Psychological adjustment among African American breast cancer patients: one-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention.     

Cognitive-behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men.

The effects of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention on psychological distress and plasma free testosterone in symptomatic, HIV-seropositive men were examined. Participants were randomized to either CBSM (n = 42) or a wait-list control group (n = 23). Men in the CBSM intervention showed significant increases in testosterone, whereas control participants showed significant decreases. Those participating in CBSM had significant distress reductions, whereas controls showed no such change. Alterations in free testosterone were inversely related to changes in distress states over time, independent of any changes in cortisol. These findings demonstrate that a short-term CBSM intervention increases free testosterone levels among symptomatic, HIV-seropositive men, and alterations in free testosterone are associated with changes in psychological distress observed during CBSM.     

Exploring Sexual Minority Women’s Experiences of External and Internalized Heterosexism and Sexism and their Links to Coping and Distress

This study examined experiences of external and internalized heterosexism and sexism and their links to coping styles and psychological distress among 473 sexual minority women. Using an online sample of United States lesbian and bisexual women, the findings indicated that many participants experienced heterosexist and sexist events at least once during the past 6 months, and a number of participants indicated some level of internalized oppression. Supporting an additive multiple oppression perspective, the results revealed that when examined concurrently heterosexist events, sexist events, internalized heterosexism, and internalized sexism were unique predictors of psychological distress. In addition, suppressive coping and reactive coping, considered to be maladaptive coping strategies, mediated the external heterosexism-distress, internalized heterosexism-distress, and internalized sexism-distress links but did not mediate the external sexism-distress link. Reflective coping, considered to be an adaptive coping strategy, did not mediate the relations between external and internalized heterosexism and sexism and psychological distress. Finally, the variables in the model accounted for 54 % of the variance in psychological distress scores. These findings suggest that maladaptive but not adaptive coping strategies help explain the relationship between various oppressive experiences and psychological distress.     

A threshold model of social support, adjustment, and distress after breast cancer treatment

This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support (Social Provisions Scale), quality of life (Functional Living Index--Cancer), adjustment (Psychological Adjustment to Illness Scale) and psychological distress (Brief Symptom Inventory) approximately 3 weeks after surgical treatment and 8-16 months later. Consistent with a threshold model, multiple regression analyses suggested a significant curvilinear relationship between social support and distress at Time 1 and Time 2 and between social support and adjustment at Time 2. Consistent with this model, the significant bivariate correlations between social support and outcomes were accounted for almost entirely by women in the lowest quartile of support. Social support among women in the highest 3 quartiles was unrelated or only marginally related to adjustment and distress.     

An exploratory study of social support, distress, and life disruption among low-income Hispanic women under treatment for early stage breast cancer.

Relationships between distress and perceived availability of social support were examined in 51 Hispanic women being treated for early stage breast cancer. Distress and different types (emotional, instrumental) and sources (spouse, women family members, other family members, friends) of support were measured at presurgery, postsurgery, and at 3-, 6-, and 12-month follow-ups. Emotional support from friends and instrumental support from spouse at presurgery predicted lower distress postsurgery. No other prospective benefits of perceived support emerged. Distress at several time points predicted erosion of subsequent support, particularly instrumental support from women in the family. In contrast to the adverse effects of distress (and independent of them), illness-related disruption of recreational and social activities at 6 months elicited greater support at 12 months.     

Group intervention for widowed survivors of suicide.

This study evaluates the effects of two group interventions, the Bereavement Group Postvention (BGP) and the Social Group Postvention (SGP), on the bereavement outcomes in widowed survivors of suicide. The goals were to determine if the group interventions would significantly decrease levels of depression, psychological distress, and grief, as well as significantly increase the level of social adjustment among widowed survivors of suicide. Sixty widowed survivors of suicide were randomized to either the BGP or SGP intervention for 1-1/2 hour weekly sessions over an 8-week period. Study participants were recruited through various media and community referrals and initiated telephone contact with the study investigators. Statistically significant changes were found on all measures when the SGP and the BGP were combined for analyses on posttreatment assessments at 3 to 5 days after completion of the group intervention, and 6 months and 12 months after the intervention. Participants experienced a significant reduction in overall depression, psychological distress, and grief, as well as an increase in social adjustment. Further research with tighter controls of confounding variables as well as the inclusion of a no-treatment control group is indicated.     

Religious coping,stigma, and psychological functioning among HIV-positive African American women

The present study examined the role of religious coping in psychological distress and adjustment both cross-sectionally and longitudinally among 141 HIV-positive African American women. Cross-sectional analyses showed that negative religious coping was associated with poorer mental health and functioning, and greater perceptions of stigma and discrimination. Longitudinal analyses revealed that greater negative religious coping at baseline significantly predicted greater changes in mental health in a negative direction 12 months later. Positive religious coping was not associated with any measures of psychological well-being, nor did it predict any mental health outcomes at 12 months. However, participants who experienced high levels of HIV-related stigma and reported high levels of positive religious coping were less depressed than those who reported lower levels of positive religious coping. These results suggest that for this population, negative religious coping was a more salient determinant of psychological distress than positive religious coping was of psychological health.     

Dispositional optimism as a predictor of men's decision-related distress after localized prostate cancer.

This study investigated prospectively the relationship between optimism, threat appraisal, seeking support and information, cognitive avoidance, physical treatment side effects, and decision-related distress in 111 men with localized prostate cancer. Men were assessed at diagnosis and 2 and 12 months after treatment. Baseline decision-related distress predicted distress 2 and 12 months after treatment. Optimism was a significant prospective and concurrent predictor of decision-related distress, with the effect mediated by proximal cancer threat appraisal. Seeking support and information and cognitive avoidance were not associated with decision-related distress at any time point. For physical treatment side effects, concurrent urinary symptoms were predictive of decision-related distress 2 months after treatment. Results suggest that decision-related distress is generated by similar processes to that of the psychological distress that follows a cancer diagnosis. Screening for men with high decision-related distress for referral to in-depth decision support is suggested. Outcome expectations may present as a therapy target to increase the effectiveness of decisional support that is utility based.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

Neuroticism,Extraversion, Perceived Social Support,and Escape Television Viewing as Determinants of Psychological Distress in Crime Victims

This study describes a longitudinal analysis of the relationship among neuroticism, extraversion, educational level, perceived social support, escape viewing, and psychological distress in crime victims. A sample of 170 crime victims completed self-report measures of these concepts. Personality traits, educational level, and baseline rates at 3 months postcrime of perceived social support and escape television viewing were modeled as predictors of psychological distress at 6 and 9 months postcrime. Neuroticism and extraversion significantly predicted psychological distress following victimization. Escape viewing had direct effects on distress and mediated the relationship between neuroticism and distress. Distress symptoms at 3 months were the strongest predictors of distress at 6 and 9 months postcrime.     

Reciprocal relationships between resource loss and psychological distress following exposure to political violence: an empirical investigation of COR theory's loss spirals

Abstract We conducted a four-wave prospective study of Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem, interviewed between 2007 and 2009 at 6-month interval to explore transactional relationships between resource loss (i.e., intra and interpersonal resource loss) and psychological distress (i.e., posttraumatic stress disorder and depression symptoms). Initially, 1196 Palestinians completed the first wave interview and 752 of these participants completed all four interviews. A cross-lagged panel design was constructed to model the effects of trauma exposure on both resource loss and psychological distress and the subsequent reciprocal effects of resource loss and psychological distress across four time waves. Specifically, resource loss was modeled to predict distress, which in turn was expected to predict further resource loss. Structural equation modeling was used to test this design. We found that psychological distress significantly predicts resource loss across shorter, 6-month time waves, but that resource loss predicts distress across longer, 12-month intervals. These findings support the Conservation of Resources theory's corollary of loss spirals.     

A randomized clinical trial of a brief, problem-focused couple therapy for depression

The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n = 18) or a waitlist control group (n = 17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.     

Randomized Controlled Pilot Study of Cognitive-Behavioral Therapy in a Sample of Incarcerated Women With Substance Use Disorder and PTSD

This randomized controlled pilot study compared a cognitive-behavioral therapy (Seeking Safety; SS) plus treatment-as-usual (TAU) to TAU-alone in 49 incarcerated women with substance use disorder (SUD) and posttraumatic stress disorder (PTSD; full or subthreshold). Seeking Safety consisted of a voluntary group treatment during incarceration and individual treatment after prison release. TAU was required in the prison and comprised 180 to 240 hours of individual and group treatment over 6 to 8 weeks. Assessments occurred at intake, 12 weeks after intake, and 3 and 6 months after release from prison. There were no significant differences between conditions on all key domains (PTSD, SUD, psychopathology, and legal problems); but both conditions showed significant improvements from intake to later time points on all of these outcomes across time. Secondary analyses at follow-up found trends for SS participants improving on clinician-rated PTSD symptoms and TAU participants worsening on self-reported PTSD symptoms. Also, SS demonstrated continued improvement on psychopathology at 3 and 6 months, whereas TAU did not. However, alcohol use improved more for TAU during follow-up. Satisfaction with SS was high, and a greater number of SS sessions was associated with greater improvement on PTSD and drug use. Six months after release from prison, 53% of the women in both conditions reported a remission in PTSD. Study limitations include lack of assessment of SS outcomes at end of group treatment; lack of blind assessment; omission of the SS case management component; and possible contamination between the two conditions. The complex needs of this population are discussed.     

Factors Associated with Psychological Distress among Women of African Descent at High Risk for BRCA Mutations

Little is known about psychological distress among women of African descent who are at high risk for a BRCA mutation. This is a group for whom breast cancer risk reduction is critical due to the group’s high rates of breast cancer mortality. Distress is important to consider as it may reduce the potential benefit of genetic counseling and negatively affect decision making related to risk reduction. The goals of the current study were to examine breast cancer-specific distress and depressive symptoms in women of African descent at who are at high risk for a BRCA mutation and to identify background factors associated with these outcomes. Participants were 148 high-risk African American and Caribbean women who were part of a larger study that offered participants BRCA counseling at no cost. Participants completed the Impact of Events Scale, which assessed breast cancer-specific distress, and the Center of Epidemiological Studies-Depression Scale, which assessed depressive symptoms. Results of analyses revealed that almost half of the sample achieved scores indicating high and clinically significant breast cancer-specific distress, while almost one-third had clinically significant depression scores. Results further showed that low income was significantly associated with cancer-specific distress, while having a cancer diagnosis was significantly associated with depressive symptoms. These results underscore the need for targeted psychological support throughout the genetic risk assessment process for this particular high-risk group.     

Coping with a threat to life: A longitudinal study of self-concept,social support,and psychological distress

The relationship of self-concept (self-esteem and mastery) and social support to psychological distress was studied among 68 Israeli women immediately prior to undergoing biopsy for suspected cancer (acute stress) and 3 months later for the noncancer group (everyday stress). It was predicted that women with stronger self-concepts and more social support would experience less state depression and state anxiety during the acute crisis than women with weaker self-concepts and less social support. It was further predicted that self-concept would be more critical than social support due to the acute nature of the event. Finally, self-concept was predicted to be related to psychological distress both during the acute and everyday stress situations (a direct effect), while social support was predicted to be related to psychological distress only during the acute stress situation (a buffering effect). The hypotheses were generally confirmed. However, self-concept and social support were seen as complexly related to psychological distress during the acute phase, one not necessarily being more critical than the other. The selective employment of available resistance resources to fit the situation and implications for preventive intervention were discussed.     

A randomized controlled trial of a coping group intervention for adults with HIV who are AIDS bereaved: longitudinal effects on grief.

The authors sought to study the longitudinal effects of a cognitive-behavioral group intervention for coping with AIDS bereavement among a diverse sample of adults who were HIV positive. Participants (N = 267) were randomly assigned to receive the 12-week intervention or individual therapy upon request. Measures were administered at baseline, postintervention, and 4-, 8-, and 12-month follow-ups. Longitudinal data were analyzed with linear mixed models to examine change in grief by condition across the study period and the effect of the intervention on grief through its interaction with psychiatric distress. The authors used the Grief Reaction Index to assess grief and the Symptom Checklist-90-Revised to assess global psychiatric distress. Participants in both conditions reported decreases in grief severity. However, among those with higher levels of psychiatric distress, participants in the group intervention had significantly lower grief severity scores compared with participants in the individual therapy condition. The long-term effectiveness of this AIDS-bereavement intervention for psychiatrically distressed people with HIV/AIDS supports the need for tailored interventions among those at risk for complicated grief responses.     

Trajectories of Adjustment to Couple Relationship Separation

To test a stress‐diathesis model of adjustment to separation, the current study describes the trajectories of different aspects of separation adjustment in people formerly married or cohabiting, and moderators of those trajectories. A convenience sample of 303 recently separated individuals (169 women; 134 men) completed assessments of their emotional attachment to the former partner, loneliness, psychological distress, and coparenting conflict at two time points 6 months apart. Multilevel modeling of the overlapping multicohort design was used to estimate the trajectories of these different aspects of adjustment as a function of time since separation, marital status, gender, presence of children from the relationship, who initiated separation, social support, and anxious attachment. Attachment to the former partner, loneliness, and psychological distress were initially high but improved markedly across the 2 years after separation, but coparenting conflict was high and stable. Adjustment problems were similar in men and women, and in those formerly married or cohabiting, except that reported coparenting conflict was higher in men than women. Low social support and high anxious attachment predicted persistent attachment to the former partner, loneliness, and psychological distress. Coparenting conflict is a common, chronic problem for many separated individuals, and individuals with certain psychological vulnerabilities also experience chronic personal distress.     

Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial

To help create an evidence base in Europe for effective interventions that improve the well‐being of homeless people, we tested whether critical time intervention (CTI), a time‐limited intervention developed to support vulnerable people during times of transition, is effective outside the United States. For this multicenter, parallel‐group randomized controlled trial, 183 adults who were moving from shelters in the Netherlands to supported or independent housing were allocated to CTI or care‐as‐usual. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9‐month follow‐up. Outcomes were analyzed with three‐level mixed‐effects models. The primary outcome did not differ between groups. CTI had a significant effect on family support and, for people experiencing less social support, psychological distress. Groups did not differ significantly on social support, fulfillment of care needs, quality of life, self‐esteem, excessive alcohol use, or cannabis use. Because few participants were homeless at 9 months, more research is needed to establish whether CTI can prevent long‐term recurrent homelessness. Given recent emphasis on informal support in public services and positive effects of CTI on family support and psychological distress, CTI is a fitting intervention for Dutch shelter services.     

An Emotionally Inexpressive (Type C) Coping Style Influences HIV Disease Progression at Six and Twelve Month Follow-ups

This study examined the effects of specific psychosocial factors on the progression of HIV infection in 200 HIV-1 seropositive but asymptomatic men and women. At baseline, participants' disease status was determined, and they were administered self-report assessments of coping style, social support and loneliness. Participants were classified at 6 and 12 month follow-ups as progressed or unchanged, compared to their baseline status. In logistic regression analyses, higher baseline Type C coping scores (indicating emotional inexpressiveness and decreased recognition of needs and feelings) significantly predicted progression at 6 months ( p <0.01) and 12 months ( p <0.02), but only among participants classified at baseline as CDC-A2 (between 200-499 CD4 cells/mm 3 ). In participants originally classified as CDC-A1 (CD4 cell counts > 500/mm 3 ), no psychosocial variable showed any significant relationship. Results emphasize the need to consider the disease context, as well as the interaction between biological and psychological factors in contributing to disease progression.     

Gender differences in patterns of emotional distress following heart transplantation

The study provides the first empirical evaluation of gender differences in psychological symptomatology and DSM-III-R major depressive disorder (MDD) across the first year following heart transplantation. An important goal was to identify physical health-related and psychosocial factors that could account for, or mediate, any association between gender and psychological distress. The sample for the present analyses was drawn from a larger cohort of 172 heart recipients and included all 28 women in the cohort plus 118 men who were matched demographically with the group of women. Detailed patient assessments were completed at 2, 7, and 12 months posttransplant. As expected, women's symptom levels were consistently higher than men's. However, while men's symptom levels in all areas declined with time posttransplant, women's distress in the area of depression initially improved but then worsened by the 12-month assessment. The distribution of episodes of MDD showed a temporal pattern of gender differences similar to that of depressive symptoms. The most important mediators of the gender-depression relationship were factors related to early posttransplant daily functional limitations: women reported more impairments in daily activities. Higher levels of such impairments, in turn, predicted subsequently higher depression levels by 12 months posttransplant. Several additional variables pertaining to transplant-related concerns and a low sense of personal mastery—while not serving as mediators—exerted their own independent effects on 12-month depression levels. The findings are relevant to the tailoring of educational and clinical interventions to the individual needs of women and men who receive heart transplants.Roberta G. Simmons, Ph.D., died on February 15, 1993, during data collection for this paper.