Social role quality,physical health,and psychological well-being in women after heart surgery

Women's social role quality may be an important factor in their adaptation after heart surgery. Relationships among different dimensions of role quality, physical health, and psychological well-being were examined in 157 midlife and older women who had undergone heart surgery. Overall, older women (n = 89) were similar to younger women (n=68) in physical recovery from heart surgery. Poorer health outcomes were associated with number of health problems, not age. Women with more health problems and lower subjective health perceptions had lower role quality. Multiple regression analyses indicated that, in general, role quality mediated the effects of physical health on psychological well-being. Regardless of the extent of physical health problems, women with higher role quality had higher levels of psychological well-being.     

Roles and well-being among healthy women and women with rheumatoid arthritis

Title.  Roles and well-being among healthy women and women with rheumatoid arthritis.
Aim.  This paper is a report of a study examining the relationships among number of roles, role quality, role stress, role balance, and psychological well-being in women diagnosed with rheumatoid arthritis.
Background.  A substantial literature exists examining multiple roles in healthy women. However, less is known about multiple roles and well-being in women with a chronic illness such as rheumatoid arthritis.
Methods.  A questionnaire study was conducted in 2003 examining four role-related constructs (number of roles, quality of roles, role stress, and role balance) and psychological well-being in healthy women ( n  = 47) and women diagnosed with rheumatoid arthritis ( n  = 50). Correlation coefficients and multiple regression analyses were calculated to determine the nature of the relationships among the variables.
Findings.  The two groups were similar in demographics except for employment, with fewer women with rheumatoid arthritis employed. The two groups differed statistically significantly on psychological well-being. Women with rheumatoid arthritis had a lower mean psychological well-being score than healthy women. Regression analyses revealed that role stress was the only unique predictor of psychological well-being in healthy women, while role balance was the sole unique predictor among women with rheumatoid arthritis.
Conclusion.  Women with rheumatoid arthritis experienced lower levels of well-being than their healthy counterparts. Examination of the relationships among the variables can facilitate the development of interventions to improve these women's mental health. Nurses are in a position to assess the psychosocial needs of women with rheumatoid arthritis and assist those experiencing role stress and role imbalance.     

The relationship between physical health and psychological well-being in elderly women: A developmental perspective

Little is known about the physical health and psychological well-being of very old women, although they are one of the fastest growing segments of the population. The relationships among physical health, psychological well-being, and age were investigated using a developmental perspective and a multidimensional approach to the assessment of psychological wellbeing. Two hundred and forty-three elderly women completed multiple self-report measures of physical health status and psychological well-being. Multiple regression analyses indicated that older age was related to lower levels of purpose in life, personal growth, and positive relationships. Poor health, regardless of age, was associated with more depression and anxiety and lower levels of positive relationships and autonomy. Implications for the nursing care of elderly women are discussed. © 1993 John Wiley & Sons, Inc.     

Social roles and health in women living with HIV/AIDS: A pilot study.

The purpose of this report is to share results from a pilot study about the social role experiences and health of women living with HIV/AIDS. This pilot was designed as part of a larger study undertaken to ensure cultural competence of measures and methods proposed for testing a model of role quality and health in culturally diverse low-income women. Thirteen women participated in the study (69% African American; 77% less than dollar 10,000 annual income; range of years since HIV diagnosis, 3-21). Measures of physical health, role quality, and psychological well-being previously used to test relationships among the variables in women with chronic illness were administered using a face-to-face interview format. Results indicated that the women experienced a number of HIV symptoms and coexisting health problems, moderate physical limitations, positive perceptions of their roles, moderate levels of well-being, and high depression scores. The pilot study represents the first step in the development of a theory-based approach to understanding linkages among health and role quality in women with HIV.     

Associations between homeless women's intimate relationships and their health and well-being

The purpose of this study was to describe the associations between intimate relationships, characterized in terms of presence or absence of conflictive interaction with the partner, and the health and well-being of homeless women. A sample of 558 homeless women were administered structured interviews by trained nurses or outreach workers of the participants' ethnicity. Women answered questions about their general physical health, health-threatening behaviors (i.e., risky drug and sexual behaviors), health-promoting behaviors (i.e., TB and Pap testing), psychological well-being and symptomatology, self-esteem, coping, and life satisfaction. Women in nonconflictive relationships reported significantly greater psychological well-being, self-esteem, and life satisfaction and less hostility and noninjection drug use than women with conflictive relationships or those without an intimate partner. Women with conflictive relationships were significantly more anxious and depressed than those with nonconflictive relationships. Results suggest that, when possible, it is advisable to involve the intimate partner in programs to facilitate the emotional well-being of homeless women.     

Mechanisms related to psychological well-being in older women with chronic illnesses: Age and disease comparisons

The influence of type of illness (breast cancer versus osteoarthritis) and age on physical health and functioning, self-system interpretive mechanisms, and women's psychological well-being were examined. Self-system interpretive mechanisms are considered mediators of the effects of physical health on psychological well-being and include social comparisons, social integration, and illness perceptions. Young-old (aged 60–74) and old-old (75+) women, diagnosed with osteoarthritis (N = 102) or breast cancer (N = 86), who volunteered for the study were interviewed using structured self-report scales. Young-old and old-old women did not differ in terms of health status, interpretive mechanisms, or on three of five indices of psychological well-being. On the other hand, women with arthritis, regardless of age, reported more functional health problems, more symptoms, and perceived their illness as more severe, more chronic, and less controllable than women with breast cancer. Although women with arthritis and breast cancer differed significantly in terms of physical health, they did not differ on multiple measures of psychological well-being. For both groups, women who made more positive social comparisons and who had more extensive social networks had higher levels of psychological well-being, regardless of physical health problems. © 1996 John Wiley & Sons, Inc.     

Depression burden, psychological adjustment, and quality of life in women with breast cancer: patterns over time

The purpose of this study was to examine how level of depression burden influences women's psychological adjustment and quality of life over time and how depression burden interacted with a community-based oncology support program to influence psychological adjustment and life quality. Participants were 169 women who completed a side effects checklist at three data collection points. Women were divided into two groups based on their depression burden scores: 123 women reporting no burden, and 46 women reporting high depression burden. For psychological adjustment, there were significant interaction effects for intervention by time and for intervention by depression burden by time and significant main effects for depression burden. For life quality, there was a significant interaction effect for intervention by time and a significant main effect for depression burden. The findings document the negative impact of depression burden on psychological adjustment and life quality. Oncology support interventions can be effective in reducing this negative impact.     

Differences in depression,anxiety, and quality of life between women with and without breast pain prior to breast cancer surgery

Purpose of the researchLittle is known about the relationships between pain, anxiety, and depression in women prior to breast cancer surgery. The purpose of this study was to evaluate for differences in anxiety, depression, and quality of life (QOL) in women who did and did not report the occurrence of breast pain prior to breast cancer surgery. We hypothesized that women with pain would report higher levels of anxiety and depression as well as poorer QOL than women without pain.Methods and sampleA total of 390 women completed self-report measures of pain, anxiety depression, and QOL prior to surgery.Key resultsWomen with preoperative breast pain (28%) were significantly younger, had a lower functional status score, were more likely to be Non-white and to have gone through menopause. Over 37% of the sample reported clinically meaningful levels of depressive symptoms. Almost 70% of the sample reported clinically meaningful levels of anxiety. Patients with preoperative breast pain reported significantly higher depression scores and significantly lower physical well-being scores. No between group differences were found for patients' ratings of state and trait anxiety or total QOL scores.ConclusionsOur a priori hypotheses were only partially supported. Findings from this study suggest that, regardless of pain status, anxiety and depression are common problems in women prior to breast cancer surgery.     

Effects of urinary incontinence: psychological well-being and distress in older community-dwelling women

Urinary incontinence (UI) has been related to lower quality of life. However, the research has generally been cross-sectional, and causal relationships have not been determined. This research was a secondary analysis of a 6-year longitudinal study of chronic illness and psychological well-being in older (mean age = 73 at Time 1), community-dwelling women (n = 103). Over time, women with UI reported significantly lower subjective health, purpose in life, affect balance, personal growth, positive relations with others, and self-esteem and higher scores for depression, compared to women without UI. Incontinence had broad effects on multiple domains of psychological well-being that persisted over time and need to be addressed by clinicians.     

Anxiety,depression and quality of life in Chinese women with breast cancer during and after treatment: A comparative evaluation

Purpose of the researchTo compare the psychological health and quality of life (QoL) of women with breast cancer, and to determine the relationship between anxiety, depression and QoL during treatment and one year afterwards.Methods and sampleFor this secondary analysis, 269 women undergoing adjuvant therapy for breast cancer, and 148 women with breast cancer who had completed all treatment within the last year completed a self-report questionnaire covering the Hospital Anxiety and Depression Scale-Cantonese/Chinese version, Functional Assessment of Cancer Therapy-General, and demographic and clinical characteristics.Key resultsThe ongoing-therapy group showed higher levels of anxiety and depression and lower levels of all QoL dimensions than the post-therapy group. Linear regression results showed that both anxiety and depression were significantly related to physical and functional well-being, while depression was associated with social/family well-being in both groups. In the case of emotional well-being, anxiety had a strong significant association in both groups and depression a significant relationship only in the ongoing-therapy group.ConclusionsThe psychological health of women with breast cancer is affected during and after treatment. Psychological distress in these patients, including anxiety and depression, has independent associations with impaired emotional, functional, physical and social well-being. The results highlight the importance of timely detection of anxiety and depression, and their proper management, during the treatment and survivorship phases of the breast cancer trajectory.     

The effect of humor on elder mental and physical health

A convenience sample of community-dwelling older people attending senior centers was asked to participate in a quasi-experimental study to examine the impact of a humor therapy workshop on physical and mental health. Participants were assessed at baseline and at six months for physical (general health and health quality of life) and mental (general well-being, anxiety, depression and psychological distress) health. The sample consisted of 92 subjects, 42 in the control group and 50 in the workshop. Compared to controls, subjects in the workshop had significantly lower follow-up levels of anxiety and depression and improved general well-being. No differences were observed for general health, health quality of life, or psychological distress. This humor therapy workshop was associated with a positive effect upon mental health. It is recommended that attendance at humor workshops be encouraged and that further investigations into the efficacy of such programs on mental and physical health be investigated.     

Differential predictors of emotional distress in HIV-infected men and women

Changes in the AIDS epidemic in many areas of the United States require information about the experience of the growing segment of women afflicted. This study compared patterns of emotional distress between men and women with symptomatic HIV and examined potential predictors of different levels of vulnerability. A sample of 126 low socioeconomic men and women seeking care from HIV treatment centers was surveyed using measures of physical and psychological well-being. Women had more HIV symptoms, poorer functioning, and greater disruptions in physical and psychosocial well-being. Physical health status and optimism were primary predictors of emotional distress in both men and women. More than 50% of men and women had scores indicative of clinical anxiety. Approximately 1 out of 10 had clinically relevant scores for depression. Gender differences may provide potentially useful information for tailoring assessment interventions for emotional distress in people infected with HIV.     

Quality of life of cancer patients receiving inpatient and home-based palliative care

AIMS: This paper reports a comparative study of the symptom experience, physical and psychological health, perceived control of the effects of cancer and quality of life of terminally ill cancer patients receiving inpatient and home-based palliative care, and the factors that predict quality of life. BACKGROUND: Quality of life is a major goal in the care of patients with terminal cancer. In addition to symptom management, psychological care and provision of support, being cared for at home is considered an important determinant of patient well-being. A more comprehensive understanding of the impact of cancer on patients and their families will inform the delivery of palliative care services. METHODS: Fifty-eight patients with terminal cancer (32 inpatients, 26 home-based) were recruited from major palliative care centres in Australia in 1999. A structured questionnaire designed to obtain sociodemographic information, medical details and standard measures of symptoms, physical and psychological health, personal control and quality of life was administered by personal interview. RESULTS: The two groups were similar on most demographic measures, although more home-care patients were married, of Australian descent and had private health insurance cover. The most prevalent symptoms reported were weakness, fatigue, sleeping during the day and pain. Patients receiving home-based services had statistically significantly less symptom severity and distress, lower depression scores, and better physical health and quality of life than those receiving inpatient care. Home-care patients also reported statistically significantly more control over the effects of their illness, medical care and treatment received, and the course of the disease. Multiple regression analyses showed that better global physical health, greater control over the effects of cancer and lower depression scores were statistically significant predictors of higher quality of life. CONCLUSIONS: The main issues arising from the findings for nurses are the early detection and management of both physical and psychological symptoms, particularly fatigue, pain, anxiety and depression, and the need to use strategies that will empower patients to have a greater sense of control over their illness and treatment. Research is needed to identify other factors that may impact on quality of life, and to establish the extent to which inpatient and home-based care meets the needs of both the patient with terminal cancer and their family.     

Differential effects of age and illness duration on pain-depression and disability-depression relationships in rheumatoid arthritis

We examined the differential effects of age and illness duration on pain—depression and disability—depression relationships in a sample of patients diagnosed with rheumatoid arthritis (RA). Consistent with existing literature, main effect results indicated that shorter illness duration and greater perceived pain and functional disability all related to increased levels of depression. More importantly, multiple regression analyses revealed that illness duration moderated the observed disability—depression relationship. Specifically, perceived functional disability exerted a greater negative impact on levels of depression in patients with relatively shorter illness durations compared to patients with longer illness durations. Neither age nor illness duration moderated the association between pain and depression. In general, our findings suggest that age and illness duration differentially influence pain—depression and disability—depression relationships in RA. We conclude the paper with a discussion of treatment implications of our findings for persons with RA.     

类风湿关节炎患者焦虑抑郁情绪及其与生活质量的相关性

目的观察类风湿关节炎(RA)患者焦虑抑郁情绪及其与主要症状体征、生活质量(QOL)的相关性,探讨RA患者抑郁情绪的机制。方法采用焦虑自评量表(SAS)和抑郁自评量表(SDS)、主要症状体征积分、生活质量量表对100例RA患者进行观察并做相关分析。结果(1)100例RA患者中,SAS标准分为(46.33±7.69),有焦虑症状者为37%;SDS标准分为(51.36±9.10),抑郁情绪的发生率为53%;两者均高于正常人;(2)SAS标准分与关节疼痛、关节压痛、关节重着、症状体征总积分呈正相关;SDS标准分与食欲减退、少气懒言、倦怠乏力、关节重着、症状体征总积分呈正相关,两者均与年龄、病程无关。(3)SAS、SDS标准分均与生理功能、社会功能、心理功能、健康自我认识能力及生活质量总积分呈正相关。结论类风湿关节炎患者存在一定程度的焦虑抑郁情绪,以抑郁情绪为主,RA患者的焦虑、抑郁情绪与病情及生活质量存在一定的相关性,提示其发生机制与生活质量下降有关。     

Cardiac rehabilitation and quality of life: a systematic review

ObjectiveThe objective of this systematic review was to explore the effects of cardiac rehabilitation interventions on the quality of life of patients with coronary heart disease with a specific focus on interventions that could be delivered within the context of a publicly funded health service.DesignSystematic review of trials reporting quality of life data as an outcome measure. Electronic databases (CINAHL, MEDLINE and PsycINFO) were searched from 1 January 1999 to 25 November 2010 in the English language. Inclusion criteria were: randomised controlled trials of cardiac rehabilitation as configured for a publicly funded health service. Data were extracted by one reviewer and checked by a second reviewer.ResultsThe 16 papers reported RCTs conducted in nine countries. Fifteen measurement instruments were utilised to measure quality of life across the different studies precluding a meta-analysis. Four themes emerged from the thematic analysis of the selected papers: physical well-being (including fitness and symptoms); psychological well-being (including anxiety and depression); social well-being (including family life and relationships); and functional status (including return to work and previous life style). Physical domain outcomes suggest that cardiac rehabilitation may improve physical well-being and levels of physical activity and thereby improved levels of physical fitness. Both physical and psychological domain outcomes suggest that home-based interventions are at least as effective as centre-based interventions. Relatively few trials reported on quality of life within the social domain and any difference between centre-based and home-based interventions appeared to favour the home-based intervention.ConclusionsThis review indicates that cardiac rehabilitation improves the quality of life for coronary heart disease patients and that quality of life improvements have a bi-directional relationship with increased physical activity and vocational status. Further research is needed to explore the relationship of quality of life outcomes to cardiac mortality, the relationship between improved physical well-being and anxiety, and the quality of life and mortality effects of cardiac rehabilitation in older people.     

Spirituality, mental health, physical health, and health-related quality of life among women with HIV/AIDS: integrating spirituality into mental health care

HIV-positive women have used spirituality as a resource to enhance their psychological well-being and health-related quality of life (HRQOL). The purpose of this article is to review the literature about depression among HIV-positive women and to describe the positive associations reported among spirituality, mental health, and HRQOL. This article also advocates the development and use of interventions integrated with spirituality. The incorporation of spirituality into traditional mental health practices can optimize healthcare for HIV-positive women who are diagnosed with depression. A case example is presented and spiritual implications are discussed.     

Higher pain sensitivity and lower muscle strength in postmenonpausal women with early rheumatoid arthritis compared with age-matched healthy women – a pilot study

Purpose: The purpose of the study was to examine muscle strength and pain sensitivity in postmenopausal women with and without RA. Methods: Ten women with and ten without early RA were recruited. All were postmenopausal, and did not use hormone replacement therapy. Measurements of isokinetic muscle strength in knee flexors/extensors, hand grip strength, timed standing, pressure pain thresholds (PPT), suprathreshold pressure pain, and segmental and plurisegmental endogenous pain inhibitory mechanisms during muscle contraction were assessed. Results: Participants with early RA were weaker in knee flexors, in hand grip strength and they needed more time for the timed standing. Women with early RA had higher sensitivity to threshold pain and suprathreshold pressure pain compared to women without RA. PPTs increased in the contracting muscle as well as in a distant resting muscle during static contractions in both groups. Conclusions: Our results indicate differences in muscular strength between postmenopausal women with and without RA. Furthermore, women with RA had decreased PPT and hyperalgesia, but no dysfunction of segmental or plurisegmental pain inhibitory mechanisms during static exercise compared to healthy controls. The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity previously reported.

Implications for Rehabilitation

• Difference in muscular strength between postmenopausal women with and without (rheumatoid arthritis) RA is present in early disease despite low disease activity.

• Women with RA have decreased pressure pain thresholds and hyperalgesia, but no dysfunction of segmental and plurisegmental pain inhibitory mechanisms.

• The normal function of endogenous pain inhibitory mechanisms despite chronic pain in women with RA might contribute to the good effects of physical activity in this group of patients.

     

中年女性围绝经期症状及影响因素的研究现状分析

围绝经期由于激素水平下降出现潮热、心悸、失眠、记忆力下降、性欲减退、烦躁、抑郁、阴道干涩及泌尿系统疾病等身体和心理的不适症状。不同种族、不同地域和个人经历的女性,在围绝经期的症状存在差异,不同程度地影响其健康。本文作者通过文献分析,探讨女性围绝经期症状及影响因素的研究趋向。发现围绝经期症状直接影响女性的身心健康状况、生活质量水平,我国大多数围绝经期女性的自我保护意识尚低。因此,明确围绝经期女性的症状特点和影响因素,有助于提供适宜有效的健康干预。