高校短程整合取向心理咨询效果研究

  目的  研究高校短程整合式心理咨询效果, 为高校心理健康工作提供实证依据。  方法  选取上海市某高校短程咨询大学生来访者965名(4 261次会谈), 在心理咨询前后采用常规临床咨询效果评估表中文表(CORE-OM)进行评估。  结果  咨询后, 除危机外, 幸福感、焦虑、抑郁、躯体化、创伤、亲密、能力得分超过临界分的比例显著下降(χ2值分别为32.91, 42.10, 33.75, 11.81, 29.64, 10.82, 15.55, P值均 < 0.01);除对他人危机外, 幸福感、问题/症状、社会功能、危机总分得分均下降, 差异均有统计学意义(t值分别为15.12, 28.85, 19.96, 5.88, P值均 < 0.01)。在640份有效样本中, 有338例CORE-OM得分变化量达可信改变度(RCI)。  结论  高校心理咨询可以有效减轻大学生常见的焦虑、抑郁情绪、亲密关系问题等心理困惑。     

Internet-mediated, protocol-driven treatment of psychological dysfunction

An Internet system was developed for assessing psychopathology, for on-line, protocol-driven cognitive-behavioural psychological treatment and for measuring the effects of treatment. The system focused on the treatment of post-traumatic stress. The treatment comprised 10 writing sessions (45 min each) over five weeks. Participants were assessed on-line before treatment, after treatment and after six-week follow-up. After treatment the participants had improved significantly in terms of post-traumatic stress symptoms (P < 0.005) and general psychological functioning (P < 0.005), and this was sustained during the follow-up. Nineteen of the 20 participants were clinically recovered after treatment. Reduction in post-traumatic stress symptoms compared favourably to changes in control and experimental groups in trials of similar but face-to-face treatment.     

手术去势对晚期前列腺癌患者生活质量的影响

目的 调查手术去势对晚期前列腺癌患者生活质量的影响.方法 采用EORTCQLQ-C30总量表和QLQ-PR25子量表调查69例接受手术去势的晚期前列腺癌患者患病前、治疗后6个月和治疗后12个月3个时闯点的生活质量情况.结果 手术去势虽然能缓解全身或局部疼痛(P＜0.01),并改善排尿症状(P＜0.01),且患者感觉总体健康状况有好转(P＜0.01),但术后患者躯体(P＜0.05)、角色(P＜0.01)、情绪(P＜0.01)、认知(P＜0.05)、社会(P＜0.05或＜0.01)等功能均有不同程度下降,且失眠增多(P＜0.05)、疲倦加剧(P＜0.01),治疗相关症状如潮红与乳房胀痛等显著出现(P＜0.01),性趣明显下降甚至丧失(P＜0.01),特别是彻底丧失了正常的性生活.结论 手术去势对前列腺癌患者的机体与心理均有不同程度的影响,尤其是性功能方面有不可逆性损害.     

EDITORIAL

We investigated the effects of physical, psychological, and sexual violence on the health status of women attending antenatal clinics at two tertiary hospitals in rural Thailand. We asked 421 pregnant women at 32 weeks gestation or later to complete a survey questionnaire. Participants reported high rates of psychological abuse (53.7%); threats, acts of physical abuse, or both (26.6%); and sexual violence (19.2%). Women abused during pregnancy had poorer health compared with nonabused women, in role emotional functioning, vitality, bodily pain, mental health, and social functioning. Given the high prevalence of violence and poor health status, routine screenings by maternity services is urgently required.     

Changes in Pain Catastrophizing Following Physical Therapy for Musculoskeletal Injury: The Influence of Depressive and Post-traumatic Stress Symptoms

Purpose: The aim of the present study was to investigate the factors that influence the change in pain catastrophizing during the course of a physical therapy intervention for musculoskeletal injury. Methods: 187 clients enrolled in a 7-week physical therapy intervention were divided into four mutually exclusive groups on the basis of a pre-treatment assessment: (1) clients whose pre-treatment catastrophizing scores and measures of mental health problems were below clinical threshold, (2) clients whose pre-treatment catastrophizing scores were above clinical threshold but who scores on measures of mental health problems were below clinical threshold, (3) clients whose pre-treatment catastrophizing scores were above clinical threshold and whose scores on measures of mental health problems were also above clinical threshold, and (4) clients whose pre-treatment catastrophizing scores were below clinical threshold but whose scores on measures of mental health problems were above clinical threshold. Results: The most prevalent risk profile consisted of clients with high levels of pain catastrophizing and high mental health problems (37 %), followed by the low catastrophizing and low mental health problems profile (35 %), the high catastrophizing and low mental health problems profile (16 %), and low catastrophizing and high mental health problems profile (10 %). Clients were considered non-responders if their post-treatment catastrophizing score remained above clinical threshold following treatment. Chi square analyses revealed a significantly higher proportion of non-responders in the high catastrophizing and mental health problem group than in any other group. Conclusions: The presence of mental health symptoms markedly reduces the effectiveness of physical therapy for reducing catastrophizing scores. The ‘risk value’ of high catastrophizing scores thus appears to vary as a function of the presence or absence of mental health symptoms. The findings argue for the inclusion of measures of mental health problems in the routine screening of individuals treated in physical therapy.     

A palliative medicine program in a community setting: 12 points from the first 12 months

This paper reports the first year's experience of a consultative, interdisciplinary, integrated palliative medicine program in a community hospital system. Prospective data collection was performed on 308 consecutive consultations. A computer database was developed and used to analyze demographics, reason for consultation, complexity of medical problems, current medications and allergies, physical suffering, spiritual concerns, personal and family concerns, consult recommendations, and mortality. In addition, data were collected on patient rating of the severity of physical symptoms, pain, spiritual suffering, and personal and family suffering; this data also was analyzed using the database. Cancer was the most frequent diagnosis (34 percent) and pain the most common reason for consultation (43 percent). Population medians were identified as follows: five (range, 1 to 10) acute medical problems; three (range, 1 to 10) chronic medical problems; and one (range, 0 to 10) medication allergy/intolerance. Patients were taking a median of 10 (range, 0 to 29) medications, including a median of two analgesics. Eighty percent could communicate concerning physical symptoms and had a median of two (range, 0 to 7) bothersome symptoms, with pain the most frequent. Fifty percent or fewer could rate physical suffering, pain, hope, spiritual suffering, or personal/family suffering using a 0 to 10 scale at consultation. Individual patient ratings provided over time for physical suffering, pain, hope, spiritual suffering, and personal/family suffering were available for less than 25 percent. A median of eight recommendations was made for each consultation, with medication changes suggested for 84 percent. For those known to have died, the median survival from time of consultation to death was 11 days.     

Life stress,psychological symptoms and weight reducing behavior in adolescent girls: A prospective analysis

Daily and major life stress, psychological symptoms, and dieting were measured in 143 adolescent girls ages 14–18 at the beginning and end of a 4-month prospective study. Two hypothetical relations among the variables were examined; (1) that weight reducing in adolescents is predicted by stress and psychological symptoms prospectively, versus (2) that stress and psychological symptoms are a consequence of increased weight-reducing efforts. Stress and symptoms were related to weight reducing in cross-sectional correlations. Multiple regressions and LISREL analyses showed that future levels of psychological stress, but not symptoms, were predicted by weight-reducing behavior when baseline scores were controlled. The hypothesis that negative psychological functioning predicts more dieting in the future was not supported. Besides potential physical health hazards of weight reducing during adolescence and its apparent status as a risk factor for eating disorders, this indicates that weight reducing also may have some negative psychological impact on the young dieter.     

Self-rated health and quality of life in adults attending regional disability services in Ireland

BackgroundThere is limited background information on self-rated health in people with disability in Ireland. This paper examines self-rated health scores and dimensions of functioning in people attending disability services and compares scores to the general population in Ireland, which has not been done before.MethodsFace-to-face interviews were carried out with 247 adults with intellectual disability and 180 with physical or sensory disability attending regional residential, day activity, or training disability centres in the East Coast Area of Ireland. EuroQol ED-5Q was used to assess five dimensions of functioning and quality of life, supplemented by questions taken from the national population study on general health, mental health, and quality of life.ResultsClients with intellectual disability scored their quality of life significantly higher than the adult general population. They scored their mental health significantly lower compared with clients with physical/sensory disability. Compared to clients with intellectual disability, and to the general population, clients with physical or sensory disability scored their quality of life significantly lower. They had more problems in all EuroQol ED-5Q dimensions (mobility; self-care; being able to carry out one's usual activities; pain; and anxiety) than both the general population and clients with intellectual disability.ConclusionThese results give an insight into self-rated health and quality of life of regional disability services attendees. Findings provide an indicator of health needs and provide a baseline to measure the impact of interventions. Further elucidation of the relationship between functional impairment and quality of life in those with disability is needed. Factors affecting self-rating of health in people with intellectual disabilities need further exploration.     

John Henryism, self-reported physical health indicators, and the mediating role of perceived stress among high socio-economic status Asian immigrants

This study examined the relationship between John Henryism (a strong behavioral predisposition to engage in high effort coping with difficult barriers to success) and self-reported physical health among high socio-economic (SES) status Asian immigrants to the USA. Cross-sectional data were collected from a community sample of 318 self-identified Chinese and Indian immigrants aged 18-73, averaging 10.2 yr lived in the US. In addition to the John Henryism Active Coping Scale, health status was measured using ordinal ratings of global self-rated health, somatic symptoms and physical health functioning. We also evaluated whether perceived stress would explain the relationship between John Henryism and health. Controlling for demographic factors, regression analyses showed that higher John Henryism significantly predicted better self-rated health and physical functioning, and fewer somatic symptoms. These relationships were significantly and fully mediated (for physical functioning and somatic symptoms) or partially mediated (for self-rated health) by lower perceived stress. Results suggest that John Henryism relates to better health among high SES Asian immigrants in part by reducing perceived stress. To better understand and improve health in all racial/ethnic groups, especially racial minorities and immigrants, more research is needed on John Henryism and perceived stress as important psychosocial mechanisms intervening between environmental exposures and health outcomes.     

How willing are parents to improve pedestrian safety in their community?

STUDY OBJECTIVE: To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions. DESIGN: A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop. SETTING: Community survey. PARTICIPANTS: A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001. Main results: The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard. CONCLUSIONS: Parents place a high value on physical and social interventions to improve child pedestrian safety.     

The relationship of changes in EORTC QLQ-C30 scores to ratings on the Subjective Significance Questionnaire in men with localized prostate cancer

PURPOSE: To examine the relationship between changes in health-related quality-of-life (HRQOL) on the EORTC Quality of Life Questionnaire (QLQ-C30), and patients' perceptions of HRQOL changes as measured by the Subjective Significance Questionnaire (SSQ). PATIENTS AND METHODS: A total of 101 patients completed the QLQ-C30 on weeks 1, 4 and 7 of radical external-beam radiation therapy (RT) for localized cancer of the prostate. Patients rated their change in physical functioning, emotional functioning, social functioning, and overall/global quality of life (QOL) by completing a seven-category SSQ at weeks 4 and 7. The association between changes in the QLQ-C30 change and the corresponding SSQ ratings were determined by calculation of mean change scores for each SSQ category and by Spearman rank correlation coefficient analysis. RESULTS: Patients' completion of the QLQ-C30 and SSQ exceeded 95%. Statistically significant changes in fatigue, pain, appetite, diarrhea, and global QOL scores were detected during RT. For patients reporting 'a little' change in global QOL on the SSQ, absolute mean QLQ-C30 change scores ranged between 0 to 15 points with 12/16 mean change scores between 2.5 and 8.5 points. In the entire study sample, correlations between SSQ patient ratings and QLQ-C30 change scores were lower than previously reported, ranging between 0.15 and 0.24 for the four different domains, but were higher when QOL scores producing ceiling effects were omitted. CONCLUSION: The SSQ and QLQ-C30 may measure related concepts that could assist in the interpretation of changes in scores and in the calibration of the QLQ-C30. However, the nature of this relationship could not be elucidated in this data set because of a lack of variance in HRQOL scores in the study sample. Further investigation should be carried out in study samples with sufficient variance to allow more robust conclusions.     

Avoidance Symptom Presentation of Preschoolers Exposed to Intimate Partner Violence in a Group Therapy Setting

Post-traumatic stress disorder (PTSD) is a serious problem for children exposed to intimate partner violence (IPV). Recent changes to diagnostic criteria for PTSD include a reduction in avoidance symptom criteria from three to one and the separation of emotional numbing from avoidance symptoms, thus creating a need to better understand how avoidance symptoms of PTSD present themselves in young children. This study evaluated 56 children aged four to six as they participated in an intervention for mothers and children exposed to IPV. Therapists documented behaviours indicative of avoidance symptoms during group sessions. Data were analysed and coded into symptom categories and thematically emergent domains. Results demonstrated that avoidance symptoms fell into three separate categories: physical avoidance, emotional avoidance, and changing topics. Additionally, the data support the Diagnostic and Statistical Manual of Mental Disorders (5th edition) change to remove emotional numbing from the avoidance symptom category. These results give insight into how to develop more targeted treatments for PTSD as well as improve the assessment and diagnosis of PTSD symptoms in preschoolers.     

Can a rural community‐based work‐related activity program make a difference for chronic pain‐disabled injured workers?

OBJECTIVE: To assess the effectiveness of a clinical guidelines-informed multidisciplinary work-related activity program, and to improve the physical, psychological and occupational functioning of chronic pain-disabled injured workers. DESIGN: An uncontrolled, repeated-measures, pilot study was conducted. SETTING: The intervention was delivered in a community setting in regional New South Wales. PARTICIPANTS: Participants (n = 30), mean age of 41 years, had a compensable musculoskeletal injury: 60% were male, 63% had back injuries; the mean time off work was 13 months. INTERVENTION: A cognitive-behavioural, interdisciplinary intervention was delivered using a multi-contributor provider model (a clinical psychologist and physiotherapist from separate practices, working in liaison with the participant's occupational rehabilitation provider and treating doctor). Groups of six participants attended for one half day per week for six weeks. MAIN OUTCOME MEASURES: The outcome measures included: physical functioning, pain intensity and psychological variables, which were assessed pre- and post-program; and medical certification and work participation, which was recorded pre-program and at six-month follow up. RESULTS: Significant gains were made in pain intensity, physical and psychological functioning, and medical certification. The mean effect size of the intervention was medium to large (d = 0.70). There was no significant change in employment status at six-month follow up. CONCLUSIONS: The results of this pilot study suggest that independent, rural or community-based practitioners, working collaboratively using an integrated treatment program, can produce positive outcomes for pain-disabled injured workers, and achieve results similar to those reported by metropolitan-based pain clinics.     

Parental Perceptions of Child Vulnerability and Parent Stress as Predictors of Pain and Adjustment in Children With Chronic Arthritis

Parental predictors of child psychological adjustment and pain were investigated in 51 children with arthritis. Children rated depressive symptoms, anxiety, and pain. Disease severity was determined by a physician provided active joint count, as well as a physician's global assessment. Parents rated their own depressive symptoms, stress, and perceptions of child vulnerability. Regression analyses indicated that higher parental perceptions of child vulnerability predicted increased child depressive symptoms and anxiety. Parent stress predicted both child anxiety and pain. Thus, the important role parent variables play in child health outcomes was reinforced, thereby strengthening the indication to assess parent functioning when performing clinical evaluations of adjustment to juvenile arthritis.     

The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study

Economic stress and uncertainty is argued to increase older adults' vulnerability to physical health decline and mental distress. Nevertheless, there is a paucity of research that examines the relationship between a large historical economic event, such as the recent global financial crisis (GFC), and health outcomes for older adults. This study provides a unique opportunity to compare self-reported health status and psychological functioning (number of depression and anxiety symptoms) in 1973 older Australian adults (mean age of 66.58 years (SD = 1.5)) prior to the GFC (2005-2006), with their status four years later during the GFC period (2009-2010). Latent difference score models revealed a significant difference in depression and anxiety symptoms over the two measurement occasions, indicating poorer psychological functioning for those who reported an impact as a result of the economic slowdown. These effects were not explained by demographic or socio-economic factors. Interaction effects showed that those participants who were surveyed within the acute salience period of the GFC (April to September 2009) were significantly less likely to report poorer psychological health over time compared to those who were surveyed after September 2009. This interesting timing effect is discussed in terms of potential time-lags in the negative effects of economic stress on health outcomes, as well as the possible protective effects of social norms that may be created by a large scale economic crisis.     

The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes

Background/aim:  The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention.
Methods:  Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention.
Results:  A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction.
Conclusions:  The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance.     

The impact of generalized malignant melanoma on quality of life evaluated by the EORTC questionnaire technique

Eighty-nine patients with generalized malignant melanoma, 63% men and median age 53 years, were included in a longitudinal quality of life (QOL) study before the start of chemotherapy. QOL was assessed by the EORTC core questionnaire technique (QLQ-C36), a study-specific melanoma (MM) module and the Hospital Anxiety and Depression (HAD) scale. The questionnaires displayed good psychometric qualities and were able to document the florid symptomatology of disseminated melanoma. They were well accepted by the patients. Before treatment the patients reported a relatively low symptom burden, good physical and social functioning, moderate psychological distress and a high overall QOL rating during the past week. Fatigue and pain were the most frequent symptoms reported. The QOL measurement differentiated between subgroups of patients differing in performance status and the tumour burden. We conclude that the EORTC questionnaire technique is feasible and clinically relevant in generalized malignant melanoma patients.This study was made possible by grants from the King Gustav V Jubilee Fund, Stockholm, Sweden.     

Effects of pain and fatigue on physical functioning and depression in persons with muscular dystrophy

BackgroundPain and fatigue are common symptoms experienced by persons with muscular dystrophy (MD). However, it is unclear from previous studies whether pain and fatigue have independent effects on physical functioning and depression, and whether age moderates the relationship of pain and fatigue with physical functioning and depression.ObjectiveThis cross-sectional study aimed to describe the relationship of pain and fatigue to physical functioning and depression in persons 20–89 years old with MD.MethodA convenience sample of 332 individuals with MD completed a questionnaire that included measures of physical functioning (PROMIS item bank items), depression (PHQ-9), pain intensity (0–10 NRS), and fatigue (0–10 NRS).ResultsPain and fatigue were each independently associated with physical functioning and depression. Depressive symptoms were most severe among middle-aged participants (45–64 years old) relative to older and younger participants. Physical functioning had a negative relationship with chronological age.ConclusionsSymptoms of pain and fatigue are significantly and independently related to physical functioning and depression in persons with MD. Research is needed to determine if treatments that target both pain and fatigue in patients with MD have more beneficial effects than treatments that target only one of these symptoms.     

Screening for patients at risk of developing chronic incapacity

Formal investigations of psychiatric disorders and long-term personality characteristics have been relatively unhelpful in the prediction of future incapacity. Clinical studies of pain patients have led to a new range of more specific measurement instruments assessing different aspects of psychological functioning: such as pain behavior, distress, beliefs about pain, and coping strategies. Recent investigations of patients with acute back problems have identified a strong relationship between levels of distress, dysfunctional coping strategies, and future disability. Measurement instruments specifically validated for occupational settings still need to be developed, but preliminary studies suggest that fear of hurting/harming, job stress, and job satisfaction may be important factors. A pilot study into occupationally-oriented back pain management for the unemployed is reported. Results suggest that such clients may have significantly more rehabilitation potential than has previously been believed.