Depressive Symptomatology Mediates Associations With Community Reintegration in Veterans With TBI

Community reintegration (CR) is a challenge for military veterans with traumatic brain injury (TBI). Posttraumatic stress disorder (PTSD), depression, bodily pain, and limitations in physical functioning—common comorbidities with TBI in veterans—have all been associated with problems in CR, but their interrelationships are unclear. The role of depression as a possible mediator of effects on CR has not been examined. We tested depressive symptoms as a possible mediator of CR’s associations with physical limitations, PTSD, and bodily pain. This cross-sectional study used baseline data from a larger randomized controlled trial that evaluated the impact of an in-home intervention for veterans with TBI and their families. Eighty-three military veterans with TBI recruited from a medical rehabilitation service at an urban U.S. Department of Veterans Affairs medical center participated in the study. Interview instruments measured CR, depressive symptoms, physical limitations (limitations in physical functioning), bodily pain, quality of the relationship with key family members, and sociodemographic characteristics. PTSD was determined through review of the electronic medical record. Interview data were collected in veterans’ homes. Depressive symptoms totally mediated the association between physical limitations and CR and the association between PTSD and CR. The bodily pain–CR association was not significant after quality of relationship had been entered into the regression models. Findings suggest that interventions to increase CR of veterans with TBI should address depression, a treatable condition. Replication of our mediation findings in larger veteran and civilian samples with TBI is needed.     

Perceived Stress and Comorbid Illness Predict Depressive Symptomatology in People with Coeliac Disease

A high prevalence of depression is found in people with coeliac disease (CD). People with CD who are depressed are less likely to manage their illness effectively, which may lead to complications. Identification of variables associated with depression in people with CD may facilitate early detection and intervention. Participants were 749 members (125 males, 622 females) of the Queensland Coeliac Society (aged 18–88 years), recruited via a mailout. Participants completed the Modified Zung Self‐Rating Depression Scale, the Perceived Stress Scale, and the Perceived Consequences Subscale (from the Revised Illness Perception Questionnaire). Stress (p = .001) and comorbid medical illness (p = .01) were significantly associated with depression in CD. The current study made an original contribution to the body of literature by identifying stress and comorbid medical illness as predictors of depression in CD.     

Proximal Predictors of Depressive Symptomatology: Perceived Losses in Self-Worth and Interpersonal Domains and Introjective and Anaclitic Mood States

Although much research has demonstrated a relationship between negative life events and depressive symptoms, relatively little research has examined the mechanisms that may mediate this relationship. The theories of Blatt (1974), Bowlby (1980), and Gilbert (1992) each propose proximal predictors of depression. In accordance with these theories, this study examined the relationships among perceived losses in self-worth and interpersonal relationships, anaclitic (dependent) and introjective (self-critical) mood states, and depressive symptoms following a significant negative life event. A sample of 172 undergraduate students completed measures of depressive symptoms and depressive vulnerability factors and retrospectively described the worst period of their lives. They also rated the extent to which the events surrounding this worst period affected their self-worth and their relationships with close others. Structural equation modeling demonstrated that the effect of a perceived loss of self-worth on depressive symptoms was fully mediated by both introjective and anaclitic mood states, whereas the effect of a perceived loss of interpersonal relationships on depressive symptoms was fully mediated by an anaclitic mood state. Additionally, perceived losses of self-worth showed a stronger effect on introjective mood in highly self-critical individuals. Findings highlight the importance of perceived losses in both self-worth and interpersonal domains in response to adverse life events and suggest pathways through which perceived losses may affect depressive symptoms.     

Spirituality and Health Outcomes in the Elderly

The purpose of this mail survey was to examine the relationship of attitudinal and behavioral measures of spirituality to physical and mental health outcomes in a sample of elderly community residents. Frequency of prayer, importance of faith, and reliance on religion for their coping were compared for their association with eight categories of physical and mental health. All three measures, prayer, faith and religious coping, correlated strongly with positive mental health, but not with the other seven physical health categories. Multiple regression analyses indicated importance of one's faith had the strongest association with positive mental health, even after controlling for the effect of other significant variables, age and education. The behavioral measure of prayer was a component of importance of faith to mental health, with no independent impact. This study highlights attitudes rather than practices, as the stronger spiritual variables related to mental health in the elderly.     

Disorders of Eating in the Elderly

The most common eating disorder in the elderly in both community and hospital settings is food refusal. This may lead to weight loss and malnutrition with all the adverse consequences on independence and function. The management of disorders of eating in the elderly is a diagnostic and therapeutic challenge, requiring the combined skills of the medical and nursing staff. The causes are often multifactorial and require careful and repeated assessment of the patient's social, psychological, and medical history. Approach to treatment involves these factors, as well as ethical and cultural considerations. Eating is the most basic biological drive for survival in nature. In human societies there are additional cultural and social aspects that may override this instinct, as in the case of hunger strikes for political motives. In the elderly, food is one of the major sources of possible pleasure and it is the challenge for health providers to try and give this enjoyment to their patients for as long as possible.     

Depressive and Anxious Symptomatology Moderate the Relationship Between Childhood Emotional Abuse Severity and Attentional Bias on the Modified Stroop Task

Research has demonstrated that the impact of childhood abuse often outlasts the initial abuse experiences, paving the way for a myriad of psychological difficulties in adulthood. Attentional bias might serve as a pathway from childhood abuse to negative outcomes associated with such experiences. The primary aim of the study was to investigate the impact of childhood emotional abuse (CEA) experiences on the presence of attentional bias in a sample of college women by comparing performance on a modified Stroop task between CEA survivors (n = 28) and a nonabused control group (n = 31). Results suggest that for CEA survivors, psychological symptoms moderated the relationship between CEA severity and attentional bias to specific word types. Results underscore the importance in continued exploration of the relationship among childhood emotional abuse, attentional bias, and concurrent psychopathology. Results also suggest that modification of attentional biases, via cognitive bias modification procedures, could help mitigate the impact of childhood abuse experiences on psychological well-being in adult survivors.     

认知年老化和老年心理健康

认知功能和心理健康是健康老龄化的两个基本要素。认知功能随年老而加速减退,其机制的探讨表明,加工速度、工作记忆和执行功能在认知年老过程中均起重要的中介作用。大多数老年人的心理健康状况较好、生活满意度较高,其心态随年龄的增高而更趋于平静满足,但独居和绝对空巢老人的某些心理健康问题不容忽视。认知年老化过程和老年人的心理健康状况分别受诸多因素的影响,研究结果为延缓认知功能的年老减退和保持老年人的心理健康,以及实现健康老龄化和积极老龄化提供了有益的启示     

基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用——基于双因素模型的老年人生命意义感与心理健康：老化态度的中介作用

在积极心理学的影响下,心理健康双因素模型包含主观幸福感和精神病理学指标。研究旨在验证心理健康双因素模型在老年人中的适用性,考察老化态度在生命意义感和心理健康间的多重中介作用。采用爱丁堡幸福量表、一般健康问卷、老化态度问卷和人生意义问卷调查了283名广州市社区老年人。结果发现：（1）心理健康双因素模型较单因素模型的拟合度更优。（2）生命意义感通过老化态度的三条路径（对身体变化、心理获得和心理社会丧失的积极态度）促进心理健康,但具体机制不同。增强意义体验、意义追寻通过老化态度的完全中介作用,提高主观幸福感。增强意义体验通过老化态度的完全中介作用,减弱意义追寻通过老化态度的部分中介作用,减少精神病理学症状。研究结果扩大了心理健康双因素模型的适用年龄范围,为提升老年人的心理健康提供实证依据。     

Depressive Symptomatology among HIV-Positive Women in the Era of HAART: A Stress and Coping Model

Objective: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace. Method: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood.     

Unemployment and Mental Health: A Longitudinal Perspective

Using longitudinal data, the current study examined the relation between mental health and unemployment. It was assumed that these concepts would mutually influence each other—that is, while the perceived characteristics of the situation of being unemployed affect mental health, mental health may also influence the intention to look for a job, amount and type of job-searching behavior, and the chances of finding a job. Drawing on partly longitudinal data from 229 unemployed Dutch youth, a model relating mental health, perceptions of the unemployment situation, job-searching behaviors, and employment status was tested using structural equation modeling and logistic regression analysis. While the expectations were largely supported, there were also several unexpected results, most notably that participants who felt powerless were more likely to be active job seekers, while only mental health (and not job-seeking behavior) was (weakly) related to the likelihood of finding a job.     

Association of Depressive Symptomatology and Elder Mistreatment in a U.S. Chinese Population: Findings From a Community-Based Participatory Research Study

Elder mistreatment (EM) is associated with increased morbidity and mortality. The objective of this study is to examine the association between depressive symptoms and EM in a U.S. Chinese population. A community-based participatory research approach was implemented to partner with the Chicago Chinatown population. Self-reported EM was assessed using a modified Vulnerability to Abuse Screening Scale instrument. Depressive symptomatology was assessed using the short form Geriatric Depression Scale. Exact logistic regression was used to assess these associations. Of the 78 participants, mean age was 74.8 (SD = 7.8) years and 52.6% were women. EM was reported in 20.5% of participants. After adjusting for potential confounding factors, higher numbers of depressive symptoms were independently associated with increased risk of EM (Exact OR, 1.99, 95% CI [1.23, 3.41]). Interaction terms analyses suggest that higher educational levels might buffer the risk of EM associated with depressive symptoms. Longitudinal studies are needed to confirm these findings in this U.S. Chinese population.     

Maternal Depressive Symptomatology and Parenting Behavior: Exploration of Possible Mediators

Possible mediators of the relation between maternal depressive symptomatology and parenting behavior were examined for 96 children with ADHD and their mothers drawn from the Multimodal Treatment Study of Children with ADHD (MTA) as part of an add-on investigation conducted by two of the six MTA sites. General cognitions (i.e., maternal locus of control and self-esteem) and parenting-specific factors (i.e., maternal parenting efficacy and parenting stress) were examined as possible mediators. Findings provide initial support that maternal parenting stress, as well as maternal locus of control and self-esteem mediate the relation between maternal depressive symptomatology and parenting behavior. This provides support for the argument that some families of children with ADHD may benefit from an expanded version of parent management training that includes sessions directly targeting affective and cognitive factors in parents, similar to treatment programs used to treat childhood conduct problems.     

Obsessive-Compulsive and Depressive Symptoms: The Role of Depressive Cognitive Styles

Obsessive-compulsive disorder (OCD) commonly co-occurs with depression, resulting in heightened severity and poorer treatment response. Research on the associations between specific obsessive-compulsive symptoms (OCS) and depressive symptoms has utilized measures that have not fully considered the relationship across OCS dimensions. Little is known about which factors explain the overlap between OCS and depressive symptoms. OCS and depressive symptoms may be related via depressive cognitive styles, such as rumination or dampening (i.e., down-regulating positive emotions). We evaluated the associations of OCS dimensions with depressive symptoms and cognitive styles. We also examined the indirect effects of rumination and dampening in the relationship between OCS and depressive symptoms. Participants (N = 250) completed questionnaires online. Greater depressive symptoms, rumination, and dampening were associated with greater levels of all OCS dimensions. Path analysis was utilized to examine a model including the direct effect of depressive symptoms on overall OCS and two indirect effects (through rumination and dampening). There was a significant indirect effect of depressive cognitive styles on the relationship between OCS and depressive symptoms, through rumination and dampening. Replication in a clinical sample and experimental manipulations may bear important implications for targeting depressive cognitive styles in treatments for OCD and depression.     

Family Mobilization: Work with Angry Elderly Couples in Declining Health

When elderly angry couples face difficulties in caring for each other, the ability to monitor each other's health problems is reduced, prompting the mobilization of the family. This article presents three sets of questions that examine for patterns of family mobilization: positive wedging, disentanglement failure, positive in-and-out participation, and defensive paralleling. In our clinical impression, these patterns often accompany the health monitoring problems of angry elderly couples. Brief case studies are used to describe approaches for assisting these couples in terms of both health monitoring and marital interactions involving anger during health decline. A procedure of deliberate paralleling for working with couples who display an especially inflexible interpersonal arrangement is outlined. Implications are drawn for therapists' education.     

Broken Bodies,Broken Spirits: How Poor Health Contributes to a Cynical Worldview

Cynical hostility (or cynicism) is often considered as a major factor leading to bad health outcomes. The present research proposes that poor health might represent both a consequence and a source of cynicism. Using cross‐lagged path analyses, we documented bidirectional associations between health and cynicism in a nationally representative sample of Germans (Study 1) and a large sample of the American elderly (Study 2): cynical individuals were more likely to develop health problems, and poor health promoted the development of a cynical worldview over time. These results were obtained using different indicators of health status, including both self‐reported and interviewer‐administered physical measures. Longitudinal mediation analyses showed perceived constraints to mediate the effect of poor health on cynicism. This effect remained robust even when adding an alternative mediator—depressive symptoms. Additional analyses showed that any particular health limitation was prospectively related to cynicism to the degree to which this limitation was associated with an increased sense of constraints in individuals' life. © 2018 The Authors. European Journal of Personality published by John Wiley & Sons Ltd on behalf of European Association of Personality Psychology     

健康行动过程取向模型的发展与前景

健康行动过程取向(HAPA)模型的提出源于健康行为社会认知模型的发展和Bandura社会认知理论的应用。在HAPA中, 健康行为变化被视为一个包括行为产生、保持和恢复在内的连续过程; 结果预期、危险感知、三种自我效能感和两类计划被用来解释意图的形成及其向行动的转化; 两个阶段的划分有助于区分三类干预对象, 建议实施菜单式干预。HAPA模型具有明显的理论优势, 也引发了有关模型实质的争论。当前和未来的研究旨在考察更多的自我调节变量、检验因果模型, 在健康行为的多个领域开展应用和干预研究。     

Depressive Cognition: A Test of Depressive Realism Versus Negativity Using General Knowledge Questions

This research is an examination of whether cognition in depressed individuals incorporates a realistic view of the world or a general tendency toward negativity. Participants provided two types of probability judgments of the likelihood that they correctly answered general knowledge questions: the probability that they correctly answered each of the individual questions and an aggregate judgment, after completing the questionnaire, of the percentage of all the questions they thought they had correctly answered. These tasks generally elicit overconfidence and accuracy in nondepressives. In accord with theories of both depressive realism and general negativity, in their item-by-item assessments of their answers to the individual questions, depressed participants demonstrated less overconfidence than nondepressed participants. In accord with the theory of general negativity but not with the theory of depressive realism, however, depressed participants demonstrated underconfidence in their aggregate judgments. The implications of these findings on theories of depressive cognition are discussed.     

Health,Healing and Wholeness in Frail Elderly People

ABSTRACT

This article explores the relationship between health, healing and wholeness in a group of twenty frail older residents of nursing homes, using in-depth interviews. While the participants in this study were all frail and lived with a number of disabilities, they demonstrated signs of transcendence in their responses to their disabilities. While independent living older adults in a previous study had all expressed fears of future vulnerability, only 45% of these nursing home residents said they had fears. Failure to thrive is discussed as one area of concern for frail older people, noting that this may stem from a lack of nourishment of the soul. Pastoral care is described as a multidisciplinary intervention for these residents, forming part of their wholistic care.     

Illness-Related Support and Negative Network Interactions: Effects on HIV-Infected Men's Depressive Symptomatology

Data collected as part of a psychosocial study of gay and bisexual men's experiences of living with HIV infection as a chronic illness were examined to investigate the psychological impact of the perceived availability of illness-related support and negative illness-related network interactions in a sample of men from this population. The sample was comprised of 144 HIV-infected non-Hispanic white, African American, and Puerto Rican men living in the New York City metropolitan area. Analyses found evidence of a conjoint (interactive) effect between perceived support and negative network interactions. There was no evidence of either perceived availability of illness-related network support buffering or negative illness-related network interactions amplifying the effect of HIV/AIDS-related physical symptomatology on depressive symptomatology.     

Mental Health and Spirituality in Later Life: Pastoral Approaches

SUMMARY

This chapter proposes a perspective on providing pastoral care for people at risk of, or who have mental health problems in later life. Two major areas of mental health, depression and dementia are explored, examining their impact on older people and strategies to identify risk in depression, and signs indicating need for pastoral intervention in depression and/or dementia. The work from two studies that examine issues for meaning of people, the first for older people living independently and the second in residential care, form the basis of the material presented in this chapter. It is maintained that pastoral interventions may greatly improve quality of life for these people, their families and carers.¹