Stress, Coping, and Circadian Disruption Among Women Awaiting Breast Cancer Surgery

Background

Psychological distress and coping related to a breast cancer diagnosis can profoundly affect psychological adjustment, possibly resulting in the disruption of circadian rest/activity and cortisol rhythms, which are prognostic for early mortality in metastatic colorectal and breast cancers, respectively.

Purpose

This study aims to explore the relationships of cancer-specific distress and avoidant coping with rest/activity and cortisol rhythm disruption in the period between diagnosis and breast cancer surgery.

Methods

Fifty-seven presurgical breast cancer patients provided daily self-reports of cancer-specific distress and avoidant coping as well as actigraphic and salivary cortisol data.

Results

Distress and avoidant coping were related to rest/activity rhythm disruption (daytime sedentariness, inconsistent rhythms). Patients with disrupted rest/activity cycles had flattened diurnal cortisol rhythms.

Conclusions

Maladaptive psychological responses to breast cancer diagnosis were associated with disruption of circadian rest/activity rhythms. Given that circadian cycles regulate tumor growth, we need greater understanding of possible psychosocial effects in cancer-related circadian disruption.     

Coping, Self-Management, and Adaptation in Adolescents with Type 1 Diabetes

Background

Adolescents with type 1 diabetes experience stress related to treatment management, feeling different from peers, and deciding to tell others about their diabetes.

Purpose

This study examined the relationship of stress reactivity and coping with self-management, quality of life, and metabolic control in an ethnically diverse sample of adolescents with type 1 diabetes.

Methods

Adolescents (n?=?327) completed measures of coping and stress reactivity, self-management, and quality of life. Glycosylated hemoglobin data were collected from medical records.

Results

Low-income and minority status were related to lower levels of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance), and higher levels of disengagement coping (e.g., avoidance). Self-management mediated the relationship between coping and stress reactivity with quality of life and metabolic control. Race/ethnicity and income moderated the relationship between coping and self-management goals.

Conclusions

Results indicate differences in coping related to income and race/ethnicity and demonstrate the impact of coping on self-management and health outcomes in adolescents with type 1 diabetes.     

Dimensions of Perceived Racism and Self-Reported Health: Examination of Racial/Ethnic Differences and Potential Mediators

Background

Many details of the negative relationship between perceived racial/ethnic discrimination and health are poorly understood.

Purpose

The purpose of this study was to examine racial/ethnic differences in the relationship between perceived discrimination and self-reported health, identify dimensions of discrimination that drive this relationship, and explore psychological mediators.

Methods

Asian, Black, and Latino(a) adults (N?=?734) completed measures of perceived racial/ethnic discrimination, self-reported health, depression, anxiety, and cynical hostility.

Results

The association between perceived discrimination and poor self-reported health was significant and did not differ across racial/ethnic subgroups. Race-related social exclusion and threat/harassment uniquely contributed to poor health for all groups. Depression, anxiety, and cynical hostility fully mediated the effect of social exclusion on health, but did not fully explain the effect of threat.

Conclusions

Our results suggest that noxious effects of race-related exclusion and threat transcend between-group differences in discriminatory experiences. The effects of race-related exclusion and threat on health, however, may operate through different mechanisms.     

Avoiding Risk Information About Breast Cancer

Background

Learning about personal risk can provide numerous benefits yet people sometimes opt to remain ignorant.

Purpose

Two studies examined the role of perceived control, coping resources, and anticipated regret in women??s decision to avoid breast cancer risk information.

Methods

Women completed a health inventory and then read a brochure about either controllable or uncontrollable predictors of breast cancer, or received no brochure. Participants then received an opportunity to learn their lifetime risk for breast cancer based on their inventory responses.

Results

Reading about controllable predictors of breast cancer reduced avoidance of risk information compared with reading about uncontrollable predictors or receiving no information. In addition, fewer coping resources, anticipated greater regret over seeking breast cancer risk information, and less regret over avoiding breast cancer risk information predicted information avoidance.

Conclusion

Reading about controllable predictors of breast cancer reduces avoidance of breast cancer risk information.     

Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults

Background

Racial discrimination is related to depression, anxiety, and severe psychological distress, and evidence drawn from studies emanating from the United Kingdom and The Netherlands suggest racial discrimination is also related to clinical psychosis and subthreshold psychotic symptoms in racial and ethnic minority (REM) populations. The present study sought to determine the association between racial discrimination experiences and attenuated positive psychotic symptoms (APPS) in a United States (US) urban, predominantly immigrant and REM young adult population.

Methods

A cohort of 650 young adults was administered a self-report inventory for psychosis risk [i.e., Prodromal Questionnaire (PQ)], and the Experiences of Discrimination Questionnaire. The PQ allowed the dimensional assessment of APPS, as well as the categorical assessment of a potentially “high risk” group (i.e., 8 or more APPS endorsed as distressing), the latter of which was based on previous validation studies using the structured interview for prodromal syndromes. The relations between self-reported racial discrimination and APPS, and racial discrimination and “high” distressing positive PQ endorsement were determined, while accounting for anxiety and depression symptoms.

Results

Racial discrimination was significantly associated with APPS and with significantly higher odds of endorsing eight or more distressing APPS, even after adjusting for anxiety and depression symptoms.

Conclusion

The present study provides preliminary evidence that racial discrimination among US ethnic minorities may be associated with APPS, as well as potentially higher risk for psychosis.     

Prevalence of neurasthenia, comorbidity, and association with impairment among a nationally representative sample of US adults

Purpose

There are no current psychiatric epidemiological studies examining prevalence estimates of neurasthenia across different racial and ethnic groups in the US. This study compares prevalence rates of International Classification of Diseases (ICD-10) lifetime and 12-month neurasthenia across racial/ethnic groups in the US (Asians, African Americans, Latinos, and non-Latino Whites) and by levels of acculturation. We examine comorbidity of neurasthenia with DSM-IV psychiatric disorders and the association between neurasthenia and impairment.

Methods

We used a pooled sample (N?=?10, 118) from two nationally representative household surveys of adults ages 18?years and older: the National Comorbidity Survey-Replication (NCS-R) and the National Latino and Asian American Study (NLAAS).

Results

Among the total sample, the adjusted prevalence rates of lifetime and 12-month neurasthenia with exclusionary criteria were 2.22 and 1.19%. The adjusted prevalence rates for lifetime and 12-month neurasthenia without exclusionary criteria were 4.89 and 2.80%. There were significant racial/ethnic group differences in prevalence for both lifetime and past-year neurasthenia, with Asians reporting significantly lower prevalence of neurasthenia than their non-Latino White counterparts. Less acculturated individuals were at a decreased risk for lifetime and past-year neurasthenia. Lifetime neurasthenia was associated with increased odds of meeting lifetime criteria for any depressive, any anxiety, and any substance use disorder. Respondents with lifetime or past-year neurasthenia had significantly greater levels of impairment compared to those without neurasthenia.

Conclusion

Neurasthenia is a prevalent condition deserving further research attention given its comorbidity with other psychiatric disorders and its association with functional impairment.     

Psychotic disorders are more common in ethnic minority than in Dutch native defendants

Purpose

The prevalence of psychotic disorders among prisoners from racial or ethnic minority groups remains uncertain. We therefore compared the frequency of psychotic disorder in ethnic minority and Dutch native defendants using the nationwide database of elaborate pre-trial reports.

Methods

Analysis of a nationwide database of pre-trial reported defendants in the Netherlands between 2000 and 2006 (n = 12,752).

Results

A diagnosis of a psychotic disorder was more common in ethnic minority than in Dutch native defendants (21.1 vs. 10.2 %). The odds ratio of this diagnosis, adjusted for age, gender, IQ below 85 and abuse of cannabis or hard drugs, was 2.6 (95 % CI 2.2–3.0). This odds ratio was highest for African defendants (OR = 5.2; 95 % CI 3.7–7.4).

Conclusions

Psychotic disorders were more common among pre-trial reported defendants from ethnic minorities than among their Dutch native counterparts.     

Eating Disorders in Ethnic Minorities: an Update

Purpose of Review

Eating disorders are recognized to occur across ethnic and racial groups. The aim of the present review was to examine recent advances in the understanding of the development, presentation, and intervention approaches specific to eating disorders among ethnic and racial minority groups.

Recent Findings

An increasing number of measures have been found to be useful tools for assessing eating disorder risk and symptoms among ethnic and racial minority populations. In addition, further evidence has emerged supporting the relationship between higher levels of eating disorder symptoms and acculturation stress, as well as investment in appearance ideals. In contrast, the relationship between ethnic identity and eating disorder symptoms is less consistent, although several studies suggest that positive ethnic identity may be protective. Finally, increasing efforts have been made to develop and implement culturally sensitive interventions by tailoring evidence-supported treatments.

Summary

Our understanding of and capacity to treat eating disorders among ethnic and racial minority groups continues to improve. However, further research is needed, particularly among neglected groups, such a smaller ethnic and racial groups, males, and intersecting minority statuses.

     

Risk of incarceration and clinical characteristics of incarcerated veterans by race/ethnicity

Purpose

Unprecedented growth in the US prison population has highlighted the overrepresentation of racial/ethnic minorities in prisons. This study examined the hypothesis that veteran status is protective against incarceration for veterans of different racial/ethnic minorities and compared the clinical characteristics of incarcerated veterans by race/ethnicity.

Methods

Using national data from a prisoner re-entry program and data from the 2010 National Survey of Veterans, this study examined the risk of incarceration among veterans who were racial/ethnic minorities and compared sociodemographic and clinical characteristics to White incarcerated veterans.

Results

Of a sample of 30,834 incarcerated veterans, 52 % were White, 39 % African American, 7 % Hispanic, and 2 % were categorized as “Other.” African American veterans were 5.6 times and Hispanic veterans 4.3 times more likely to be incarcerated than White veterans across age groups. However, the published odds of being incarcerated as an African American in the general population compared to Whites (6.7 times) is higher, suggesting that veteran status may be somewhat protective against incarceration for African Americans, particularly among certain age groups. Among incarcerated veterans, multivariate analyses found that African American veterans were significantly more likely to have a drug/abuse dependency diagnosis and be currently incarcerated for a drug offense than Whites. Hispanic veterans were significantly more likely to be chronically homeless and also more likely to be incarcerated for a drug offense.

Conclusions

Racial/ethnic differences in incarceration persist among veterans, although are slightly attenuated. Efforts to connect incarcerated veterans with mental health services post-release should be supported, especially in connecting veterans to substance abuse treatment.     

An Ecological Momentary Assessment of Lapse Occurrences in Dieters

Purpose

The aim of this study is to investigate the factors related to dietary lapse occurrence in a community sample of dieters.

Methods

An ecological momentary assessment (EMA) methodology, via mobile phone-based diaries, was employed to record dietary lapse occurrences in a group of dieters (N?=?80; M _age ?=?41.21?±?15.60 years; M _BMI?=?30.78?±?7.26) over 7 days.

Results

Analyses indicated that lapses were positively associated with the strength of dietary temptation, presence of others, coping responses, and the environment (exposure to food cues) in which the dieters were in; lapses were more likely to occur in the evening and were negatively associated with the use of coping mechanisms. Additionally, lapse occurrence was found to mediate the relationships among the above predictors of lapse and the self-efficacy to resist future dietary temptations.

Conclusions

Results provide an insight into the occurrence of lapses in dieters and have implications for interventions focusing on weight loss maintenance and relapse prevention.     

Depressive Symptom Trajectories During and After Adjuvant Treatment for Breast Cancer

Background

The course of depressive symptoms during and after breast cancer treatment is not well understood.

Purpose

We identified patient subgroups based on distinct trajectories of depressive symptoms and determined whether subgroups could be distinguished by personal characteristics and coping strategies.

Methods

Breast cancer patients completed the Center for Epidemiologic Studies–Depression Scale on clinically meaningful occasions and during the posttreatment period. The Illness Management Questionnaire was completed prior to treatment.

Results

A three-class mixture model provided the best fit to the data. Subgroup membership was significantly (p?<?.05) associated with marital status, history of depression, and focusing on symptoms. In multivariate analysis, marital status and focusing on symptoms remained significant (p?<?.05) predictors of subgroup membership.

Conclusions

Distinct trajectories can be identified during and after adjuvant breast cancer therapy. Predictors of these trajectories have implications for addressing depressive symptoms in this clinical population and for future research.     

The Distinct Role of Comparative Risk Perceptions in a Breast Cancer Prevention Program

Background

Comparative risk perceptions may rival other types of information in terms of effects on health behavior decisions.

Purpose

We examined associations between comparative risk perceptions, affect, and behavior while controlling for absolute risk perceptions and actual risk.

Methods

Women at an increased risk of breast cancer participated in a program to learn about tamoxifen which can reduce the risk of breast cancer. They reported comparative risk perceptions of breast cancer and completed measures of anxiety, knowledge, and tamoxifen-related behavior intentions. Three months later, the women reported their behavior.

Results

Comparative risk perceptions were positively correlated with anxiety, knowledge, intentions, and behavior 3 months later. After controlling for participants’ actual risk of breast cancer and absolute risk perceptions, comparative risk perceptions predicted anxiety and knowledge, but not intentions or behavior.

Conclusions

Comparative risk perceptions can affect patient outcomes like anxiety and knowledge independently of absolute risk perceptions and actual risk information.     

Ethnic density is not associated with psychological distress in Turkish-Dutch,Moroccan-Dutch and Surinamese-Dutch ethnic minorities in the Netherlands

Purpose

Ethnic density, the proportion of people of the same ethnic group in the neighbourhood, has been identified as a protective factor with regard to mental health in ethnic minorities. Research on the putative intermediating factors, exposure to discrimination and improved social support, has not yielded conclusive evidence. We investigated the association between ethnic density and psychological well-being in three ethnic minority groups in the Netherlands. We also assessed whether a protective ethnic density effect is related to the degree to which each group experiences discrimination and social support at group level.

Methods

Using multi-level linear regression modelling, we studied the influence of ethnic density at neighbourhood level on psychological distress, measured with the Kessler Psychological Distress scale (K10), in 13,864 native Dutch, 1,206 Surinamese-Dutch, 978 Turkish-Dutch and 784 Moroccan-Dutch citizens of the four major cities in the Netherlands. Based on a nationwide survey among ethnic minorities on social integration, ethnic groups were ordered with respect to the intermediating factors.

Results

Ethnic density was not associated with psychological distress in any of the three ethnic minority groups. As a consequence, we found no support for either experiences of discrimination or for own-group social interactions at group level as intermediating factors. In all three ethnic minority groups, as well as in the native Dutch group, individual demographic and socio-economic factors emerged as the main explanations for individuals’ mental well-being.

Conclusions

These results suggest that individual demographic and socio-economic risk characteristics outweigh the influence of neighbourhood attributes on mental health.     

Responses to conflict,family loss and flight: posttraumatic stress disorder among unaccompanied refugee minors from Africa

Objective

To investigate African unaccompanied refugee minors (URMs) living in Austria for posttraumatic stress disorder (PTSD) prevalence and related symptoms, comorbidity, demographics and coping strategies.

Method

“UCLA PTSD Index and inventories” and “Scales for Children Afflicted by War and Persecution (SCWP)” were used to assess 41 African URMs.

Results

The study revealed lower PTSD rates than measured among URMs in previous studies. Girls were more likely to develop PTSD. PTSD was significantly correlated with single war-related traumatic events. The depression score for the sample was above the clinical cut-off value.

Conclusions

Trauma-specific psychopathology was less severe than reported in other studies. These findings could be explained by concepts of resilience. Other implications, such as response bias, are discussed.     

The course of postdisaster psychiatric disorders in directly exposed civilians after the US Embassy bombing in Nairobi, Kenya: a follow-up study

Purpose

While disasters are common in Africa, disaster studies in Africa are underrepresented in the published literature. This study prospectively examined the longitudinal course of psychopathology, coping, and functioning among 128 directly exposed Kenyan civilian survivors of the 1998 US Embassy bombing in Nairobi.

Methods

The Diagnostic Interview Schedule/Disaster Supplement assessed predisaster and postdisaster psychiatric disorders and variables related to coping, functioning, safety, and religion near the end of the first and third postdisaster years.

Results

Total postdisaster prevalence of posttraumatic stress disorder (PTSD) at the 3-year follow-up was 49; 28 % of the sample still had active PTSD. Delayed-onset PTSD was not observed. Posttraumatic symptoms decayed more slowly in individuals with than those without PTSD. PTSD was more prevalent and chronic than major depression. Those with current PTSD or major depression reported more functioning problems than those without. The length of hospitalization for injuries after the bombing predicted major depression remission, but no predictors of PTSD remission were found.

Conclusions

Despite differences in coping and social variables, longitudinal psychopathology in the Nairobi terrorism survivors appeared broadly similar to results in Western disaster populations. These findings contribute to the understanding of disaster mental health in Africa and may have implications for generalizability of psychiatric effects of terrorist attacks around the globe.     

Racial and ethnic disparities in the use of antipsychotic medication: a systematic review and meta-analysis

Objective

To conduct a systematic review and meta-analysis of published evidence on ethnic or racial disparities in the outpatient use versus non-use of antipsychotics and in the outpatient use of newer versus older antipsychotics.

Method

Electronic databases were searched for potentially relevant studies. Two independent reviewers conducted the review in three stages: title review, abstract review and full-text review. Included studies were those that: (a) report measures of disparity in the outpatient use of antipsychotic drugs in clearly defined racial or ethnic groups (b) have a primary focus on ethnic or racial disparities, and (c) have adjusted for factors known to influence medicine use. Odds ratios were pooled following the inverse-variance method of weighting effect sizes. I ² statistics were calculated to quantify the amount of variation that is likely due to heterogeneity between studies. Funnel plots were produced and Egger’s statistic was calculated to assess potential publication bias.

Results

No significant differences were found in the odds of using any antipsychotics among African Americans (OR = 1.01, CI = 0.99–1.02) compared with non-African Americans and among Latinos (OR = 0.98, CI = 0.86–1.13) compared with non-Latinos. Small to moderate but statistically non-significant disparities were also noted in other ethnic groups: Asians (OR = 1.10, CI = 0.88–1.36), Maoris (OR = 0.78, CI = 0.53–1.13) and Pacific Islanders (OR = 0.97, CI = 0.84–1.11). Among those who received antipsychotic medication, African Americans (OR = 0.62, CI = 0.50–0.78) and Latinos (OR = 0.77, CI = 0.73–0.81) appeared to have lower odds of receiving newer antipsychotics compared with non-African Americans and non-Latinos.

Conclusion

No significant ethnic disparities in the use versus non-use of any antipsychotics were observed, but, among those who received antipsychotic treatment, ethnic minorities were consistently less likely than non-ethnic minorities to be treated with newer antipsychotics.     

A systematic review and meta-analysis of the ethnic density effect in psychotic disorders

Purpose

A number of studies have found an ethnic density effect in psychotic disorders, where the incidence for ethnic minorities increases as the neighbourhood proportional ethnic composition decreases [Morgan and Hutchinson, Psychol Med 40:705–709, (2010); Singh, Psychol Med 39:1402–1403, (2009); Schofield et al., Psychol Med 41:1263–1269, (2010)]. However, there is a mixed picture with some studies reporting no effect [Schofield et al., Psychol Med 41:1263–1269, (2010)]. This review aimed to establish the existence of the effect by answering the review question: is there an ethnic density dose effect in the prevalence of psychotic disorders?

Methods

A systematic review and meta-analysis was conducted by two independent reviewers using PsychINFO, Web of Science and PubMed databases. Studies were measured against eligibility criteria and then pooled with any discrepancies discussed between reviewers. Studies were then assessed for quality using a standardised quality assessment.

Results

In total, eight studies were included. A meta-analysis was conducted which found that the incidence of psychotic disorders was higher in low ethnic density areas than high ethnic density areas. A narrative synthesis reflected the complexity when results were broken down by individual ethnic groups where some ethnic groups had inverse or no associations with ethnic density. The synthesis also analysed methodological differences between studies.

Conclusions

The review reports evidence of an overall ethnic density dose effect for ethnic minorities, but with more mixed results for individual ethnic groups. The possible mechanisms behind this effect are explored, including exposure to racism, social capital and social cohesion hypotheses. The wide-ranging implications of the review are discussed along with recommendations for future research to continue to inform public health policy.     

Psychiatric Disorder Criteria and their Application to Research in Different Racial Groups

Background

The advent of standardized classification and assessment of psychiatric disorders, and considerable joint efforts among many countries has led to the reporting of international rates of psychiatric disorders, and inevitably, their comparison between different racial groups.

Results

In neurologic diseases with defined genetic etiologies, the same genetic cause has different phenotypes in different racial groups.

Conclusion

We suggest that genetic differences between races mean that diagnostic criteria refined in one racial group, may not be directly and simply applicable to other racial groups and thus more effort needs to be expended on defining diseases in other groups. Cross-racial confounds (in addition to cultural confounds) make the interpretation of rates in different groups even more hazardous than seems to have been appreciated.     

Competitive Testing of Health Behavior Theories: How Do Benefits,Barriers, Subjective Norm,and Intention Influence Mammography Behavior?

Background

Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories.

Purpose

We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior.

Methods

We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n?=?704). We compared direct, partial mediation, and full mediation models with Satorra–Bentler χ ² difference testing.

Results

Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers.

Conclusions

Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.