Predicting change in depression following renal transplantation: effect of patient coping preferences.

Improvement in patient quality of life is a central goal of renal transplantation. This study examined the hypothesis that change in depression following transplantation would vary as a function of patient coping preferences. Sixty patients were assessed with the Krantz Health Opinion Survey and the Beck Depression Inventory while on the waiting list for a cadaveric renal transplant. Patients were reassessed approximately 12 months later. Among the 33 patients receiving a transplant during the follow-up period, those with a high preference for health-related information exhibited a substantial reduction in depression. In contrast, patients low in preference for information showed a slight increase in depression. Among the 27 patients who were not transplanted during the follow-up period, preference for information had no effect on depression. Patient differences in preference for behavioral involvement did not exert a significant effect on depression.     

A one year study of coping,social support and quality of life in parkinson's disease

Abstract

The role of coping and social support in the quality of life for Parkinson's Disease (PD) patients is not well understood. Most studies are cross-sectional and concentrate on depression as an outcome measure. The aim of the present study was to explore the role of coping and social support in quality of life for patients with PD. Self-report measures were completed by 105 sufferers of PD; 75 completed the same questionnaire a year later. Patients had the most problems with social function, followed by problems with mobility control and psychological autonomy and communication. After controlling for age, gender and illness duration, the number of PD symptoms predicted mobility control, social functioning and psychological function. Passive coping explained additional variance in most functional domains with more passive coping being related to increased problems. The quality of life was highly stable over the course of the year. Active coping was related to superior psychological functioning one year later. In fact, this was the only coping and social support variable related to functioning after one year, when controlling for previous functions. The results are discussed in terms of the importance of symptom management in PD.     

Depression and appearance-related distress in functioning with lipedema

Lipedema is a chronic, progressive adipose tissue disorder that may impact the quality of life of women who suffer from it. The main aim of this study was to asses the role of perceived symptom severity, physical and psychological functioning with the disease in predicting quality of life in patients with lipedema. We conducted an online study with 329 participants who responded to five questionnaires measuring quality of life (World Health Organization Quality of Life BREF), lipedema symptom severity, mobility (Lower Extremity Functional Scale), depression (Patients Health Questionnaire-9), and appearance-related distress (Derriford Appearance Scale 24). Multiple hierarchical regression analyses showed that appearance-related distress and depression explained significantly more variance in quality of life when added to the symptom severity and mobility. Lower quality of life was predicted by higher symptom severity, lower mobility, higher appearance-related distress and higher depression severity. Appearance-related distress and depression constitute important aspects of psychological functioning in women with lipedema. Considering their relationship with quality of life, their assessment should be included in lipedema treatment with appropriate interventions aimed at decreasing appearance-related distress, as well as preventing and addressing depression.     

Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors

Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.     

Life stressors, social resources, coping, and the 4-year course of unipolar depression

Little is known about the effects of psychosocial factors on the long-term course of unipolar depression. This article examines the 4-year stability and change in life stressors, social resources, and coping, and their effect on the course of treated unipolar depression among 352 men and women. Depressed patients were assessed at treatment intake and at 1-year and 4-year follow-ups. Over the 4 years, patients improved in symptom outcomes, the quality of social resources, and coping responses; there were some declines in life stressors. Life stressors, social resources, and coping were related to patient functioning concurrently, after controlling for demographics, initial treatment, and initial dysfunction severity. Preintake medical conditions and family conflict consistently predicted poorer long-term outcomes. The findings imply that medical conditions and family conflict are important risk factors that predict poorer long-term outcome of depression.     

The effects of perceived social support on quality of life in patients awaiting coronary artery bypass grafting and their partners: testing dyadic dynamics using the Actor-Partner Interdependence Model

Patients awaiting coronary artery bypass grafting (CABG) need support from their partners or family caregivers to manage their self care successfully and to maximise quality of life. Partners need social support to help overcome the stressful tasks of an unexpected caregiving role. It is not known whether the individual's perceived social support contributes to their own, as well as their partner's quality of life. The aims of this study were to assess differences in social support and quality of life in patients and partners awaiting CABG, and to examine whether patients' and partners' perceived social support predicted their own, as well as their partner's quality of life before CABG. This cross-sectional study recruited 84 dyads (patients 84% males, aged 64.5 years and partners 94% females, aged 61.05 years). Perceived social support was assessed using the Medical Outcomes Study Social Support survey, with sub-scales for informational/emotional support, affectionate support, tangible support and positive social interaction. Quality of life was assessed using the Short-Form 12 Health Survey. Dyadic data were analysed using the Actor-Partner Interdependence Model, with distinguishable dyad regression. Results revealed the patients' informational/emotional support exhibited an actor effect on their own mental health (? = 0.19, p = 0.001); indicating those with low informational/emotional support had poorer mental health. There was a partner effect of the patients' informational/emotional support on their partner's mental health (? = 0.14, p = 0.024), indicating the patients' informational/emotional support was associated with the partner's mental health. None of the other types of social support exhibited an actor effect or a partner effect on the patient's or the partner's mental or physical health. More research into the relationship between social support and mental health is needed to help inform the design of interventions that target the dyad.     

Ecological Correlates of Family Functioning

Guided by ecological theory, we empirically explored how parents' psychological functioning, social relationships, and demographic characteristics related to family functioning. Our sample of 197 participants included both neglectful and control families. We found statistically significant associations between the predictor variables (i.e., maternal personal maturity, depression, stressful life events, social support, family of origin difficulties, education, income) and family functioning as rated by mothers, caseworkers familiar with the families, and observers who coded family interaction tasks. However, the exact pattern of significant associations differed as a function the rater of family health.     

Quality of life in transplant patients, compared to other stressful health situations in pulmonary patients

Transplantation may imply severe biopsychosocial impairments. In order to know the quality of life of patients one year after transplantation, 58 subjects were compared to three different groups of patients (stabilized and acute COPD patients, and lung cancer patients in a surgery unit). Patients filled in two questionnaires: EORTC QLQ-C30 (quality of life) and HAD (anxiety and depression). The quality of life dimensions with inter-group differences were physical, role, emotional and cognitive functioning, global health status, and a number of symptoms (fatigue, dyspnea, insomnia and appetite loss). There were differences in depression, and but not in anxiety. Transplant and surgical patients showed better quality of life and affective status than chronic pulmonary patients. Discriminant analysis showed that the transplant group was the best described group. We conclude that patients, one year after transplantation, show similar quality of life as asymptomatic hospitalised patients, somewhat better than chronic patients in a stabilized stage of the disease, and much better than severe chronic patients.     

Influence of perceived social support and functioning on the quality of life of patients with schizophrenia and their caregivers

Perception of social support and functioning of patients with schizophrenia and their primary caregivers and its relationship to quality of life are described. Forty-five patients and their 45 relatives, treated at the Mental Health Services in Arica, Chile, participated. Both patients and caregivers in the study have a poor perception of social support with regard to extra-family people, as well as a low social integration. However, patients showed adequate capacity to function within their immediate family. Unlike what was found in developed countries, these patients showed moderate levels of quality of life, with a strong relationship with perceptions of the social support they receive from family and significant others and the ability to establish and maintain social contacts. Quality of life of primary caregivers is linked to patients' ability to establish and maintain social contacts within the family group, as in other social instances, such as keeping a job. The results of the study suggest the need to consider the design and application of programs of support for these patients and their caregivers, with the central aim of the social functioning of the above-mentioned patients and their familiar and community integration.     

Organ donation terminology: are we communicating life or death?

The continued functioning of organ transplantation depends on obtaining the permission of the next of kin. This communication process between medical or transplant professionals and a donor family hinges heavily on the understanding of certain critical terms like brain dead, life support, and transplantation. Communication issues in obtaining organ donation consent were examined, with particular focus on what are literally life-and-death decisions. Using an experimental simulation methodology, data are offered in support of the claim that much miscommunication occurs in such situations. Directions for improving such communication by allaying latent fears and more carefully defining crucial terminology are offered.     

Child Psychosocial Functioning and Parent Quality of Life Among Clinically Referred Children

We examined factors that account for quality of life among parents of clinically referred children. Families (N = 201) of children (ages 3-14) referred for oppositional, aggressive, and antisocial behavior participated. Parent and family contextual factors and child psychosocial functioning (symptoms and impairment) were predicted to influence parents' quality of life. As predicted, socioeconomic disadvantage, parent stress and psychopathology, poor interpersonal relations, and limited social support were related to lower levels of quality of life. Once these factors were controlled, child psychosocial functioning also contributed positively to quality of life. Further research on quality of life in the family can have important implications for understanding the context of both child and parent functioning.     

Predictors of Family Functioning Among Clergy and Spouses: Influences of Social Context and Perceptions of Work-Related Stressors

We wished to identify predictors of family functioning from models including perceptions of stresses associated with mobility, financial compensation, intrusiveness to family boundaries, expectations on time demands, and the lack of social support. Data were collected from 136 randomly selected couples from six denominations in which husbands were clergy. Participants completed a survey that included the Clergy Family Life Inventory which assessed perceptions of five work-related stressors and the Self Report Measure of Family Functioning scale which measured 12 dimensions of family functioning. Separate regression models were tested for husbands and wives and these analyses indicated that no single stressor seemed influential for all 12 dimensions of family functioning. However, for both husbands and wives, family boundary intrusiveness, lack of social support, and mobility stresses influenced their competence in numerous areas of family functioning. In addition, husbands and wives experienced similar effects of stress among several dimensions of family functioning (e.g. enmeshment, family organization, democratic family atmosphere expressiveness).     

Quality of life and family functioning in schizophrenia patients

Quality of life and family functioning of patients with schizophrenia are described. A sample of 49 schizophrenic patients and their 70 relatives, treated at the Mental Health Services of Arica, Chile, were included in the study. The Quality of Life Questionnaire of Sevilla (CSCV), the General Health Questionnaire (GHQ-12) and the Family Function Questionnaire (APGAR) were used to assess the patients, the last one also administered to their caregivers. Contrary to the results found in researches done in developed countries, the patients of this sample indicated suitable levels of quality of life, to a great extent, related to the perception of their family functioning. This confirms the importance of the family as social network of emotional support. Nevertheless, perceived family functioning is different in patients and their caregivers. Higher scores were obtained in caregivers who participated in a family psychoeducational program. The conclusion reached was that there are differences in the levels of quality of life perceived by patients of developed countries and those of developing countries, being higher in the latter ones, despite limitations in economic, sanitary and community resources. Future research should study why the variables that explain these levels of quality of life differ.     

The Impact of Social and Political Changes on Survivors of Political Persecutions in Rural Russia and Ukraine

Differences in depressive symptoms and attitudes about political and social changes were examined for individuals with and without family histories of Stalinist persecution in several small villages in Russia and Ukraine. In a sample of 422 villagers, there were 37 family members of survivors of Stalinist purges. In comparison to villagers with no family history of persecution, those who had such history perceived their social life with other villagers and their life in general to be much improved in the late 1990s. They also reported much lower levels of depression than those without a history of persecution. Differences that were discovered could not be accounted for by demographic characteristics of the respondents. The results suggest that individuals with a history of family trauma related to political persecution may perceive their environment as more positive as a result of political changes and may cope with political transitions differently than persons who have no history of family persecution.     

Depressed patients with dysfunctional families: description and course of illness.

Sixty-eight depressed patients were subdivided according to their family's level of family functioning into functional and dysfunctional groups. Patients from dysfunctional families did not differ from those from functional families on measures of severity of depression, chronicity of depression, depression subtypes, other nonaffective psychiatric diagnoses, history of depression, or neuroendocrine functioning. Patients from dysfunctional families did have significantly higher levels of neuroticism. A 12-month follow-up of these patients indicated that depressed patients with dysfunctional families had a significantly poorer course of illness, as manifested by higher levels of depression, lower levels of overall adjustment, and a lower proportion of recovered patients. Thus, impaired family functioning appears to be an important prognostic factor in major depression.     

Family Functioning and Social Support in Men and Women Diagnosed with Depression in China

Previous research has demonstrated the association between family functioning and depression. This study evaluated family functioning and perceived social support in men and women in Shanghai who had received a diagnosis of a major depressive disorder (N = 100), including sixty-six women and thirty-four men. The relationship between family functioning and social support of outpatients with major depressive disorders was explored using the Chinese Family Assessment Device and the Multidimensional Scale of Perceived Social Support. The scores from all dimensions of family functioning for both men and women indicated that depressed men and women all reported experiencing unhealthy family functioning. The clinical implications of these findings for the developing practice of family therapy in China are discussed.     

Quality of life post-myocardial infarction: effects of a transtelephonic coronary intervention system

The impact of an outpatient, risk-management system, including a transtelephonic electrocardiographic monitor and lidocaine injector, on the quality of life in post-myocardial infarction patients was examined. Patients (n = 238) were assigned randomly to either the system or to standard medical care (control). Quality of life was defined in terms of psychological status, return to work, and social functioning. Relative to control patients, system patients showed a significant decrease in concerns about physical functioning and symptoms, and, over time, reported less depressive affect. At 9-month follow-up, control patients were more than twice as likely to be in the range of clinical depression. Patients' perceptions of their ability to manage a recurrence of cardiac symptoms appeared to be related inversely to depressive affect. Moreover, a larger percentage of system patients (92%) had returned to work by the 9-month follow-up, compared with control patients (76%). There were, however, no significant differences between groups in the degree of impairment in social interaction. Overall, these results indicate that the use of a "system" encouraging patient participation in treatment can significantly improve qualify of life after a myocardial infarction.     

Alltag mit der Depression des Partners

Objective. Clinical research on the quality of interpersonal relationships in individuals with unipolar depression supports the idea that the family plays a major role in the development and the course of major depression. In order to further explore how family functioning relates to unipolar depression, the authors examined changes in family functioning as viewed by the patients' spouses. Methods. Interview data from 54 spouses of patients with unipolar depression were analysed as part of the baseline assessment of a study on the economic and health burden experienced by families with mentally ill relatives. Results. Having a family member with a current major depressive disorder is a general stressor for families and has implications for the health and well-being of the patient's spouse. Depressive symptoms affect a wide range of aspects of marriage and family life and result in a process of adaptation and transformation of the patient's family. Thus, in assessing burden experienced by spouses particular attention should be paid both to the social environments and to different aspects of the relationship as perceived by the patient's spouse in order to further understand the factors mediating the interaction between major depression and family functioning.     

Attributing Problem-Solving to God,Receiving Social Support,and Stress-Moderation

This research note explores the stress-moderating effects of attributing a problem-solving role to God among a nationwide sample of 2,260 Americans. Specifically, the ways in which the perception of “God-as-a-problem-solver” moderates stress is explored for Americans reporting low and high levels of social support from other people. Within a model that interacts two moderators (i.e., a moderated moderation analysis), two predictions are tested that extend from social support and sense of control frameworks. Consistent with one prediction, viewing God-as-a-problem-solver had a stress-buffering effect (i.e., a reduction of the negative impact of life stressors on a depressive symptomology outcome measure) among those receiving low social support. Consistent with a second prediction, viewing God-as-a-problem-solver served as a stress-exacerbator among those already receiving high levels of social support. Findings suggest that the optimal count of supportive sets of entities (be it God or other people) is no fewer or no more than one.     

Quality of social support and associated social and psychological functioning in women with rheumatoid arthritis

Using a cross-sectional interview study of 194 women with rheumatoid arthritis, investigated the relationship between health status, social integration, qualitative aspects of social support, and social and psychological functioning in the presence of a chronic, disabling disease. Even after controlling for the influences of current physical limitations and social integration, qualitative dimensions of social support as measured by the Quality of Social Support Scale, a scale developed for this study, explained a significant proportion of the variance in home and family functioning and in depression.