Psychosocial adjustment and quality of life following heart transplantation

This article describes the pre-operative psychosocial and quality-of-life adjustment of a consecutive series of 27 heart transplant recipients and the adjustment of the 24 survivors at 12 months follow-up. Pre-operatively, 14 had a psychiatric diagnosis and this figure had dropped to five at 12 months follow-up. Those patients without a psychiatric diagnosis preoperatively had not developed one at follow-up. There was a significant correlation between pre-operative psychiatric diagnosis and a rating of poor medical compliance. Ratings of physical activity, employment and questionnaire ratings of psychological adjustment also showed highly significant improvement at follow-up and the majority of patients were active sexually. It is concluded that heart transplantation in selected subjects with terminal heart disease results in a substantial improvement in psychosocial adjustment and quality-of-life 12 months following surgery.     

Psychosocial changes and psychosocial adjustment with chronic and severe nonfluent aphasia

Abstract

Data concerning type and degree of psychological changes resulting from communicative impairment were obtained from close relatives of 20 chronic non-fluent aphasics by means of a structured and standardized interview. Expectations concerning further psychosocial adaptation were assessed with a modified translation of the ‘Code-Muller Scale of Psychosocial Adjustment’ in patients, relatives, and the speech therapists concerned. The data demonstrate that patients and relatives suffer from considerable psychosocial strain. Patients and relatives estimated the probability of an improvement of psychosocial adjustment as being significantly higher than the speech therapists did, a finding which replicated the results obtained by Müller and his colleagues.     

Psychosocial adjustment to a mastectomy

Increasing attention is being given to treating the psychosocial as well as the physical needs of mastectomy patients. The present study investigated and endeavored to quantify the psychological, sexual, and social adjustment reactions to a mastectomy, the possible interaction of these reactions, and the role of environmental support in mediating these responses. Forty married and 37 unmarried mastectomy patients completed a battery of tests, including the Body-Cathexis/Self-Cathexis Scale, SCL-90, Derogatis Sexual Functioning Inventory, Social Adjustment Scale-Self-Report, Perceived Social Support Scale, and a Support Questionnaire. Overall findings indicated that a mastectomy has the potential for affecting psychological, sexual, and social adjustment for at least a limited time post-operatively. Specifically, significant correlations were found between psychological, sexual, and social adjustment. Significant differences were also demonstrated in the married/nonmarried comparison. Additionally, results emphasized the importance of environmental support for postoperative adjustment.     

Psychosocial adjustment after renal retransplants

Twenty-four patients who underwent more than one kidney transplant were interviewed to assess their psychosocial adaptation. Of these 24, we found 15 patients with a functioning kidney and 9 patients with a nonfunctioning transplant who were back on hemodialysis. In both groups, approximately 50% of the patients had life satisfaction ratings of "good" and "very good." The groups differed in two respects. Those with a functioning kidney had a higher employment rate and a better sexual functioning than the group on dialysis. We found many similarities in all other scored parameters (optimism, object relationships, coping devices, psychologic functioning). Denial was commonly used by most of the patients, but the group of patients who scored "good" and "very good" on life satisfaction more frequently utilized other coping devices, such as altruism, "feeling chosen," inner control, and activity than patients with "fair" or "poor" life satisfaction.     

Psychosocial adjustment following major gynaecological surgery for carcinoma of the cervix and vulva.

One-hundred and five women had undergone major gynaecological surgery for carcinoma of the cervix and vulva were interviewed retrospectively to elicit post-operative psychosocial and psychosexual problems. This interview took place between 6 months and 5 yr after surgery. Responses to the Hospital Anxiety and Depression Scale indicated that 20% of the women were 'probable' cases of anxiety and 21% were 'definite' cases. On the depression scale, 18% were 'doubtful' cases and 14% were 'definite' cases. Scores on the scales were not associated with age of the woman, the type of operation or the time period between being interviewed and the operation. Two-thirds of the women who were sexually active prior to the operation indicated ongoing sexual problems when interviewed and the presence of these problems was found to be significantly associated with the woman's level of anxiety.     

Psychosocial functioning following successful surgical relief from seizures. Evidence of prediction from preoperative personality characteristics

The relationship of preoperative personality tests to psychosocial functioning following relief of seizures was studied in a group of nonpsychiatric patients of average intelligence. Patients with no psychopathology in their preoperative personality tests were correctly predicted by a clinical medical psychologist to have good psychosocial adjustment following surgical success. However, predictions of postoperative psychosocial functioning in patients with psychopathology on their preoperative personality tests were correct in only 26% of the cases. Analyses of the personality test results showed that the younger patients who had evidence of disorganized confusion preoperatively did well psychosocially following surgical relief of seizures. On the other hand, older patients with indications of an organized, well-structured psychopathology had poor psychosocial adjustment postoperatively, even though seizures were relieved.     

Psychosocial adjustment of epilepsy patients in Cyprus

This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs.     

Psychosocial adjustment 17 years after severe brain injury

OBJECTIVES: To examine very long term psychosocial outcome following severe brain injury in a large cohort, with the aim of evaluating Thomsen's observation that even after very serious head trauma the long term outcome in some patients is reasonably good. METHODS: The cohort consisted of 80 patients who had suffered severe brain injury evaluated at a mean time of 17 years post injury (range 10-32 years). Information regarding employment status and relationship status was obtained during clinical interview. Psychosocial outcome measures included the Supervision Rating Scale, Satisfaction with Life Scale, Hospital Anxiety and Depression Scale (HADS), Patient Competency Rating Scale, and Community Integration Questionnaire. RESULTS: Of the cohort, 72.0% lived independently, 28.7% were in full time employment, and 60.0% were married or cohabiting. The mean rating of life satisfaction was "slightly dissatisfied", but no serious emotional problems were evident from self report ratings on the HADS. Mean functional competency ratings and community integration levels were just below those reported for non-disabled patients. CONCLUSIONS: Results indicate that although long term psychosocial functioning in patients with severe head injury remains compromised, long term adjustment may be better than expected from data reported by studies assessing psychosocial outcome at earlier stages of recovery.     

Psychosocial adjustment three years after traumatic brain injury

This study examined the relationship of social support and family cohesion to psychosocial outcome in a group of 25 individuals three years after they each sustained a severe brain injury (TBI). The subject group was initially recruited while they were inpatients in a community hospital rehabilitation unit. The subjects were assessed with the Portland Adaptability Inventory (PAI), the Family Environment Scale (FES), and a family interview at various intervals up to three years post-trauma. Findings suggested that family cohesion and available perceived social support for the injured person were related to the individual's psychosocial and vocational status three years after injury, with higher levels of cohesion and support being related to better outcomes. Implications for researching and applying techniques to improve social support variables in TBI rehabilitation are provided.     

Psychosocial adjustment of people with epilepsy in Hong Kong

PURPOSE: In light of the issues associated with the psychosocial adjustment of people with epilepsy that have been widely reported, this study examined these issues within a Chinese cultural context. METHODS: Fifty patients with epilepsy completed The Washington Psychosocial Inventory, the Coping Inventory for Stressful Situations, and a questionnaire that assessed their psychosocial difficulties and coping styles. Multiple regression procedure was used to examine the strength of various medical and social factors in predicting the psychosocial adjustment problems of these participants. RESULTS: Social factors, such as self-perception and coping strategies, were more powerful predictors of psychosocial adjustment in people with epilepsy than the medical factors associated with epilepsy. CONCLUSIONS: These findings showed that psychosocial maladjustment is a significant issue for people with epilepsy in Hong Kong. The emerging importance of social factors as predictors of psychosocial adjustment in epilepsy, as compared with medical factors, highlights the need for developing tailored counseling therapy and social support groups for people with epilepsy.     

Psychosocial outcomes following long-term,double-blind treatment of chronic depression with sertraline vs placebo

BACKGROUND: Chronic forms of depression are associated with significant functional and psychosocial impairments. To date, no study has measured psychosocial functioning in this population during long-term maintenance antidepressant treatment or following the double-blind discontinuation of treatment. METHODS: Patients with chronic major or double depression completed 12 weeks of short-term treatment followed by 16 weeks of continuation treatment with sertraline hydrochloride. Responders at the end of the continuation phase were randomized, double-blind, to 18 months of maintenance therapy with either sertraline (n = 77) or placebo (n = 84). Multiple domains of psychosocial functioning were assessed during double-blind therapy. RESULTS: Substantial worsening in psychosocial function measures occurred in patients taking placebo compared with sertraline during maintenance. Patients with reemergence of depression lost psychosocial gains regardless of treatment. In the subsample of patients who remained in remission throughout maintenance, most of the observed improvement in psychosocial functioning occurred during short-term treatment. By maintenance end point, normalization of functioning was achieved by 58% to 84% of remitters, depending on the outcome measure used. CONCLUSIONS: These results indicate that long-term treatment of chronic forms of depression can result in sustained psychosocial benefits. Discontinuation of treatment results in frequent reemergence of symptoms and loss of psychosocial gains. Long-term treatment resulted in only modest further improvement of psychosocial measures over that achieved in the short-term phase.     

Psychosocial adjustment in patients one year after myocardial infarction

One year after a first myocardial infarction substantial psychological distress and changes in social activities and relationships are described, both for patients and their families. Outcome cannot be seen as unitary, since the various aspects of life are affected to different extents. It was also evident that pre-morbid adjustment and other life events and difficulties are important in determining adjustment at one year. Implications for improvement in routine management are discussed.     

Psychosocial adjustment among pediatric cancer patients and their parents

Children with cancer face both physical and psychosocial challenges. However, there is not enough empirical evidence in Taiwan regarding how they and their families cope with their illness. The purpose of the present study was to explore the psychosocial impact of cancer on target children and their families as well as the degree of depression experienced by these children. Twenty-four pediatric cancer patients, aged 8 through 17 years, completed the Chinese version of Children Depression Inventory (CDI). Both these patients and 18 parents completed questionnaires about their psychosocial adjustment since the diagnosis of cancer. The results showed: (i) patients did not perceive significant changes in their psychosocial adjustment, whereas parents indicated significantly lower mood of patients and a slight decrease in the number of friends; (ii) both parents and siblings showed positive adjustment; and (iii) there was neither significant difference on the CDI scores between the pediatric cancer patients and a normative group, nor significant relationships between patients' CDI scores and demographic characteristics of both patients and their parents, parenting attitudes, as well as variables related to the illness. Lastly, the results are discussed in terms of issues of methodology and instruments. Possible direction for further investigations is suggested.     

Psychosocial adjustment before and after coronary artery bypass surgery

Twenty-eight consecutive male patients were examined a few days before, and again twelve months after, coronary artery bypass surgery. The evaluation included the patients' psychological distress, psychosocial adjustment, cardiac state, personality and family relations. Before surgery the patients were relatively well adjusted, despite being severely disabled physically. On the follow-up evaluation the cardiac state improved significantly on every index examined. On the other hand no change occurred in the psychological distress, personality and family relations. Significant post-operative improvement was found in some of the domains of the psychosocial adjustment, but not in others.     

Psychosocial adjustment of children with a terminally ill parent.

Although a substantial number of children experience serious parental illness and death, the adjustment problems attendant to the stress of having a fatally ill parent have not been examined systematically. This paper compares the psychosocial adjustment of 62 school-aged children with a terminally ill parent (study sample) with that of children in a community sample, using several standard rating scales. Study children had significantly higher levels of self-reported depression (Children's Depression Inventory) and anxiety (State-Trait Anxiety Inventory) and lower self-esteem (Self-Esteem Inventory). Parents also reported study children's significantly higher behavior problems and lower social competence (Child Behavior Checklist). Increased professional attention to this vulnerable population is encouraged.