Psychosocial risk factors for tobacco use among adolescents with asthma

OBJECTIVE: To determine the prevalence of smoking among adolescents with asthma and smoking's psychosocial risk factors (environmental smoking exposure, autonomy, depression). METHOD: Participants were 2,039 adolescents with asthma and 2,039 matched controls from the Add Health study. RESULTS: The prevalence of ever smoking among adolescents with asthma was 56%. Among ever smokers with asthma, the prevalence of current smoking was 48%, and the prevalence of current smokers having made a recent attempt to stop smoking was 57%. Having parents who have smoked, exposure to friends who smoke, and depression were significant psychosocial risk factors for ever smoking. Asthma and exposure to friends who smoke were significantly associated with current smoking, and attempts to stop smoking were significantly associated with asthma and depression. CONCLUSIONS: Psychosocial risk factors for smoking among adolescents with and without asthma appear similar. Research on the role of illness in tobacco control is warranted.     

Brief report: social risk factors predict cigarette smoking progression among adolescents with asthma

OBJECTIVE: To compare smoking progression in adolescents with and without asthma and to compare their psychosocial risk factors. METHODS: Participants were 1,507 adolescents with asthma and 1,507 healthy matched controls from Waves I and II of the Add Health Project assessed at baseline and again 1 to 2 years later at follow-up. Three levels of smoking progression (defined as smoking more frequently and/or intensely over time) were identified: (a) Late Experimenters (never smokers at baseline, ever smokers at follow-up), (b) Early Experimenters (ever smokers at baseline, current/current frequent smokers at follow-up), and (c) Early Smokers (current smokers at baseline, current frequent smokers at follow-up). RESULTS: Twenty percent of adolescents experienced progression in their smoking behavior; those with and without asthma were equally likely to progress. Among adolescents who progressed, 37% were Late Experimenters, 42% were Early Experimenters, and 21% were Early Smokers. Exposure to friends who smoked was a consistent and powerful social risk factor for smoking progression among adolescents with asthma-more so than among adolescents without asthma. This effect was intensified among Late Experimenters by the presence of a positive history of parent smoking. CONCLUSIONS: Findings underscore the importance of addressing cigarette smoking behavior and its social risk factors among adolescents with asthma in both clinical and public health contexts, during early adolescence, and through research on this topic.     

Psychological status and diabetes-related distress of Chinese type 1 diabetes patients in Jiangsu province,China

We sought to assess the psychological status and diabetes-related distress of Chinese type 1 diabetes patients in Jiangsu province, China. According to the World Health Organization criteria, 42 patients with type 1 diabetes were enrolled in the study and assessed with the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Diabetes Distress Scale (DDS). All data were tabulated and statistical analyses were performed. The study summarized cases of 42 patients with type 1 diabetes, including 17 males and 25 females with a mean age of 23±12 years and a mean duration of diabetes of 7±6 years. Compared to the Chinese normative data, the SAS standard score was significantly higher, whereas SDS standard score had no statistical significance. The SAS standard score was most highly correlated with diabetes duration (γ = 0.547, P = 0.011). Additionally, 19.5% of the patients had moderate or even severe diabetes-related distress and 21.4% had moderate or even severe emotional burden while 26.2% had regimen-related distress. Multiple stepwise regression analysis showed that the mean correlation between DDS and the four domains was high, particularly the emotional burden domain (estimated β = 0.363, P < 0.001) and regimen-related distress domain (estimated β = 0.356, P < 0.001). The correlation between SAS and DDS was positive (estimated β = 0.039, P = 0.027). In conclusion, the results showed the importance of psychological aspects in Chinese individuals with type 1 diabetes. Screening and treatment of psychological aspects may result in better adherence and increased quality of life for patients with diabetes.     

Asthma-specific predictors of smoking onset in adolescents with asthma: a longitudinal study

Objective Despite even occasional smoking being more riskyfor adolescents with asthma, the smoking rate in this vulnerablepopulation remains high. This is the first longitudinal studyinvestigating asthma-specific predictors of smoking initiation. Methods Athree-wave longitudinal survey study (22 months) among 257 adolescentswith asthma was conducted. The effects of asthma-specific factors[symptom severity, medication adherence, coping, attitude towardsasthma, and quality of life (QOL)] on smoking onset were testedwith logistic regression models. Results Poorer self-reportedadherence and the maladaptive coping strategy of hiding asthmapredicted smoking onset. Poorer QOL predicted smoking in boysonly. Conclusions Our findings underscore the importanceof recognizing and addressing adherence problems during adolescenceas low adherence is a risk factor for smoking initiation. Moreover,psychosocial factors, such as coping and QOL for boys, wereassociated with smoking initiation. This highlights the importanceof attending to the psychosocial needs of youth with asthma.     

Maternal Posttraumatic Stress Symptoms and Psychological Burden in Mothers of Korean Children With Anaphylaxis

PurposeAnaphylaxis is a severe allergic reaction that is potentially life-threatening, but post-traumatic stress symptoms (PTSS) in the caregivers of children with anaphylaxis have not been evaluated. This study aimed to investigate the psychological burden on mothers of children with recent anaphylaxis.MethodsA total of 188 children with recent anaphylaxis was recruited from 13 hospitals in Korea. Validated questionnaires, including the Korean versions of the Beck Anxiety Inventory (K-BAI), the Beck Depression Inventory (K-BDI), and the Impact of Event Scale Revised-Korean version (IES-R-K), were used to evaluate maternal anxiety, depression, and PTSS.ResultsThe median ages of children and their mothers were 4 and 36 years, respectively. PTSS (IES-R-K ≥ 25) were identified in 56.9% of mothers, and 57.9% of them showed severe PTSS. The proportions of mothers who had anxiety (K-BAI ≥ 22) and depression (K-BDI ≥ 17) were 18.6% and 33.0%, respectively. Multivariable logistic regression analysis indicated that the patient’s history of asthma (adjusted odds ratio [aOR], 5.46; 95% CI, 1.17–25.59) and the presence of central nervous symptoms (aOR, 3.27; 95% CI, 1.07–9.96) were associated with PTSS. Age of 2 or older (aOR, 2.87; 95% CI, 1.10–7.52) and eggs, milk, or wheat as the cause of anaphylaxis (aOR, 2.87; 95% CI, 1.10–7.52) increased the risk of severe PTSS.ConclusionsThe rate of PTSS among mothers of children with recent anaphylaxis was high at 56.9%. Clinicians who care for pediatric anaphylaxis patients should be aware of the psychological burden on their caregivers.     

围手术期癌症病人心理状况及心理干预的作用

目的 :了解围手术期癌症病人抑郁、焦虑、恐惧状况及心理干预对其产生的影响。方法 :对10 8例癌症病人手术前行心理评估 ,其中 6 1例在围手术期行心理干预 ,即一般性心理支持治疗、个别心理治疗、病人互助治疗、家庭和社会支持治疗、肌肉放松和意念引导等。对照组 47例仅采取手术治疗。观察两组治疗前后抑郁、焦虑、恐惧情绪变化。结果 :围手术期癌症病人存在较严重的不良情绪 ,心理干预能明显改善其抑郁、焦虑、恐惧情绪 ,有助于其躯体疾病的治疗及生存质量的提高。结论 :外科医护人员应重视癌症病人围手术期存在的不良心理 ,积极进行心理干预能有效改善其情绪 ,有助于躯体疾病的治疗及生存质量的提高。     

Impact of the Repressive Personality Style on the Measurement of Psychological Distress in Children and Adolescents with Chronic Illness: An Example from Hemophilia

Described the impact of the repressive personality style onthe measurement of psychological distress among children andadolescents with hemophilia. Two groups were compared on parentand self-report measures of anxiety and depression: a nondefensivegroup (n = 34) with low distress; and a highly defensive group(n = 26) who were identified as having a repressive personalitystyle and who also reported low distress. Consistent with hypotheses,highly defensive children reported comparable levels of anxietyand lower levels of depression than nondefensive children. Onthe other hand, mothers of highly defensive children and adolescentsdescribed them as more distressed than mothers of nondefensive(self-assured) children. Findings underscore the importanceof including data from other informants, (e.g., parents, teachers,or peers) to avoid misleading findings based on self-reportsof anxiety and depression obtained from highly defensive children.     

Family emotional climate, depression, emotional triggering of asthma, and disease severity in pediatric asthma: examination of pathways of effect

OBJECTIVES: (a) To assess emotional triggering of pediatric asthma and ascertain its contribution to disease morbidity and functional status; (b) to test whether negative family emotional climate (NFEQ) is associated with depressive and/or anxious symptoms and emotional triggering of asthma attacks in the child. METHOD: Children with asthma (N = 272, 56% male, age 7-17) and their primary caregivers answered together an Asthma Trigger Inventory (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006). Children reported on anxious (STAIC) and depressive (CDI) symptoms and on asthma-related quality of life (PAQLQ). Parent(s) reported on their child's internalizing (CBCL-I) and depressive symptoms (CDI-P). A clinician also rated the child's depression using the structured CDRS-R. Asthma diagnosis was confirmed and disease severity rated according to NHLBI guidelines by an asthma clinician. RESULTS: Path analyses indicated that NFEQ was associated with depressive symptoms, which in turn were associated both directly and indirectly (by way of emotional triggering) with disease severity. Comparison of nested models indicated the possibility of differential roles and pathways for anxious versus depressive symptoms. CONCLUSION: Findings elucidate possible pathways of effect by which family emotional climate and child depressive symptoms may influence pediatric asthma disease severity by way of potentiating emotional triggering of asthma.     

Family rituals as a protective factor for children with asthma

OBJECTIVE: To examine how one aspect of family life, notably family rituals and routines, may protect children with asthma from anxiety-related symptoms. METHODS: Eighty-six families (43 children with asthma, 43 healthy comparison children) participated in the study. Children completed measures of anxiety (Revised Child Manifest Anxiety Scale) and health. Parents completed measures of stress (Parenting Stress Index), family rituals (Family Routines Questionnaire), and family health. RESULTS: Families that reported more meaning in their family routines had children who reported lower levels of anxiety. Mother endorsement of family ritual meaning and father endorsement of family ritual routine were most strongly related to lower levels of anxiety. Support for the protective function of meaningful family rituals was stronger when a general health stress model was used rather than the presence or absence of asthma alone. CONCLUSIONS: Family rituals may serve a protective function for children with asthma under conditions of heightened parenting stress.     

Psychological morbidity and coping skills in patients with brittle and non-brittle asthma: a case-control study

Background An association between psychological morbidity and asthma is well recognized and an increase in negative psychosocial factors in brittle asthma has been previously reported. Stich factors, apart from affecting patient perceptions, may alter patients’ self-management of their condition. Methods We have undertaken a case-control study on 29 well characterized brittle and non-brittle asthmatics in the West Midlands Region to assess their level of psychological morbidity, using the General Health Questionnaire (GHQ) and the living with asthma questionnaire, and their responses to changes in asthma symptoms, using the Asthma Symptom Checklist and a taped interview. Results Significant differences in GHQ (mean score brittle 19.5 vs non-brittle 7.2, P = 0.0002) and living with asthma (mean score brittle 1.30 vs non-brittle 1.00, P = 0.002) reinforced the presence of psychological factors in this group of patients with severe asthma. Interviews regarding responses to hypothetical asthma attacks showed that patients with brittle asthma delayed seeking medical attention more often than those with non-brittle asthma and instead preferred to self-administer beta-agonist medication. Sixteen (55.2%) of the 29 patients with brittle asthma would have delayed 7 days before seeking medical attention in a slow onset attack compared with 6/29 (20.7%) in the non-brittle group. In a fast onset attack 14 (48.3%) patients with brittle asthma would not have summoned help, despite finding it difficult to walk to the kitchen for a drink whereas in the non-brittle group 24 out of 29 (82.8%) would have summoned help. Levels of family support tended to be lower in patients with brittle asthma (mean family APGAR 7.3 vs 8.65 P = 0.09). Conclusions Brittle asthma is associated with greater psychological morbidity and altered strategies for coping with deteriorating asthma symptoms. Attention should be paid to the presence of such factors in the management of patients with brittle asthma.     

Psychological adjustment of children with asthma: effects of illness severity and recent stressful life events.

Although children with chronic illness are at greater risk for decreased psychological adjustment than physically healthy children, little is known about the factors that lead to increased risk. Eighty-one children with asthma between the ages of 6 and 14 years and their parents participated in a study to determine the relative contribution of background variables (age, gender, and socioeconomic status), recent stressful life events, and illness severity to psychological adaptation. Overall 11.5% of the children had CBCL Total Behavior Problems scores above the 98th percentile. Multiple regression revealed that lower SES, negative life change, and high illness severity were predictive of less optimal psychological adjustment. The results highlight the need for interventions to improve coping with both disease and nondisease issues.     

Interacting effects of depression and tobacco advertising receptivity on adolescent smoking

OBJECTIVE: To evaluate the independent effects of exposure to others who smoke and receptivity to tobacco advertising on adolescent smoking practices and the moderating influence of depression on these relationships. METHODS: Participants were 1,123 high school freshmen who completed a self-report survey as part of a longitudinal investigation of the biobehavioral predictors of adolescent smoking adoption. Sixty percent of freshmen reported that they were never smokers (i.e., never tried or experimented with smoking, even a few puffs), and 40% reported being ever smokers (i.e., ever smoked at least a partial or whole cigarette). RESULTS: In logistic regression models, the adjusted likelihood of ever smoking was greater for students reporting exposure to peer smoking. Further, a significant interaction was detected between receptivity to tobacco advertising and depression; specifically, adolescents with a high receptivity to tobacco advertising and clinically significant depressive symptoms were more likely to smoke than adolescents without these symptoms. CONCLUSIONS: Our data support the hypothesis that adolescents with both high advertising receptivity and depressed moods are most vulnerable to experiment with smoking. Tailoring prevention and intervention efforts to encompass tobacco advertising's effects and the role of depression could lead to a reduction in youth smoking.     

Correlates of Psychological Distress Among Mothers of Children and Adolescents with Hemophilia and HIV Infection

Evaluated the correlates of mood state (psychological distress)in a multisite study of two groups: (a) mothers of HIV–positivechildren and adolescents with hemophilia (n=91), and (b) mothersof HIV –negative children and adolescents with hemophilia(n=92). Socioeconomic status, quality of family relationshipsupport, and frequency of negative life events accounted forsignificant variance in Total Mood Disturbance (psychologicaldistress) as measured by the Profile of Mood States in the overallsample. Severity of hemophilia was unrelated to distress. Asignificant interaction between HIV status and frequency ofstressful life events indicated that this variable related morestrongly to distress among mothers of HIV–infected childrenand adolescents with hemophilia than among mothers of HIV–negativechildren with hemophilia. Findings suggest that the presenceof HIV infection in their children and adolescents may hightenthe impact of negative life events on the psychological distressexperienced by these mothers.     

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.     

Reverse culture shock,distress symptoms and psychological well-being of fresh foreign degree holders in Pakistan

This study explored to what extent does reverse culture shock predict the level of anxiety, depression, and psychological well-being among fresh foreign degree holders in Pakistan, in addition to finding out the relationship between the study variables. Participants consisted of 124 fresh foreign degree holders (109 men and 15 women) who were recruited through purposive and snowball sampling techniques. Reverse Culture Shock Scale, Major Depression Inventory, Beck Anxiety Inventory, and WHO-5 Well-being Index were used to measure study variables. Results show that reverse culture shock is a strong predictor of psychological well-being explaining 23% variance in well-being scores of fresh foreign degree holders. As hypothesized, it has positive associations with distress symptoms including anxiety and depression, whereas, a negative correlation was found with psychological well-being and the age of fresh foreign degree holders. However, contrary to the hypothesis, reverse culture shock has no association with time passed since arrival back home and duration of stay abroad.     

Pulmonary function in adolescents with childhood asthma

The aim of this study was to determine the pulmonary function in former and present asthmatics. We examined 77 persons aged 12–24 years, classified into four groups: 1) healthy subjects (controls) ( n = 19), 2) former asthmatics ( n = 19), 3) present mild asthmatics ( n = 20), and 4) present severe asthmatics ( n = 19). Although exhibiting no respiratory symptoms, former asthmatics had reduced airflow values measured by FEV, (median (range) 89.7 (83–99) vs 101.4 (91–110)) and MEF₂₅ (76.5 (68–94) vs 103.0 (97–124)), as compared with controls. Furthermore, former asthmatics had significantly increased PEF variability, as compared with controls, whereas no significant differences were found in static lung parameters, i.e. total lung capacity and residual volume, as compared with controls. In conclusion, former asthmatics, although now exhibiting no respiratory symptoms, were found to have obstructive airflow limitation, increased bronchial responsiveness, and normal lung volumes.     

Brief report: psychological symptoms in healthy female siblings of adolescents with and without chronic conditions

OBJECTIVE: To examine the psychological impact of having a sibling with a chronic condition on healthy adolescent females and to explore the potential moderating role of birth order on this relationship. METHOD: We compared selected Brief Symptom Index subscales (anxiety, depression, interpersonal sensitivity, hostility) and global severity scores (GSI) in two groups of healthy, inner-city female adolescents matched for sibling age, gender, birth order, and age spacing: 34 sisters of males and females ages 13-19 years with chronic health conditions (ILLSIBS) and 34 sisters of males and females in the same age range without conditions (WELLSIBS). RESULTS: ILLSIBS generally had more symptoms than WELLSIBS. MANOVA yielded significant three-way interactions of sibling illness status, birth order, and gender for the anxiety, hostility, and GSI. A similar pattern was nonsignificant for the two other subscales. Among younger sisters in general and among older sisters of males only, ILLSIBS had higher scores; however, ILLSIBS who were older sisters of females did not differ significantly in symptom levels from the comparable group of WELLSIBS. CONCLUSIONS: Psychological symptoms in sisters of inner-city, male and female adolescents are related to sibling health status. However, the combination of sibling gender and birth order may modify this relationship and should be considered when evaluating psychological risk or designing interventions.