A longitudinal study of psychosocial distress in breast cancer: Prevalence and risk factors

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

Intimacy motivation and psychosocial adjustment: a longitudinal study

Longitudinal data of 57 middle-aged men from the Grant Study Adult Development were analyzed in terms of nine indices of psychosocial adjustment and four social motives: achievement, power, affiliation, and intimacy motivation. The Thematic Apperception Test (TAT), administered in 1950-52, was scored for the four motives. Psychosocial adjustment, determined by ratings made primarily with reference to life history data gathered between 1950 and 1967, was comprised of scores on income level, occupational promotion, occupational enjoyment, days of sick leave, marital enjoyment, regular vacations, pastimes with friends, drug or alcohol misuse, and psychiatric visits. High intimacy motivation at age 30 was significantly associated with better adjustment 17 years later. The results are discussed in terms of contemporary theories of psychosocial adaptation.     

Adolescent suicide risk: four psychosocial factors

Suicide is a leading cause of death among adolescents. This study examined the suicidal ideation, behavior, and attempt history of 100 adolescents ages seventeen to nineteen. Four psychosocial factors were found to be important for overall suicide risk: hopelessness, hostility, negative self-concept, and isolation. It is suggested that focusing on these four psychosocial factors would enhance suicide assessment and prevention efforts with adolescents.     

Assessing the relationship of Type A beliefs to cardiovascular disease risk and psychosocial distress

Investigators have begun to take a multimodal approach to the assessment and treatment of psychosocial risk factors for cardiovascular disease (CVD). For instance, cognitive responses have become the focus of contemporary research along with continued examination of overt Type A behaviors. Price (1982) has outlined a set of beliefs purportedly associated with Type A behavior and subsequent CVD risk. The current study examines the validity of this belief set as represented by a newly developed measure, the Type A Cognitive Questionnaire (TACQ). Subjects were 221 employed adults participating in a worksite CVD risk reduction program. They completed the TACQ as part of a pretreatment CVD risk screening protocol. As hypothesized, TACQ scores were significantly associated with Type A behavior, hostility, physiological mediators of CVD, and psychosocial distress. Discussion addresses continued refinement of the Type A belief construct.     

Pathways for psychological adjustment in breast cancer: A longitudinal study on coping strategies and posttraumatic growth

This longitudinal study examined the role of coping strategies and posttraumatic growth (PTG) on the psychological adjustment to breast cancer trajectory. The participants were 50 women assessed at the time of surgery (T1), during adjuvant treatment (T2) and six months after the end of treatment (T3). Women completed questionnaires assessing coping strategies, PTG and psychological adjustment (psychological quality of life, anxiety and depression). Results showed that the greatest impact of breast cancer on women's adjustment occurred at T1, when patients were significantly more anxious than in the other phases of the disease. The type of surgery and adjuvant treatment did not account for the course of PTG and adjustment. Coping through seeking social support and using cognitive strategies at T1 were linked to psychological quality of life and depression at T3 via PTG dimension of personal resources and skills at T2. Findings emphasise the value of promoting adaptive coping strategies and PTG in order to improve psychological adjustment in breast cancer patients.     

Pathways for psychological adjustment in breast cancer: A longitudinal study on coping strategies and posttraumatic growth

This longitudinal study examined the role of coping strategies and posttraumatic growth (PTG) on the psychological adjustment to breast cancer trajectory. The participants were 50 women assessed at the time of surgery (T1), during adjuvant treatment (T2) and six months after the end of treatment (T3). Women completed questionnaires assessing coping strategies, PTG and psychological adjustment (psychological quality of life, anxiety and depression). Results showed that the greatest impact of breast cancer on women's adjustment occurred at T1, when patients were significantly more anxious than in the other phases of the disease. The type of surgery and adjuvant treatment did not account for the course of PTG and adjustment. Coping through seeking social support and using cognitive strategies at T1 were linked to psychological quality of life and depression at T3 via PTG dimension of personal resources and skills at T2. Findings emphasise the value of promoting adaptive coping strategies and PTG in order to improve psychological adjustment in breast cancer patients.     

Attention and reaction to distress in infancy: a longitudinal study

The primary aim of this study was to verify whether early individual differences in look duration are related to general mechanisms of the infant nervous system that draw together attention and emotion. Thirty-one infants were observed at 3, 5, and 11 months of age. Facial expressions of pain and distress were observed by means of C. Izard's (1979) Maximally Discriminative Facial Movement Coding System 90 s after routine pediatric vaccinations. Several measures of visual attention were taken experimentally in a separate testing session. Significant correlations between measures of attention and duration of facial expressions of pain and distress were found at each age level. Infants who showed pain or distress for a shorter time period also paid attention for a shorter time period and vice versa. The main conclusion is that individual differences combining control of both pain and attention can be identified from early infancy.     

A short-term longitudinal study of Internet and computer game use by adolescent boys and girls: prevalence, frequency of use, and psychosocial predictors

Prevalence, frequency, and psychosocial predictors of Internet and computer game use were assessed with 803 male and 788 female adolescents across 2 time periods, 21 months apart. At Time 1, participants were in the 9th or 10th grade; at Time 2, they were in the 11th or 12th grade. Most girls (93.7%) and boys (94.7%) reported using the Internet at both time periods, whereas more boys (80.3%) than girls (28.8%) reported gaming at both time periods. Girls reported a small decrease over time in the frequency of hours spent per day on overall technology use, mostly due to a decrease in gaming. Both linear and curvilinear relations were examined between parental relationships, friendship quality, academic orientation, and well-being measured in early high school and the frequency of technology use in late high school. Being male significantly predicted both computer gaming and Internet use. There also were trends in favor of higher friendship quality and less positive parental relationships predicting higher frequency of Internet use. Importantly, moderate use of the Internet was associated with a more positive academic orientation than nonuse or high levels of use.     

The role of goal adjustment in symptoms of depression,anxiety and fatigue in cancer patients receiving psychosocial care: A longitudinal study

Objective: This study examined whether cancer patients reported increases in their goal adjustment capacities while receiving psychosocial care and whether these increases were related to changes in symptoms of depression, anxiety and fatigue. Goal adjustment was conceptualised as two independent capacities: goal disengagement (i.e. disengage from unattainable goals) and goal reengagement (i.e. reengage into new goals).

Design: This naturalistic, longitudinal study focused on 241 cancer patients receiving psychosocial care at one of the seven psycho-oncology institutions in the Netherlands. Data was collected before the start of psychosocial care (T1) and nine months thereafter (T2). Hierarchical regression analysis was used to examine the research questions.

Main Outcome Measures: Goal adjustment, symptoms of depression, anxiety and fatigue.

Results: At group level, patients reported small increases in goal disengagement (d = .22) but no significant change in goal reengagement (d = .09). At an individual level, 34% of cancer patients reported an increase in goal disengagement and 30% reported an increase in goal reengagement. Increases in goal reengagement were significantly associated with decreases in both depressive and anxiety symptoms, but not to changes in fatigue.

Conclusion: Findings indicate that particularly improvements in goal reengagement are beneficial for cancer patients’ psychological functioning.     

Psychological adjustment in breast cancer: processes of emotional distress.

The process of psychological adjustment to breast cancer was examined at diagnosis and at 3- and 6-month follow-ups in a sample of 80 women with Stage I-Stage IV breast cancer. At diagnosis, symptoms of anxiety/depression were predicted by low dispositional optimism, and this path was partially mediated by use of emotion-focused disengagement coping. Younger age also was predictive of anxiety/depression symptoms at time of diagnosis, and this relationship was fully mediated by magnitude of intrusive thoughts. At 3 months, changes in anxiety/depression symptoms were predicted only by intrusive thoughts. At 6 months, low dispositional optimism reemerged as a significant predictor of changes in anxiety/depression and again was partially mediated by the use of emotion-focused disengagement coping. Independent effects for problem-focused engagement and disengagement and emotion-focused engagement coping were also found at 6 months. Implications of these data for psychosocial interventions with breast cancer patients are highlighted.     

Gender differences in psychosocial risk factors among Slovenian adolescents

This study investigated psychosocial risk factors in adolescents and assessed gender differences in the frequency of their occurrence. A specially designed questionnaire, which included validated scales for the evaluation of depression (Zung Self-rating Depression Scale) and self-esteem (Rosenberg Self-Esteem Scale), was administered to a representative sample of Slovenian adolescents. The final sample consisted of 4,590 high school students of both sexes, aged 14 to 19 years. Data analysis revealed several significant gender differences. Girls more often than boys reported family conflict, personal problems, physical inactivity, attempts to control body weight, use of psychoactive drugs, suicidal ideation, and suicide attempts. Their level of depression was higher and self-esteem lower when compared with their male counterparts. Boys more often than girls indicated that they watched a great deal of television, were the victims of peer violence, and drank alcohol.     

A longitudinal study of the psychosocial impact of stroke on primary support persons

We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patient's primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.     

Neurodevelopmental and psychosocial risk factors in serial killers and mass murderers

Multiple and serial murders are rare events that have a very profound societal impact. We have conducted a systematic review, following PRISMA guidelines, of both the peer reviewed literature and of journalistic and legal sources regarding mass and serial killings. Our findings tentatively indicate that these extreme forms of violence may be a result of a highly complex interaction of biological, psychological and sociological factors and that, potentially, a significant proportion of mass or serial killers may have had neurodevelopmental disorders such as autism spectrum disorder or head injury. Research into multiple and serial murders is in its infancy: there is a lack of rigorous studies and most of the literature is anecdotal and speculative. Specific future study of the potential role of neurodevelopmental disorders in multiple and serial murders is warranted and, due to the rarity of these events, innovative research techniques may be required.     

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.     

Marital dissolution and distress in a psychiatric population: A longitudinal design

There has been interest in recent years in the relationship between marital distress and psychopathology. It has been rare, however, for investigators to follow patients after their release from the hospital and observe the course of their marital relationships. The present study included patients meeting criteria for three DSM III DISORDERS (MAjor depressive, bipolar, and schizophrenic) and a normal control sample, all of whom are participants in an ongoing longitudinal study of children at risk for psychopathology (Stony Brook High-Risk Project; Weintraub & Neale, 1984). Marital Adjustment Test (MAT; Locke & Wallace, 1959) scores were collected on patients at entry into the project (Phase I) and at a three year follow-up (Phase II). Course of marriage was defined as negative if the couple's marital adjustment was rated as poor at Phase II or resulted in divorce or separation at Phase II. It was found that only the depressed group differed from the normal group in having significantly worse course of marital relationship; 84% of the depressive couples showed a “negative” course of marital change over time. However, all three patient groups had significantly higher rates of divorce by Phase II. MAT scores at Phase I successfully predicted course of marital relationship for all diagnostic groups. Implications for aftercare of psychiatric inpatients are discussed.     

Self-reported psychological stress and the risk of breast cancer: a case-control study

The aim of this study was to examine the relationship between severe life events and breast cancer risk. This study was based on a case-control examination of 858 Polish invasive breast cancer cases and 1085 controls matched for age and place of residence. Data on life events, sociodemographic characteristic, reproductive factors, family history of breast cancer, current weight and height, and lifestyle habits were collected between January 2003 and May 2007 using a self-administered questionnaire. Odds ratios with 95% confidence intervals were estimated as the measure of the relationship between life event stress and breast cancer risk using unconditional logistic regression analyses. After adjustment for potential breast cancer risk factors, women with four to six individual major life events had 5.33 times higher risk for breast cancer, compared with those in the lowest quartile. Similarly, women with a lifetime life change score greater than 210 had about 5 times higher risk compared to women with corresponding scores in the range 0-70. Several life events (death of a close family member, personal injury or illness, imprisonment/trouble with the law, retirement) were significantly associated with breast cancer risk. These findings suggest that major life events can play an important role in the etiology of breast cancer.