Mentoring and Peer-led Interventions to Improve Quality of Life Outcomes among Adolescents with Chronic Illnesses

Advancing adolescent medicine has resulted in increased survival rates for life-limiting health conditions that are now considered chronic conditions. Due to the increased rates of chronic illnesses, the broad outcomes of community-based programs for adolescents with these illnesses need to be examined. Therefore, the present study seeks to examine community-based, mentoring and peer-led programs that have a social support component to increase quality of life outcomes for adolescents with chronic illnesses. A comprehensive literature review was conducted to identify articles that included a social support component to increase quality of life outcomes for adolescents with chronic illnesses. Six articles were included in the narrative analysis. Programs were divided into two types of interventions: mentoring/coaching (n?=?3) and peer-led interventions (n?=?3). A summary of each study was developed and main themes from each intervention were identified by the research team. This review found six community-based peer-led and mentoring interventions that incorporated a social support component to improve the quality of life of adolescents with chronic illnesses. Critical components for a peer-led or mentoring intervention should include social support components such as health coaching and mentoring by peers or adults. Since the nature of chronic illnesses is lengthy in duration, social support research translated into practice may offer adolescents who have any of these illnesses a means to improve their psychosocial outcomes. The interventions outlined in this present review have yielded promising results. Recommendations for future studies are included.     

Involving Family in Psychosocial Interventions for Chronic Illness

ABSTRACT— Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.     

Spezielle Aspekte bei Angststörungen

Anxiety disorders are among the most common mental health conditions worldwide and frequently cause significant functional impairment. Generalized anxiety disorder is the most commonly occurring impairing anxiety disorder in primary care. The degree of disability attributable to generalized anxiety disorder is comparable to that of major depression and is similar to that of chronic physical illnesses, such as peptic ulceration, arthritis, asthma and diabetes mellitus. Comorbid illnesses, such as mood disorders are commonly seen in clinical practice and have a significant impact on the clinical presentation and the treatment approach. Both psychotherapeutic and pharmacological techniques are recognized as being effective management strategies. The present article focuses on two case-reports of patients with anxiety disorders in an inpatient setting. By describing comorbid conditions subsequent difficulties and challenges in treatment are underlined.     

Psychoonkologie

Changes in the spectrum of illnesses have led to a predominance of chronic diseases, including oncological disorders, that are connected with substantial mental health problems. The needs of people with cancer are increasingly attracting the attention of psychosocial and psychosomatic disciplines as far as patient-oriented health care research and counselling practice are concerned. Psychosocial work in oncology appears to be becoming increasingly professionalized. Theories of the psychosocial origin of cancer are gradually losing ground in the scientific community, giving way to a rational attitude towards oncological diseases that counters the stigma of cancer. At the same time, the demand for psycho-oncological services is becoming more important if we take into account the high rate of psychiatric co-morbidity and the fact that these patients are poorly diagnosed and inadequately treated. This is all the more regrettable in that a broad range of evidence-based interventions are available which are gradually being implemented in the guidelines of rehabilitation facilities and oncological centres of excellence. The transfer of knowledge in the everyday care of cancer patients, however, has yet not been accomplished.     

Chronic illness and its impact: considerations for psychologists

A significant proportion of the population is affected by chronic illnesses, which have a marked impact on psychological adjustment at both the individual and family level. The nature of these illnesses and their impacts is complex, and has implications for psychological practice. This paper reviews these issues, and argues that more emphasis should be given to medical conditions in training programmes for psychologists.     

Stigma as a barrier to recovery from mental illness

Advances in neuroscience, technology and research sophistication have greatly increased understanding of mental illnesses and improved the treatment of these disorders. However, there are also important psychosocial aspects of mental illness that play a significant role in recovery from these conditions. One set of these factors involves the prejudice and discrimination, often referred to as 'stigma', faced by people when others learn that they have been diagnosed with, and/or treated for, a mental disorder.     

Religion and Disability: Variation in Religious Service Attendance Rates for Children with Chronic Health Conditions

Prior research consistently demonstrates greater religious involvement is associated with improved health outcomes for those with chronic health conditions. Fewer studies focus on how chronic health conditions influence religious service attendance rates and most focus on older Americans. Using three waves of a nationally representative sample of children in the United States, I test whether children with a chronic health condition never attend religious worship services at rates significantly higher than children without a condition. I also investigate variation in attendance rates across a broad range of conditions, something previously overlooked. Children with chronic health conditions are more likely to never attend religious worship services. Specifically, children with chronic health conditions that impede communication and social interaction are most likely to never attend. Despite shifts in prevalence these findings are stable over time. Implications for researchers, religious communities, families with children with chronic health conditions, and health‐care providers are discussed.     

Religiosity, psychological resources, and physical health

Various explanations have been given for the positive association between religiosity and physical health. Using data from two waves of the National Survey of Midlife in the United States (1995, 2005) and retrospective data on the importance of religion in the home in which respondents were raised we find that psychological resources, operationalized by measures of emotional and psychological well-being, mediate the effect of this early exposure to religion but only on self-rated health and physical symptomatology; chronic illnesses and health limitations on activities of daily living are unaffected.     

Can We Improve Our Physical Health by Altering Our Social Networks?

ABSTRACT— Persons with more types of social relationships live longer and have less cognitive decline with aging, greater resistance to infectious disease, and better prognoses when facing chronic life-threatening illnesses. We have known about the importance of social integration (engaging in diverse types of relationships) for health and longevity for 30 years. Yet, we still do not know why having a more diverse social network would have a positive influence on our health, and we have yet to design effective interventions that influence key components of the network and in turn physical health. Better understanding of the role of social integration in health will require research on how integrated social networks influence health relevant behaviors, regulate emotions and biological responses, and contribute to our expectations and worldviews.     

Hostility and health: current status of a psychosomatic hypothesis.

Recent research has renewed interest in the potential influence of hostility on physical health. This review indicates that the evidence available from prospective studies, although not entirely consistent, suggests that hostile persons may be at increased risk for subsequent coronary heart disease and other life-threatening illnesses. Further, several plausible mechanisms possibly linking hostility and health have been articulated and subjected to initial evaluation. Hostile individuals display heightened physiological reactivity in some situations, report greater degrees of interpersonal conflict and less social support, and may have more unhealthy daily habits. Additional research is needed, and it must address a variety of past conceptual and methodological limitations. Perhaps the most central of these concerns are the assessment of individual differences in hostility and the role of social contexts in the psychosomatic process.     

Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self‐report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non‐urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses.     

Cumulative burden of comorbid mental disorders,substance use disorders,chronic medical conditions,and poverty on health among adults in the U.S.A.

The health of individuals in the U.S.A. is increasingly being defined by complexity and multimorbidity. We examined the patterns of co-occurrence of mental illness, substance abuse/dependence, and chronic medical conditions and the cumulative burden of these conditions and living in poverty on self-rated health. We conducted a secondary data analysis using publically-available data from the National Survey on Drug Use and Health (NSDUH), which is an annual nationally-representative survey. Pooled data from the 2010–2012 NSDUH surveys included 115,921 adults 18 years of age or older. The majority of adults (52.2%) had at least one type of condition (mental illness, substance abuse/dependence, or chronic medical conditions), with substantial overlap across the conditions. 1.2%, or 2.2 million people, reported all three conditions. Generally, as the number of conditions increased, the odds of reporting worse health also increased. The likelihood of reporting fair/poor health was greatest for people who reported AMI, chronic medical conditions, and poverty (AOR = 9.41; 95% CI: 7.53–11.76), followed by all three conditions and poverty (AOR = 9.32; 95% CI: 6.67–13.02). For each combination of conditions, the addition of poverty increased the likelihood of reporting fair/poor health. Traditional conceptualizations of multimorbidity should be expanded to take into account the complexities of co-occurrence between mental illnesses, chronic medical conditions, and socioeconomic factors.     

When adolescents "mismanage" their chronic medical conditions: an ethical exploration

Many adolescent patients with chronic medical conditions do not manage their illnesses very closely and often put themselves at risk for serious health complications. Setting aside cases of nonadherence that are due to practical difficulties involving the implementation of a management plan, a deeply problematic question remains. How should health care providers respond to adolescent patients who express a conscious and value-driven decision to pursue other goals and interests that are incompatible with their doctors' recommended directives? Using two guiding ethical principles, the "relevant difference principle" and the "principle of noninterference," as well as available empirical data on adolescent decision making and risk perception, the paper concludes that most adolescents ages 14 and older should be allowed to make self-determining decisions regarding the management of their chronic medical conditions.     

海马NMDA受体经SP-NK1受体通路参与慢性应激诱发的抑郁样行为

为探讨海马N-甲基-D-天冬氨酸(N-methyl-D-aspartic acid, NMDA)受体与P物质(Substance P, SP)及其神经激肽1 (neurokinin1, NK1)受体在慢性不可预见性温和应激(chronic unpredictable mild stress, CUMS) 中的作用及其关系, 通过建立CUMS动物模型, 大鼠海马微量注射给药, 测量大鼠体重, 并采用糖水偏爱测试、旷场实验和悬尾实验等方法对大鼠进行行为学检测, 运用高效液相色谱(HPLC)法分析大鼠海马组织中SP和谷氨酸(glutamate, Glu)的含量变化。结果显示, CUMS诱发大鼠表现出明显的抑郁样行为, 海马组织中SP和Glu水平显著增加; 海马注射NMDA, 大鼠表现出与CUMS/SAL组相似的抑郁样行为, 且海马组织中SP的含量比正常对照组显著增加; 微量注射NK1受体阻断剂CP-96345和/或NMDA受体阻断剂MK-801后, 大鼠抑郁样行为明显改善, 且MK-801使CUMS导致的大鼠海马P物质水平升高得到明显控制, 而CP-96345没有明显改变CUMS引起的海马Glu水平升高; CP-96345使NMDA引起的抑郁样行为得到极显著改善。以上结果表明, 慢性应激引起大鼠海马Glu过量释放, 通过激活NMDA受体, 促进P物质合成释放增加, 激活NK1受体, 是导致抑郁样行为发生的重要途径之一。     

Spirituality in Disability and Illness

Spirituality appears with increasing frequency in the research literature, and a paradigm involving mind-body-spirit interaction is emerging. The relationship of spirituality to disability and illness is at the center of a growing body of knowledge. A comprehensive literature review supported spirituality as coping method among individuals experiencing a variety of illnesses including hypertension, pulmonary disease, diabetes, chronic renal failure, surgery, rheumatoid arthritis, multiple sclerosis, HIV/AIDS, polio and addictive illnesses. Additionally, spirituality is a resource when dealing with critical illness as well as terminal illness and end of life issues, and it is utilized by both patients, and family members. Discussion of research findings, implications for health care practice and future research is also presented.     

Perceptions of Hospitalization by Children with Chronic Illnesses and Siblings

Understanding children’s perceptions of their illnesses and functioning when they are undergoing medical procedures remains an important area for research. Further research about siblings’ perceptions will also provide knowledge about how they are coping with a brother or sister’s chronic illness. The current study examined the perceptions of children with illnesses and their siblings using a play interview. Themes in the data indicated resilience in child functioning for both patients and siblings. Children with chronic illnesses could experience pain, which often related to fears and other negative feelings about hospitalization and potentially doctors or nurses, if they were administering painful procedures. Distraction and prayer were coping tools for patients. However, most patients believed their illness and recovery would be a “long journey.” Brothers and sisters of children with chronic illnesses could experience loneliness. A more common report was a strong desire to help and be a support for a brother or sister with an illness. Support from parents was critical for both patients and siblings and both typically enjoyed child life activities. A member-checking process, with a different group of children with illnesses and siblings, was used to audit themes discovered after reviewing play interviews. The audit process supported the positive and negative themes in the data. In the future, examining the impact of magical thinking on outcomes and conducting studies after the children have gained distance from medical trauma will be important. Moreover, increasing a focus on resilience as a hallmark of children’s functioning remains another area for further research.     

Individual and Family Contributions to Depressive Symptoms in African American Children with Sickle Cell Disease

Depressive disorders in children with chronic illnesses have received little attention despite some evidence suggesting that these children experience increased psychological difficulties as a result of their medical condition. Most of the research on depressive disorders among children has been conducted primarily with Caucasian youth, limiting generalizability to ethnically diverse populations. Further, even less research exists on depressive disorders among African American children with Sickle Cell Disease (SCD) and for African American youth from lower socioeconomic status who are at greater risk for depressive disorders. This paper is an extensive review of the major studies conducted on depression and psychosocial aspects of SCD in African American children. The Transactional Stress and Coping model is provided as a conceptual framework. Following the review, clinical and research implications are provided, as well as an illustration of a psychoeducational family intervention with an African American child who has SCD and internalizing behaviors.     

Assessment of Chronic Illness-Related Cognitive Fusion: Preliminary Development and Validation of a New Scale with an IBD Sample

Although research recognizes the advantages of creating specific content measures, no specific measure of chronic illness-related cognitive fusion had been developed to date. The current study presents the development and validation of the Cognitive Fusion Questionnaire-Chronic Illness (CFQ-CI) in a sample of inflammatory bowel disease (IBD) patients and the analysis of the role of this construct in the psychological health of those patients. Results indicated that the 7-item CFQ-CI was a unidimensional measure of cognitive fusion in patients with chronic illnesses, and that scores had adequate/good internal consistency and construct, convergent, and discriminant validity. This study also showed that chronic illness-related cognitive fusion as assessed by the CFQ-CI acted as a mediator in the association between both IBD-related symptoms and shame with quality of life. The development of the CFQ-CI may thus contribute to a better understanding of the mechanisms influencing functional outcomes in chronic illness.     

Repressive adaptation in children with cancer: a replication and extension.

Prior research has shown a higher incidence of a repressive adaptive style in children with cancer. To explore whether repressive adaptation in this population is premorbid or reactive, adaptive style was assessed longitudinally in children with cancer at the time of diagnosis and at 6 months and 1 year after diagnosis. Comparison groups included healthy children and children with other serious but nonmalignant chronic illnesses. At diagnosis, children with cancer showed a higher incidence of a repressive adaptive style than healthy children, and the incidence of repressive adaptation remained stable over time. Children with other chronic illnesses also showed levels of repressive adaptive style comparable to the cancer group. These findings suggest a shift toward repressiveness in response to the diagnosis of cancer that is then maintained over time and necessitate further examination of the health consequences of adaptive style in this population.     

Anxiety Sensitivity and Disabling Chronic Health Conditions State of the Art and Future Directions

Anxiety sensitivity (AS) is a construct that denotes an individual difference in fear of anxiety. Most research into the AS construct has focused on its association with panic attacks, panic disorder and several other psychiatric disorders. There has been growing interest recently in AS as an important factor in the maintenance and exacerbation of morbidity associated with some disabling chronic health conditions (e.g. gastrointestinal dysfunction, asthma, vestibular dysfunction and chronic pain). The purposes of this paper are (a) to provide a brief overview of the theoretical framework within which the AS and chronic health condition literature can be synthesized, (b) to review the existing literature regarding AS and chronic health conditions and (c) to offer recommendations for assessment and treatment. Theoretically and practically relevant directions for future investigation are provided throughout the review.