larger genetic and environmental correlations of opposite sign. Negative environmental effects of psychological distress and fatigue on immune responsiveness were countered by a positive genetic relationship between psychological distress and immune function. CONCLUSIONS: Our study suggests that current psychoneuroimmunological hypotheses in humans need to be modified to place increasing importance on the individual's genotype. In this cohort immune responsiveness varied in response to a complex interplay of genetic and environmental factors. Additionally, although psychological distress and fatigue had some shared genetic determinants, independent genetic and environmental risk factors for fatigue were also identified.     

Predicting fatigue and depression in HIV-positive gay men

HIV-related fatigue is a prevalent and troubling symptom for HIV-positive people. The purpose of the study was to develop a model for predicting fatigue and depression among HIV-positive gay men as a function of history of fatigue and depression in the previous year and to determine whether psychological and psychosocial variables or physiologic variables better predict fatigue. Data from 96 HIV-positive gay men followed longitudinally for up to 7.5 years were used to develop logistic regression models for predicting fatigue and depression. Fatigue was predicted by both physiologic and psychological risk factors, whereas depression was predicted by only psychological risk factors.     

Sleep and its associations with perceived and objective cognitive impairment in individuals with multiple sclerosis

Problems with sleep and cognitive impairment are common among people with multiple sclerosis (MS). The present study examined the relationship between self‐reported sleep and both objective and perceived cognitive impairment in MS. Data were obtained from the baseline assessment of a multi‐centre intervention trial (NCT00841321). Participants were 121 individuals with MS. Nearly half (49%) of participants met the criteria for objective cognitive impairment; however, cognitively impaired and unimpaired participants did not differ on any self‐reported sleep measures. Nearly two‐thirds (65%) of participants met the criteria for ‘poor’ sleep, and poorer sleep was significantly associated with greater levels of perceived cognitive impairment. Moreover, the relationships between self‐reported sleep and perceived cognitive impairment were significant beyond the influence of clinical and demographic factors known to influence sleep and cognitive functioning (e.g. age, sex, education level, disability severity, type of MS, disease duration, depression and fatigue). However, self‐reported sleep was not associated with any measures of objective cognitive impairment. Among different types of perceived cognitive impairment, poor self‐reported sleep was most commonly related to worse perceived executive function (e.g. planning/organization) and prospective memory. Results from the present study emphasize that self‐reported sleep is significantly and independently related to perceived cognitive impairment in MS. In terms of clinical implications, interventions focused on improving sleep may help improve perceived cognitive function and quality of life in this population; however, the impact of improved sleep on objective cognitive function requires further investigation.     

Cognitive and social processes predicting partner psychological adaptation to early stage breast cancer

Introduction. The diagnosis and subsequent treatment for early stage breast cancer is stressful for partners. Little is known about the role of cognitive and social processes predicting the longitudinal course of partners' psychosocial adaptation. This study evaluated the role of cognitive and social processing in partner psychological adaptation to early stage breast cancer, evaluating both main and moderator effect models. Moderating effects for meaning making, acceptance, and positive reappraisal on the predictive association of searching for meaning, emotional processing, and emotional expression on partner psychological distress were examined. Materials and methods. Partners of women diagnosed with early stage breast cancer were evaluated shortly after the ill partner's diagnosis (N=253), 9 (N=167), and 18 months (N=149) later. Partners completed measures of emotional expression, emotional processing, acceptance, meaning making, and general and cancer‐specific distress at all time points. Results. Lower satisfaction with partner support predicted greater global distress, and greater use of positive reappraisal was associated with greater distress. The predicted moderator effects for found meaning on the associations between the search for meaning and cancer‐specific distress were found and similar moderating effects for positive reappraisal on the associations between emotional expression and global distress and for acceptance on the association between emotional processing and cancer‐specific distress were found. Conclusions. Results indicate several cognitive–social processes directly predict partner distress. However, moderator effect models in which the effects of partners' processing depends upon whether these efforts result in changes in perceptions of the cancer experience may add to the understanding of partners' adaptation to cancer.     

Psychosocial work characteristics as risk factors for the onset of fatigue and psychological distress: prospective results from the Maastricht Cohort Study

BACKGROUND: Prolonged fatigue has recently attracted attention in occupational (mental) health research since it may lead to sickness absenteeism and work disability. To date, little is known about the role of psychosocial work characteristics in the aetiology of fatigue. In this study we examined prospectively a wide range of psychosocial work characteristics as possible risk factors for the onset of fatigue and psychological distress in the working population. METHODS: This study is based on 8833 employees, participating in the Maastricht Cohort Study of 'Fatigue at Work'. A wide range of psychosocial work characteristics, measured at baseline, was used to predict the onset of fatigue and psychological distress 1 year later. Fatigue was measured with the Checklist Individual Strength; the General Health Questionnaire was used to measure psychological distress. RESULTS: The cumulative incidence of fatigue during 1 year follow-up was 9.7% (N = 492) in men, and 13.5% (N = 241) in women. Psychological demands at work as well as physical and emotional demands increased the risk for fatigue in men, whereas decision latitude in men and co-worker social support in women were protective against fatigue. These prospective associations remained significant after adjustments for potential confounders and baseline fatigue. As regards psychological distress, no association was found with decision latitude, while conflicts at work increased the risk of psychological distress. CONCLUSIONS: Psychosocial work characteristics were significant predictors for the onset of fatigue in the working population. The prospective associations suggest some differential effects in the aetiology of fatigue and psychological distress. Good interpersonal relationships at work and high decision authority were demonstrated to be relevant aspects that should be targeted for prevention.     

Longitudinal Predictors of Bipolar Spectrum Disorders: A Behavioral Approach System Perspective

We review longitudinal predictors, primarily psychosocial, of the onset, course, and expression of bipolar spectrum disorders. We organize our review along a proximal–distal continuum, discussing the most proximal (i.e., prodromes) predictors of bipolar episodes first, then recent environmental (i.e., life events) predictors of bipolar symptoms and episodes next, followed by more distal psychological (i.e., cognitive styles) predictors, and ending with the most distal temperament (i.e., Behavioral Approach System [BAS] sensitivity) predictors. We then present a theoretical model, the BAS dysregulation model, for understanding and integrating the role of these predictors of bipolar spectrum disorders. Finally, we consider the implications of the reviewed longitudinal predictors for future research and psychosocial treatments of bipolar disorders.