Affective disorders and Health-Related Quality of Life (HRQoL) in adolescents and young adults with Multiple Sclerosis (MS): the moderating role of resilience

Purpose

To investigate the moderating role of resilience in the relationship between affective disorders and Health-Related Quality of Life (HRQoL) for adolescents and young adults with multiple sclerosis (MS).

Methods

A quantitative methodology was adopted. Fifty-three adolescents and young adults were interviewed to assess resilience as a personality trait (Ego-Resiliency Scale) and resilience as an interactive competence (CYRM-28), Health-Related Quality of Life (PedsQL 4.0), depression and anxiety (BDI-II and STAI-Y).

Results

Affective disorders, both depression (β = ?.38, p < .001) and anxiety (State β = –.35, p < .001; Trait β = ?.41, p < .001), were negatively associated with HRQoL. Data also showed that the resilience competencies using Individual (β = .22, p < .001) and relational resources (β = .12, p < .05) are significantly associated HRQoL. According to the regression analyses, we tested the moderating role of resilience competence using individual resources on the relationship between the Depression Cognitive Factor and Emotional Functioning. Data show that in step 2 of the regression analysis, we obtained a variation of β = ?.45 (p < .001) to β = ?.30 (p < .001) in the dimension for the Depression Cognitive Factor. The Sobel test showed that the moderating effect of resilience was significant regarding the increase in R² (p < .01).

Conclusions

Resilience competence using individual resources moderates the relationship between the Depression Cognitive Factor and Emotional Functioning in adolescents with MS. Our study suggests that to improve well-being for adolescents with MS resilience could play a key role.

     

The association between social network factors and mental health at different life stages

Objectives

Psychosocial factors are important determinants of an individual’s health. This study examines the association between health scores and social network factors on mental health across different life stages.

Methods

Data were drawn from the Household Income and Labour Dynamics in Australia survey for adolescents (n = 1739), adults (n = 10,309) and seniors (n = 2287). Hierarchical regression modelling was applied to examine effects within and across age groups. All the variables were derived from the self-completion questionnaire.

Results

The social network factors were statistically significant predictors of mental health outcomes for all three life stages. For adolescents, the three social network factors were statistically significant with social isolation having the largest impact (β = ?.284, p < .001), followed by social connection (β = .084, p < .001) and social trust having a similar effect (β = .073, p < .001). For adults social isolation had the highest impact (β = ?.203, p < .001), followed by social connection (β = .110, p < .001) and social trust (β = .087, p < .001).The results for seniors were social isolation (β = ?.188, p < .001), social connection (β = .147, p < .001) and social trust (β = .032, p < .05).

Conclusions

After adding the social network factors, the models improved significantly with social isolation playing the most significant role across all life stages, whereas the other social network factors played a differentiated role depending upon the life stage. These findings have practical implications in the design of mental health interventions across different life stages.

     

In-person and online social participation and emotional health in individuals with multiple sclerosis

Purpose

Individuals with multiple sclerosis (MS) sometimes have barriers to social participation. The advent of the internet has created online support systems for social participation such as websites for individuals with MS. However, minimal research has been conducted about determinants of individuals’ in-person and online social participation or how types of social participation contribute to emotional well-being. The present study aims are: (1) to assess the role of access to resources and other determinants as enabling in-person and online social participation, and (2) to analyze the association between social participation and emotional health of individuals with MS.

Methods

The sample consisted of 508 individuals diagnosed with relapsing/remitting or secondary/progressive MS. Data from NARCOMS registry and data from original questionnaire on determinants of social participation and emotional health were merged. Logistic and linear regression analyses were performed.

Results

Individuals with access to the internet were more likely to participate online with friends (OR 5.47, p < .001) and the community (OR 47.7, p < .001). Individuals who regularly participate in in-person social participation with friends reported being happier (B = .38, p < .001), less depressed (B = ?2.01, p < .001), and less anxious (B = ?1.21, p < .001) than those who did not. However, there was no evidence of a relationship between emotional health and online social participation.

Conclusion

Increasing access to in-person social participation with friends will likely have the most positive impact on emotional health. Future research should examine the aspects of online participation that are helpful or harmful.

     

Assessing Spatial Relationships between Race,Inequality, Crime,and Gonorrhea and Chlamydia in the United States

Incidence rates of chlamydia and gonorrhea reached unprecedented levels in 2015 and are concentrated in southern counties of the USA. Using incidence data from the Center for Disease Control, Moran’s I analyses assessed the data for statistically significant clusters of chlamydia and gonorrhea at the county level in 46 states of the USA. Lagrange multiplier diagnostics justified selection of the spatial Durbin regression model for chlamydia and the spatial error model for gonorrhea. Rates of chlamydia (Moran’s I = .37, p < .001) and gonorrhea (Moran’s I = .38, p < .001) were highly clustered particularly in the southern region of the USA. Logged percent in poverty (B = .49, p < .001 and B = .48, p < .001) and racial composition of African-Americans (B = .16, p < .001 and B = .40, p < .001); Native Americans (B = .12, p < .001 and B = .20, p < .001); and Asians (B = .14, p < .001 and B = .09, p < .001) were significantly associated with greater rates of chlamydia and gonorrhea, respectively, after accounting for spatial dependence in the data. Logged rates of rates violent crimes were associated with chlamydia (B = .053, p < .001) and gonorrhea (B = .10, p < .001). Logged rates of drug crimes (.052, p < .001) were only associated with chlamydia. Metropolitan census designation was associated with logged rates of chlamydia (B = .12, p < .001) and gonorrhea (B = .24, p < .001). Spatial heterogeneity in the distribution of rates of chlamydia and gonorrhea provide important insights for strategic public health interventions in the USA and inform the allocation of limited resources for the prevention of chlamydia and gonorrhea.     

Asymmetric responsiveness of disability and health-related quality of life to improvement versus decline in Parkinson’s disease

Purpose

Clinical trials in Parkinson’s disease commonly employ outcome measures of disability and quality of life. Responsiveness of these outcomes measures to symptomatic decline versus improvement has not been studied. We wanted to study the responsiveness of Schwab & England Activities of Daily Living Scale (SE) and Short Form-12 (SF-12) to symptomatic decline versus improvement in Parkinson’s disease over a 4-year period among a naturalistic cohort of patients.

Methods

Parkinson’s disease patients (N = 228, disease duration 6.1 years) were followed for 4 years with assessments of disease severity, Unified Parkinson’s Disease Rating Scale (UPDRS), health-related quality of life (SF-12 physical/mental health), and disability (SE). The sample was subdivided into those who declined (N = 118) or improved (N = 102) on total-UPDRS. Responsiveness was assessed with Cohen’s effect size and standardized response mean.

Results

At baseline, patients who improved over 4 years had greater disease severity and worse quality of life than decliners (p < .05). Decliners had a 13.5-point worsening on total-UPDRS, 26.3–39.8; p < .001) associated with concomitant decline on the SF-12 (physical health 42.9–39.2, mental health 50.0–46.6; both p < .001) and the SE (85–74 %; p < .001). Improvers had a 13.0-point improvement on total-UPDRS (39.8–26.8; p < .001) associated with minimal change on the SF-12 (physical health 40.8–39.5, mental health 47.1–46.3) and SE (79–79 %). Based on effect size, the rank order of responsiveness of measures for decliners from high to low was SE (?0.78), Short Form-12 mental health (?0.45), and SF-12 physical health (?0.34). Rank order of responsiveness for improvers was Short Form-12 physical health (?0.11), SF-12 mental health (?0.10), and SE (?0.03).

Conclusions

Among decliners, measures of disability and quality of life were moderate to highly responsive to change in disease severity. Among improvers, both disability and quality of life were poorly responsive despite UPDRS improvement of comparable magnitude.

     

Health-related quality of life in multiple sclerosis: role of cognitive appraisals of self,illness and treatment

Purpose

Health-related quality of life (HRQoL) is considered an important measure of treatment and rehabilitation outcomes in multiple sclerosis (MS) patients. In this study, we used multivariate regression analysis to examine the role of cognitive appraisals, adjusted for clinical, socioeconomic and demographic variables, as correlates of HRQoL in MS.

Methods

The cross-sectional study included 257 MS patients, who completed Multiple Sclerosis Impact Scale, Generalized Self-Efficacy Scale, Rosenberg Self-Esteem Scale, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Actually Received Support Scale (a part of Berlin Social Support Scale) and Socioeconomic Resources Scale. Demographic and clinical characteristics of the participants were collected with a self-report survey. Correlation and regression analyses were conducted to determine associations between the variables.

Results

Five variables, illness identity (β = 0.29, p ≤ 0.001), self-esteem (β = ?0.22, p ≤ 0.001), general self-efficacy (β = ?0.21, p ≤ 0.001), disability subgroup “EDSS” (β = 0.14, p = 0.006) and age (β = 0.12, p = 0.012), were significant correlates of HRQoL in MS. These variables explained 46 % of variance in the dependent variable. Moreover, we identified correlates of physical and psychological dimensions of HRQoL.

Conclusions

Cognitive appraisals, such as general self-efficacy, self-esteem and illness perception, are more salient correlates of HRQoL than social support, socioeconomic resources and clinical characteristics, such as type and duration of MS. Therefore, interventions aimed at cognitive appraisals may also improve HRQoL of MS patients.

     

Evaluation of bone mineral density and 25-hydroxyvitamin D levels in subjects with silica exposure

Objective

The purpose of the study was to evaluate the bone mineral density (BMD) and 25-hydroxyvitamin D (25(OH)D) levels in patients with silica exposure.

Materials and methods

The study included 104 male subjects with silica exposure and 36 healthy subjects. Posterior–anterior radiographs were classified according to the International Labour Office (ILO) Classification. Category 0 patients were classified as Group I (n = 54), category I patients were classified as Group II (n = 25), Category II and III patients were classified as Group III (n = 25).

Results

Femoral neck BMD values were significantly lower in Group III (p = 0.007). Lumbar vertebrae BMD values were significantly lower in all groups with silica exposure than in the control group (p = 0.000). The osteoporosis rate was significantly higher in Group III (p = 0.000). Subjects with silica exposure were determined to have diminished 25(OH)D levels (p = 0.012).

Conclusion

The results of this study demonstrated that subjects with silica exposure have diminished BMD and 25(OH)D levels.

     

Quality of life in patients with a permanent stoma after rectal cancer surgery

Aim

Health-related quality of life (HRQoL) assessment is important in understanding the patient’s perspective and for decision-making in health care. HRQoL is often impaired in patients with stoma. The aim was to evaluate HRQoL in rectal cancer patients with permanent stoma compared to patients without stoma.

Methods

711 patients operated for rectal cancer with abdomino-perineal resection or Hartman’s procedure and a control group (n = 275) operated with anterior resection were eligible. Four QoL questionnaires were sent by mail. Comparisons of mean values between groups were made by Student´s independent t test. Comparison was made to a Swedish background population.

Results

336 patients with a stoma and 117 without stoma replied (453/986; 46 %). A bulging or a hernia around the stoma was present in 31.5 %. Operation due to parastomal hernia had been performed in 11.7 % in the stoma group. Mental health (p = 0.007), body image (p < 0.001), and physical (p = 0.016) and emotional function (p = 0.003) were inferior in patients with stoma. Fatigue (p = 0.019) and loss of appetite (p = 0.027) were also more prominent in the stoma group. Sexual function was impaired in the non-stoma group (p = 0.034). However in the stoma group, patients with a bulge/hernia had more sexual problems (p = 0.004). Pain was associated with bulge/hernia (p < 0.001) and fear for leakage decreased QoL (p < 0.001). HRQoL was impaired compared to the Swedish background population.

Conclusion

Overall HRQoL in patients operated for rectal cancer with permanent stoma was inferior compared to patients without stoma. In the stoma group, a bulge or a hernia around the stoma further impaired HRQoL.

     

Neonatal treatment philosophy in Dutch and German NICUs: health-related quality of life in adulthood of VP/VLBW infants

Purpose

Although survival after very preterm birth (VP)/very low birth weight (VLBW) has improved, a significant number of VP/VLBW individuals develop physical and cognitive problems during their life course that may affect their health-related quality of life (HRQoL). We compared HRQoL in VP/VLBW cohorts from two countries: The Netherlands (n = 314) versus Germany (n = 260) and examined whether different neonatal treatment and rates of disability affect HRQoL in adulthood.

Method

To analyse whether cohorts differed in adult HRQoL, linear regression analyses were performed for three HRQoL outcomes assessed with the Health Utilities Index 3 (HUI3), the London Handicap Scale (LHS), and the WHO Quality of Life instrument (WHOQOL-BREF). Stepwise hierarchical linear regression was used to test whether neonatal physical health and treatment, social environment, and intelligence (IQ) were related to VP/VLBW adults’ HRQoL and cohort differences.

Results

Dutch VP/VLBW adults reported a significantly higher HRQoL on all three general HRQoL measures than German VP/VLBW adults (HUI3: .86 vs .83, p = .036; LHS: .93 vs. .90, p = .018; WHOQOL-BREF: 82.8 vs. 78.3, p < .001). Main predictor of cohort differences in all three HRQoL measures was adult IQ (p < .001).

Conclusions

Lower HRQoL in German versus Dutch adults was related to more cognitive impairment in German adults. Due to different policies, German VP/VLBW infants received more intensive treatment that may have affected their cognitive development. Our findings stress the importance of examining effects of different neonatal treatment policies for VP/VLBW adults’ life.

     

The role of mindfulness in distress and quality of life for men with advanced prostate cancer

Objective

To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer.

Patients and methods

A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40–91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes.

Results

Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months.Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001).Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress was also related to higher non-reactivity to inner experience and a lower level of observing (p < 0.05).

Conclusions

Men with advanced prostate cancer are at risk of poor psychological outcomes. Psychological flexibility may be a promising target for interventions to improve adjustment outcomes in this patient group.

Clinical Trial Registry

Trial Registration: ACTRN12612000306819

     

Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients’ relatives: a multilevel analysis

Objective

The objective of the present investigation was to examine the association of mindful creativity with the trajectory of recovery (emotional, interpersonal, cognitive, and total functioning) of patients with severe TBI.

Methods

This was drawn from a subsample of an adult prospective cohort study on severe TBI in Switzerland; patients and their relatives were assessed at 3, 6, and 12 months (patients N = 176, relatives N = 176). Predictor measures were assessed using Mindful Creativity Scale—short form and time (trajectory of functioning of the patient over time). Outcome measures were assessed using Patient Competency Rating Scale for Neuro-rehabilitation (PCRS-NR; measuring emotional, interpersonal, cognitive, and total functioning post-injury). All measures were assessed at each time point. Mixed linear models were run separately for ages >50 and ≤50 (i.e., bimodal distribution).

Results

Patients’ mindful creativity showed no significant association with patients’ functioning across time in any of the models. In all age groups, interpersonal functioning decreased across time (slope_>50 = ?4.66, p = .037; slope_≤50 = ?7.19, p = .007). Interestingly, in age group ≤50, interpersonal functioning increased when looking at relative mindful creativity by time (slope = 1.69, p = .005). Additionally, relatives mindful creativity was significantly associated with patients’ functioning in age group ≤50: (a) patients’ total functioning (slope = 0.18, p = .03) and (b) cognitive functioning (slope = 0.72, p = .020).

Conclusions

Relatives’ mindful creativity was significantly associated with patients’ functioning after severe TBI. Implications for treatment and future research are discussed.

     

Phenotypic and molecular characteristics associated with various domains of quality of life in oncology patients and their family caregivers

Purpose

Not all oncology patients and their family caregivers (FCs) experience the same quality of life (QOL). The purposes of this study were to identify latent classes of oncology patients (n = 168) and their FCs (n = 85) with distinct physical, psychological, social, and spiritual well-being trajectories from prior to through 4 months after the completion of radiation therapy and to evaluate for demographic, clinical, and genetic characteristics that distinguished between these latent classes.

Methods

Using growth mixture modeling, two latent classes were found for three (i.e., physical, psychological, and social well-being) of the four QOL domains evaluated.

Results

Across these three domains, the largest percentage of participants reported relatively high well-being scores across the 6 months of the study. Across these three QOL domains, patients and FCs who were younger, female, belonged to an ethnic minority group, had children at home, had multiple comorbid conditions, or had a lower functional status, were more likely to be classified in the lower QOL class. The social well-being domain was the only domain that had a polymorphism in nuclear factor kappa beta 2 (NFKB2) associated with latent class membership. Carrying one or two doses of the rare allele for rs7897947 was associated with a 54 % decrease in the odds of belonging to the lower social well-being class [OR (95 % CI) = .46 (.21, .99), p = .049].

Conclusions

These findings suggest that a number of phenotypic and molecular characteristics contribute to differences in QOL in oncology patients and their FCs.

     

Physical job demands and related health complaints among surgeons

Purpose

Surgeons’ poor physical health and high physical job demands might threaten good quality of care. We aimed to compare the prevalence of physical complaints of surgeons, their physical work ability and the physical job demands of surgeons with that of other hospital physicians.

Methods

All medical doctors (n = 958) of one academic medical center were invited to complete the online questionnaire to assess the physical work ability and the prevalence of regional musculoskeletal complaints. A purposive sample of 44 surgeons and 82 other hospital physicians were systematically observed during work to quantify the physical job demands for an average working day.

Results

More surgeons found their work to be physically strenuous (41 vs. 13 %, p < .000) and more were bothered by working in uncomfortable or exhausting postures (73 vs. 27 %, p < .001). Both groups reported that most of their physical complaints were in the neck (39 and 32 %) and arm regions (36 and 27 %). The majority of surgeons (86 %) and other hospital physicians (79 %) experienced difficulties coping with their job demands because of their physical state once a month or less. Compared with other hospital physicians, surgeons stand longer (4 vs. 3 h, p = .004) and perform fine repetitive movements longer (80 vs. 3 min, p < .001) during an average working day.

Conclusions

Exposure to several physical job demands that are perceived as uncomfortable and exhausting and the presence of physical health complaints reduce surgeons’ work functioning.

     

Dutch normative data and psychometric properties for the Distress Thermometer for Parents

Purpose

The aim of this study was to provide Dutch normative data for the Distress Thermometer for Parents (DT-P) and to assess internal consistency and known-groups validity.

Methods

A sample of 1421 parents (60.7 % mothers), representative of the Dutch population, completed online sociodemographic questionnaire and the DT-P, which includes a thermometer (0 (no distress) to 10 (extreme distress), ≥4 clinically elevated distress) and everyday problems across six problem domains (practical, social, emotional, physical, cognitive, and parenting). Internal consistency was calculated using Cronbach’s alphas. Known-groups validity was assessed by comparing parents of a child with a chronic condition (N = 287, 20.2 %) with parents of healthy children, using Mann–Whitney U tests and Chi-square tests.

Results

The DT-P showed acceptable internal consistency (Cronbach’s alphas = .52–.89). Parents of a child with a chronic condition more often reported clinically elevated distress than parents of healthy children (53.0 versus 38.2 %, p < .001). Also, on all domains they reported more problems (p = .000–.022). Normative scores for mothers and fathers separately were provided.

Conclusion

The DT-P distinguishes well between parents of a child with and without a chronic condition. With the current norms available, distress can be evaluated in parents of a child with a chronic condition compared to parents of healthy children in pediatric clinical practice.

     

Using Electronic Health Record Alerts to Increase Safety Planning with Youth At-Risk for Suicide: A Non-randomized Trial

Background

No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide.

Objective

This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community.

Methods

An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation.

Results

There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p < .01). The pattern of results remained the same after adjusting for demographic variables (p = .01). Forty clinicians also completed a questionnaire assessing their satisfaction with the EHR alert, indicating moderate satisfaction (M = 3.01; SD = 0.63; range = 1.11–4.11).

Conclusions

EHR alerts are associated with changes in clinicians’ behavior and improved compliance with best clinical practices for at-risk youth.

     

Maximal tachycardia and high cardiac strain during night shifts of emergency physicians

Purpose

To compare tachycardia and cardiac strain between 24-hour shifts (24hS) and 14-hour night shifts (14hS) in emergency physicians (EPs), and to investigate key factors influencing tachycardia and cardiac strain.

Methods

We monitored heart rate (HR) with Holter-ECG in a shift-randomized trial comparing a 24hS, a 14hS, and a control day, within a potential for 19 EPs. We also measured 24-h HR the third day (D3) after both shifts. We measured perceived stress by visual analog scale and the number of life-and-death emergencies.

Results

The 17 EPs completing the whole protocol reached maximal HR (180.9?±?6.9 bpm) during both shifts. Minutes of tachycardia?>100 bpm were higher in 24hS (208.3?±?63.8) than in any other days (14hS: 142.3?±?36.9; D3/14hS: 64.8?±?31.4; D3/24hS: 57.6?±?19.1; control day: 39.2?±?11.6 min, p?<?.05). Shifts induced a cardiac strain twice higher than in days not involving patients contact. Each life-and-death emergency enhanced 26 min of tachycardia?≥100 bpm (p?<?.001), 7 min?≥?110 bpm (p?<?.001), 2 min?≥?120 bpm (p?<?.001) and 19 min of cardiac strain?≥30% (p?=?.014). Stress was associated with greater duration of tachycardia?≥100, 110 and 120 bpm, and of cardiac strain?≥30% (p?<?.001).

Conclusion

We demonstrated several incidences of maximal HR during shifts combined with a high cardiac strain. Duration of tachycardia were the highest in 24hS and lasted several hours. Such values are comparable to those of workers exposed to high physical demanding tasks or heat. Therefore, we suggest that EPs limit their exposure to 24hS. We, furthermore, demonstrated benefits of HR monitoring for identifying stressful events. ClinicalTrials.gov identifier: NCT01874704.

     

Testing a model of health-related quality of life in women living with HIV infection

Purpose

The purpose of this secondary analysis was to test Ferrans et al.’s (J Nurs Scholarsh 37(4):336–342, 2005) revised model of health-related quality of life (HRQoL) (2005) modified from the Wilson and Cleary (J Am Med Assoc 273(1):59–65, 1995) model on women living with HIV. The primary aim was to test this model, examining the relations among the five central components (biological function, symptoms, functional status, general health perceptions, and HRQoL). The secondary aim was to explore the individual (age, children, race, marital status, education) and environmental (HIV-related stigma, social support) characteristics that may impact the main components of the model.

Methods

This study employed a cross-sectional correlational design using baseline data from 178 women living with HIV/AIDS who participated in one of the two independent randomized controlled trials designed to enhance HIV medication adherence. Path analysis using structural equation modeling was used to examine the hypothesized multivariate relations proposed in the revised Wilson and Cleary (J Am Med Assoc 273(1):59–65, 1995) model of HRQoL.

Results

While the revised model did not fit, exploratory post hoc modified models with a path from depressive symptoms to overall general health had an adequate model fit. Women with lower depressive symptoms (r = ?.457, p < .01), lower HIV-related stigma (r = ?.462, p < .01), higher social support (r = .413, p < .01), higher physical functioning (r = .350, p < .01), and higher general health perceptions (r = .537, p < .01) had higher overall HRQoL.

Conclusions

The results of this study have the potential to assist healthcare professionals in improving HRQoL for women living with HIV/AIDS.

     

Acculturation matters in the relation between ambivalence over emotional expressions and well-being among Chinese American breast cancer survivors

Purpose

Ambivalence over emotional expression (AEE) is the inner conflict of desiring emotion expression and fearing consequence of emotion expression. Few studies to date have examined the effects of AEE within an ethnic group that prioritizes emotional self-control. The present study examined the associations between AEE and well-being (viz., quality of life and depressive symptoms) as a function of acculturation among a sample of Chinese American breast cancer survivors.

Methods

Ninety-six Chinese breast cancer survivors (M _age = 54.64 years old, SD = 7.98) were recruited from Southern California. Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-Breast (FACT-B), and the Center for Epidemiologic Studies Depression Scale—Short Form (CESD-10).

Results

Acculturation was a statistically significant moderator of the relations between AEE and depressive symptoms, and a statistically marginally significant moderator of the relations between AEE and quality of life. Simple slopes revealed that AEE was negatively associated with quality of life (B = ?.45, p < .001) and depressive symptoms (B = .20, p < .001) for women with high acculturation, but not associated for women with low acculturation (Bs = ?.15 and .04, ps > .05, for quality of life and depressive symptoms, respectively).

Conclusions

These results suggest that less acculturated Chinese breast cancer survivors are protected by Chinese cultural values of emotional self-control and restraint, and thus do not experience the detrimental effects of AEE on their depressive symptoms and quality of life. Implications are discussed.

     

Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease

Purpose

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD).

Methods

In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4 weeks, and 130 at 4 months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George’s Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed.

Results

At 4 weeks and 4 months, changes in disease-specific QOL (st. β = –0.35, p < 0.001, partial (p) R ² = 11–12 %), depression (st. β = –0.32 to –0.36, p < 0.001, pR ² = 9–12 %), and anxiety (st. β = –0.21 to –0.40, p < 0.02–0.001, pR ² = 4–15 %) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4 months (st. β = 0.21, p = 0.02, pR ² = 4 %), but not with changes in depression.

Conclusions

Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.