Interest and Beliefs About BRCA Genetic Counseling Among At-Risk Latinas in New York City

Background: Latinas are less likely to use genetic services (counseling and testing) for hereditary breast and/or ovarian cancer risk compared to other ethnic groups. Meanwhile, little is known about barriers to genetic counseling among Latinas at increased risk of inherited breast cancer. Methods: A two-phase pilot study was conducted to examine interest, barriers and beliefs about BRCA genetic counseling among at-risk Latinas in New York City and explore the potential for developing a culturally-tailored narrative educational tool for use in future studies. Phase 1 included quantitative telephone interviews (N = 15) with bilingual participants with a personal diagnosis at a young age and/or family history of breast and/or ovarian cancer. Quantitative results informed development of a narrative prototype educational presentation viewed by a subset of participants (N = 10) in Phase 2 focus groups. Results: Despite barriers, including lack of awareness/knowledge, concerns related to learning cancer risks of family members, and concerns about cost/health insurance, participants reported positive attitudes, beliefs and interest in learning about BRCA genetic counseling. Further, significant increases in knowledge were demonstrated from pre-post presentation (p = 0.04). Conclusion: There is an unmet need to educate at-risk Latinas about BRCA genetic counseling. Culturally-tailored educational materials including narratives may increase knowledge about BRCA genetic counseling among this underserved group. The effectiveness of these approaches should be tested in future research with larger samples.     

Death Anxiety in Cancer Survival: A Preliminary Cross-Validation Study

In an attempt to cross-validate the results with cancer survivors and to test its sensitivity to illness-related variables, the Death Anxiety Questionnaire (DAQ) was administered with measures of general anxiety, depression, somatization, and global psychological distress to 90 young adult men (60 Hodgkin's disease survivors, 30 testicular cancer survivors). There were no differences between groups on any of the dependent measures. Significant but weak to moderate intercorrelations confirmed that death anxiety is separate but related to general anxiety, depression, somatic distress, and global psychological distress. The DAQ was the most highly correlated with time elapsed since diagnosis, but no measure was significantly associated with extent of the disease at diagnosis (i.e., prognosis). Factor analysis of the DAQ provided confirmation of its multidimensionality and lent partial support to the presence of previously reported specific dimensions. The factor structure of the DAQ in cancer survivors may be different from that in the general population. Further study is needed to examine this aspect.     

Body image issues in women with breast cancer

Diagnosis and treatment of breast cancer affects women physically as well as psychologically. There are many obvious and real factors that are related to psychological distress in women coping with breast cancer, such as facing a life-threatening illness, painful and impairing treatments, and significant role changes. Although these factors are clearly important, issues related to body image in women faced with breast cancer can also add to psychological distress. Women, in general, are concerned with their appearance, their weight, and their body, with recent studies suggesting 89% of women reported concerns with weight. Such premorbid concerns are often deeply ingrained and can contribute to psychological distress in women treated for breast cancer. The present article is a summary of the literature that has examined body image issues and related psychological adjustment in women with breast cancer. Implications for clinical practice and recommendations for future investigations are discussed.     

Death anxiety in cancer survival: a preliminary cross-validation study

In an attempt to cross-validate the results with cancer survivors and to test its sensitivity to illness-related variables, the Death Anxiety Questionnaire (DAQ) was administered with measures of general anxiety, depression, somatization, and global psychological distress to 90 young adult men (60 Hodgkin's disease survivors, 30 testicular cancer survivors). There were no differences between groups on any of the dependent measures. Significant but weak to moderate intercorrelations confirmed that death anxiety is separate but related to general anxiety, depression, somatic distress, and global psychological distress. The DAQ was the most highly correlated with time elapsed since diagnosis, but no measure was significantly associated with extent of the disease at diagnosis (i.e., prognosis). Factor analysis of the DAQ provided confirmation of its multidimensionality and lent partial support to the presence of previously reported specific dimensions. The factor structure of the DAQ in cancer survivors may be different from that in the general population. Further study is needed to examine this aspect.     

Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

Latina breast cancer survivors' lived experiences: diagnosis, treatment, and beyond

Latina breast cancer survivors are not benefiting from advances in psychosocial interventions. Despite their greater breast cancer burden, there is a dearth of information about this population. This qualitative study examined the experiences of 18 immigrant Latina breast cancer survivors along the survivorship continuum, from diagnosis to long-term survivorship. The authors conducted separate focus groups with women in the acute, reentry, and long-term survivorship stages. Through grounded theory analysis, the authors uncovered 5 themes of experience: perceptions of psychological well-being, impact of diagnosis, impact of treatment, need for social support, and development of new attitudes. Some themes were applicable across all survivorship stages, whereas others were more salient at a particular stage. Within themes, the authors identified experiences reported in the general literature (i.e., the debilitating effect of chemotherapy) and distinct cultural experiences (i.e., fear that a cancer diagnosis leads to certain death). Results suggest that treatments tailored for each survivorship stage are more likely to be effective than generic interventions. These findings have the potential to lessen health disparities in utilization of psychosocial treatments by Latina breast cancer survivors.     

Randomised trial of expressive writing for distressed metastatic breast cancer patients

Women with metastatic breast cancer and significant psychological distress (N?=?87) were assigned randomly to engage in four home-based sessions of expressive writing or neutral writing. Women in the expressive writing group wrote about their deepest thoughts and feelings regarding their cancer, whereas women in the neutral writing group wrote about their daily activities in a factual manner. No statistically significant group differences in existential and psychological well-being, fatigue and sleep quality were found at 8-weeks post-writing. However, the expressive writing group reported significantly greater use of mental health services during the study than the neutral writing group (55% vs. 26%, respectively; p?<?0.05). Findings suggest that expressive writing may improve the uptake of mental health services among distressed cancer patients, but is not broadly effective as a psychotherapeutic intervention.     

Does a self management intervention lower distress in woman diagnosed with breast cancer?1

Psychological distress is particularly common with any cancer diagnosis. This paper examined the psychological distress in a cohort of women newly diagnosed with breast cancer and postulates on the underlying theory. A longitudinal study of a cohort of women (n = 147) diagnosed with breast cancer (within the past 1 year), was conducted at University Malaya Medical Centre, Kuala Lumpur. Data were collected at baseline and at post 4‐week intervention. Analysis of variance was conducted to examine for any significant differences in the change‐scores between the experimental group (n = 69) and the control group (n = 78). Using the change scores, analyses of variance showed significant differences between groups for stress, F(1, 140) = 13.68, p < .0001, anxiety F(1, 140) = 8.44, p < .004, and depression, F(1, 140) = 11.57, p < .0001. Levels of stress, anxiety and depression generally decreased significantly in the experimental groups, p < .05, but either maintained or increased in the control group. This study indicates that the level of psychological distress of women with breast cancer can be ameliorated with a 4‐week self‐management intervention. Lower stress levels were also found in women who reported engagement in higher physical activity than women with low physical activity.     

Healing Faith: A Qualitative Exploration of Latina Breast Cancer Survivors

Latina cancer survivors report higher levels of distress and depression and lower levels of social quality of life and overall health‐related quality of life when compared with all other cancer survivors. Cultural values influence cancer survivorship; however, little research to date has examined how aspects of the Latina culture may be healing during the cancer journey. Therefore, the purpose of this article is to present findings from a qualitative study exploring the influence of culture on quality of life for Latina breast cancer survivors. The authors use consensual qualitative research to understand the lived experiences of Latina breast cancer survivors.     

Randomised trial of expressive writing for distressed metastatic breast cancer patients

Women with metastatic breast cancer and significant psychological distress (N?=?87) were assigned randomly to engage in four home-based sessions of expressive writing or neutral writing. Women in the expressive writing group wrote about their deepest thoughts and feelings regarding their cancer, whereas women in the neutral writing group wrote about their daily activities in a factual manner. No statistically significant group differences in existential and psychological well-being, fatigue and sleep quality were found at 8-weeks post-writing. However, the expressive writing group reported significantly greater use of mental health services during the study than the neutral writing group (55% vs. 26%, respectively; p?相似文献   

Sinnorientierte Interventionen in der Psychoonkologie

Patients with advanced cancer often suffer from existential distress. Although a variety of effective psychotherapeutic interventions for the treatment of psychological distress in cancer patients are available, concerns such as hope and meaning of life are only occasionally at the center of therapeutic attention. During recent years growing efforts have been made to develop and evaluate meaning-based interventions for cancer patients, particularly in the Anglo-American research literature. Meaning-based interventions are often realized as group therapy approaches to reduce emotional and spiritual distress and to promote hope, courage and control, to mobilize internal resources and to discuss future goals despite a noticeable limited life expectancy. Further aims include strengthening a patient??s self-esteem and sense of dignity, to appreciate strengths and past achievements, to reduce feelings of isolation, to strengthen the relationship with the partner and family members and to improve communication with the professional healthcare team.     

What do Suicide Survivors Tell Us They Need? Results of a Pilot Study

Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.     

Aspiration Strain and Mental Health: The Education‐Contingent Role of Religion

This study examines whether dimensions of religious involvement (i.e., perceived divine control, private religious practices, and religious social integration) buffer associations between aspiration strain and mental health outcomes (i.e., psychological distress, loneliness, and optimism). We also test three‐way interactions to determine whether the stress‐buffering effects of religious involvement are amplified among undereducated persons. We test our hypotheses with cross‐sectional survey data from Vanderbilt University's Nashville Stress and Health Study (2011–2014), a probability sample of non‐Hispanic white and black adults from Davidson County, Tennessee (n = 1,252). Results from multivariate regression models confirmed: (1) aspiration strain was positively associated with psychological distress and loneliness, and negatively associated with optimism; and (2) religious involvement attenuated these associations, but only for respondents with less than or equal to a high school education. We discuss the implications and limitations of our findings and outline avenues for future research.     

The effects of torture‐related stressors on long‐term complex post‐traumatic symptoms in South Korean torture survivors

This study explored whether perceived distress from specific stressors during and after torture explain long‐term complex post‐traumatic symptoms of South Korean torture survivors. We conducted a cross‐sectional survey of survivors who had been tortured by the homeland regime from the 1970s to the 2000s. Data from 206 survivors were gathered by key informants using target sampling and snowballing techniques. Project staff designed scales to encompass the specific types of stressors related to torture techniques used in Korea. Frequencies and distress ratings of exposure to torture, post‐torture psychosocial stressors and physical damage related to torture were gathered. Psychological symptoms were assessed by the Impact of Event Scale‐Revised‐Korean version and subscales of the Symptom Checklist 90‐Revised‐Korean version. Perceived distress from torture stressors was mainly divided into factors representing physical, psychological and deprivation torture by adapting a principal axis factor analysis. Hierarchical regression analyses showed that distress from psychological torture explained post‐traumatic stress disorder (PTSD) and that distress from deprivation explained PTSD and anxiety after controlling for demographic variables, psychological preparedness, time span since torture and distress from trauma other than torture. Among post‐torture stressors, distress from physical damage related to torture and social exclusion were strong indicators of complex symptoms.     

The worm at the core: A terror management perspective on the roots of psychological dysfunction

A growing body of research derived from terror management theory [e.g., Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). A terror management theory of social behavior: The psychological functions of self-esteem and cultural worldviews. In M. P. Zanna (Ed.), Advances in experimental social psychology: vol. 24 (pp. 93–159). New York: Academic Press] suggests that the human struggle with the awareness of inevitable death can greatly impact people's physical and psychological well-being. The current article reviews converging lines of research that investigate the role of terror management processes in physical and mental health. Specifically, we present research that elucidates the role of death concerns in (1) conscious threat-focused defenses, (2) self-esteem striving, (3) depression, (4) anxiety disorders, (5) discomfort with the physicality of the body and (6) neuroticism. We conclude that terror management theory builds upon the work of other existential scholars and mental health perspectives to provide a broad conceptual and empirically based account of how deeply rooted existential fears manifest in ways that prove both psychologically and physically problematic. We also suggest how future research and social interventions can be employed to help individuals manage basic fears in ways that do not compromise their psychological and physical health.     

Individual Characteristics and Self-Perceived Burden in Cancer Patients

Past research on self-perceived burden (SPB) has primarily focused on palliative care cancer patients with the scope of the research concentrating on explanations of the construct and identification of correlated variables, such as psychological distress. Little is known, however, about individual differences and how they may contribute to the experience of SPB. This quantitative study was designed to investigate the relationship between SPB and autonomy, environmental mastery, and resiliency, as well as the occurrence of SPB in cancer patients with varying prognoses. Using a cross-sectional survey method, 61 cancer patients were recruited from three regional cancer centers in Central and Southwest Virginia. The findings revealed autonomy and environmental mastery to statistically significantly predict a small amount of variance in SPB scores R ²?=?0.12, adjusted R ²?=?0.09, F (2, 54)?=?3.61, p?<?0.05. Resilience did not prove to predict SPB. Findings also revealed SPB to be a relatively common occurrence in cancer patient with varying prognoses. The results also demonstrate that cancer patients with varying prognoses are impacted by self-perceived burden increasing their risk of physical, psychological, and existential distress.     

Psychological distress and subjective well‐being in partners of somatically ill or physically disabled: The Nord‐Trøndelag Health Study

Borren, I., Tambs, K., Idstad, M., Ask, H. & Sundet, J. M. (2012). Psychological distress and subjective well‐being in partners of somatically ill or physically disabled: The Nord‐Trøndelag Health Study. Scandinavian Journal of Psychology 53, 475–482. This study investigated the cross‐sectional associations between various somatic conditions in one partner and the level of distress and well‐being in the spouse. The study is based on survey data from the Norwegian Nord‐Trøndelag Health Study, HUNT II (1995–1997). A sample of 9,797 married or cohabiting couples with valid data on subjective well‐being (SWB), psychological distress (Hopkins Symptom Check List (SCL)‐10) and somatic illness were identified. Regression analyses stratified by sex were conducted with SCL‐10 and SWB scores as dependent variables and a joint somatic score as predictor, including; stroke, cancer, angina, myocardial infarction and physical disability (PD). The contribution of each somatic condition was also explored. Spouses of persons previously diagnosed with at least one somatic condition scored significantly lower on SWB and significantly higher on SCL‐10 than spouses of healthy persons, though effect sizes were small. The effect seems to be at least partly mediated by the ill partner’s psychological distress. Of the specific conditions, PD had the most significant contribution for both genders, though an association between male angina and spousal distress/SWB was also demonstrated.     

Alleviation of Side Effects and Distress in Breast Cancer Patients by Cognitive-Behavioral Interventions: A Systematic Review and Meta-analysis

Cognitive and behavioral interventions (CBI) have been used for breast cancer patients with various stages of the disease or undergoing different treatments. However, no quantitative review has summarized their efficacy on the side effects of treatment, distress, and quality of life in the acute treatment setting after diagnosis. This meta-analysis synthesizes data from 19 randomized clinical trials in order to: (a) provide an estimation of overall effect of CBI in breast cancer patients during treatment for breast cancer, i.e., neo-adjuvant and adjuvant treatment; (b) provide average effect sizes on side effects of treatment, distress, and quality of life; and (c) test possible moderators of effect size. The results show that CBI yielded a small effect size overall, specifically on general side effects of treatment, nausea, vomiting, distress, and quality of life. Individual and behavioral interventions seem to elicit better results on distress and on general side effects of treatment, respectively. While more studies are needed with regard to specific side effects (i.e., fatigue, pain, and sleep disturbance), the overall results clearly support the use of CBI in breast cancer patients during treatment.     

Religious Coping and Psychological Distress in Military Veteran Cancer Survivors

Research on the relationship between religious coping and psychological well-being in cancer survivors is limited. Forty-eight veteran cancer survivors completed measures of psychological distress, posttraumatic growth, and positive and negative religious coping. Negative religious coping was associated with greater distress and growth. Positive religious coping was associated with greater growth. Gender, race, and religious affiliation were significant predictors of positive and negative religious coping. Veteran cancer survivors who utilize negative religious coping may benefit from referral to clergy or a mental health professional. Assessment of religious coping may be particularly important for female, non-White, and Christian cancer survivors.     

A Moral‐Existential Account of the Psychological Factors Fostering Intergroup Conflict

We combine ideas from terror management and moral foundations theories to analyze the role of existential and moral concerns in the creation and escalation of intergroup conflict. We argue that moral values, as important components of cultural worldviews, serve to buffer existential anxiety. Perceived threats to one’s moral values thus are capable of inducing existential anxiety and unleashing strong moral emotions, creating the psychological impetus for intergroup conflict and violence. We review evidence that threats to the five core moral intuitions posited by moral foundations theory (harm/care, fairness/reciprocity, ingroup/loyalty, authority/respect, and purity/ sanctity) are associated with existential anxiety and that this contributes to intergroup strife and violence. Moral and existential concerns combine to create a vicious feedback loop that leads to self‐perpetuating spirals of violence, which helps explain the intractability of many real‐life conflicts.