Quality-of-life after penile prosthesis placed at radical prostatectomy

Abstract

The clinical and psychosocial effects of immediate penile prosthesis implantation at the time of radical prostatectomy (RP) were investigated in 97 consecutive patients and 68 partners. Prosthesis recipients reported more frequent sexual contact, fewer marital problems and slightly fewer sexual functioning problems than the RP-alone patients. There were no group differences on any sociodemographic characteristics, on disease recurrence, on physical and psychosocial functioning, or on reported depression. Patients who chose the prosthesis did, however, evidence less of a link between depression and functional limitations and between depression and marital problems. They also had lower levels of agreement with their partners in reporting their own depression, as compared to the patients who opted for RP surgery alone. We conclude that the penile prosthesis was associated with an increased frequency of sexual contact, a reduction in reported marital problems, and stylistic differences between the two patient groups in dealing with affect.     

Enhancing recovery rates: Lessons from year one of IAPT

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.     

Is laughter the best medicine?

Abstract

One hundred patients with chronic arthritis were interviewed and completed questionnaires about coping, well-being and their use of humour. A comparison of patients scoring high or low on each of 3 measures of humour showed that those who reported they used humour least, had most difficulty recognising it and valued it least. They also reported more depressive symptoms and lower personal self-esteem. Regressions showed that depression was best predicted by the inactive use of humour in coping. and to a lesser extent, pain intensity. Cluster analysis of data on general coping strategies showed that valuing humour distinguished two-thirds of patients who were relatively normal and cautiously optimistic, from the other third, where the outlook was negative and hopeless. Those with a more positive view tended to be younger, less disabled, in less pain and with several social advantages on a number of indicators. However they also had a longer duration of disease. Two-thirds of patients said they were able to laugh when in pain but those most able to do this had less intense pain during the previous week. Furthermore the most disabled arthritis patients found laughter to be a most effective strategy. The research has implications for preventing depression and coping with disability.     

Depression,anxiety and social support in rheumatoid arthritic women without and with a spouse

Abstract

A comparison was made of income and physical, social and psychological aspects of health between 22 female patients who had never married, 127 patients living with a spouse and 53 patients who were widowed or divorced. No significant differences were found between never married patients and patients living with a spouse. The widowed or divorced patients however had a lower income, reported less potential support, more depression and anxiety than the patients who were never married and those living with a spouse. The relationship of social support to depression and anxiety was investigated in spouseless patients (n=75) and in those living with a spouse (n=127). In both groups of patients, less potential support was found to be related to more anxiety. In addition, pain was found to contribute significantly to depression and to anxiety only in the patients living with a spouse. With regard to the latter, it is suggested that the debilitating influence of pain on the relationship with the partner might have been the mediating factor.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

On the Relation Between Job Characteristics and Depression: A Longitudinal Study

The current study assumes that workers actively influence the characteristics of their work environment. Not only will one's work environment (job characteristics) affect personal characteristics, such as feelings of depression; depression in turn is expected to affect the characteristics of one's work environment as well. Using a sample of 593 young Dutch workers, a longitudinal model relating feelings of depression and job characteristics to each other was tested using structural equation modeling. The results largely supported our expectations. Depressive workers were less likely to experience a job transition than non-depressive workers. If depressive workers did experience a job transition, work outcomes were less positive than for nondepressive workers. Thus, it appears that the relation between job characteristics and depression can be construed as a reciprocal relation. Implications and limitations of the study are discussed.     

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

Very Long-term Recall in Infants: Infantile Amnesia Reconsidered

Abstract

Subjects who had participated in a study on non-verbal recall before their first birthday returned to the laboratory one year later and were tested for recall of their previous visit. During their previous visit they had shown recall of both familiar and novel actions on a set of novel objects. However, after a year's delay, evidence for recall was found for the familiar actions only. One action in particular was responsible for this finding: feeding a teddy bear with a schematic bottle. The majority of the returning subjects who had been shown this action repeated it after a year, whereas none of the other returning subjects and few of the subjects in the control groups performed this action. The results indicate that young infants have the ability to recall an event both at 11 months of age and after a delay as long as one year. The finding that infants can recall during a period that later becomes inaccessible to memory is important to our understanding of infantile amnesia.     

Book Review: Feminism and Psychotherapy: Reflections on Contemporary Theories and Practices

Abstract

I felt a compulsion to return to the Roseland Peninsula in Cornwall late last autumn. My son had returned for his third university year, my daughter had left for her first university term. I felt very sad as one glorious autumn day succeeded another and I walked until I was exhausted. I felt full of memories, of endless summer and Easter holidays, of excited children running to beaches, of expeditions, of tired children trailing home, of prawning, sailing, picnics, crabbing—and later of long walks and evenings spent playing chess, racing demon or scrabble. All past. A chapter had closed, everything around me echoed and I mourned for what had passed. I remember vividly sitting alone gazing at a favourite view, acknowledging my womb had done its work, and how immensely sad that felt.     

The psychosocial predictors of long-term distress in partners of patients with acute coronary syndrome

Objective: Partners of acute coronary syndrome (ACS) patients are at risk of experiencing long-term distress and the purpose of this study was to identify its predictors.

Design: Using an observational design, 80 partners of ACS patients completed validated questionnaires at three time points. The predictor variables, marital satisfaction and optimism were assessed three weeks after patient hospital discharge (T1). The outcomes, depressive symptoms and physical health status (from a quality of life scale) were measured 6 (T2) and 12 (T3) months post-discharge, and scores were combined to indicate the long-term response.

Main outcome measures: Depressive symptoms and physical health status.

Results: Partner depressive symptoms increased and physical health status deteriorated over the months following the patients’ ACS. After controlling for demographics, clinical severity of ACS and T1 levels of the outcome variable, partners’ long-term depressive symptoms were predicted by poor marital satisfaction and low optimism at T1, and poor physical health status was predicted by low T1 optimism.

Conclusion: Psychosocial factors are predictors of long-term distress for ACS partners. Partners in an unhappy marriage or with low optimism after ACS are at an increased risk of depression and low physical health status, and should be the target of additional support.     

Personal characteristics as predictors for dual career dropout versus continuation – A prospective study of adolescent athletes from German elite sport schools

ObjectivesThe primary objective of this study is to identify the personal characteristics that predict dropout versus continuation among dual career athletes from different sports who attend sports schools. These schools provide an optimal environment for combining an academic education with a sports career.MethodsAt the end of the school year, all 10th graders (52 girls, 73 boys) from five out of six sports schools in Saxony, Germany, completed a standardised questionnaire that measured personal characteristics deemed important for a successful career – personality traits (Freiburger Persönlichkeitsinventar – FPI), goal orientation (Sport Orientation Questionnaire – SOQ), and volitional skills (Volitional Components in Sport – VKS). In addition, demographic and sport-related data were collected. One year later, at the end of 11th grade, all participants again completed the questionnaire.ResultsAt Time 2, 37 athletes (29.6%) had dropped out of their sport career, and 88 athletes were still pursuing their sport career. A majority of the dropouts were from individual sports (n = 31) and were females (n = 23). A logistic regression analysis of physical complaints (higher for dropouts), win motivation and self-optimisation (each lower for dropouts) as significant covariates correctly classified 65% of the dropouts and 92% of the non-dropouts.ConclusionsPersonal characteristics, motivation and volition in particular, played important roles for those adolescent athletes who remained active in their sport. Accordingly, it is suggested that young athletes receive psychological training focused on these specific personal characteristics.     

The relationship between childhood abuse and depression in a sample of Chinese people who use methamphetamine

Background/ObjectivePrevious studies have shown that childhood abuse is associated with symptoms of depression. This study aims to examine the prevalence of childhood abuse or neglect and its correlation with depression among a sample of Chinese people who use methamphetamine.MethodPeople who use methamphetamine (MA) (N = 1,173) were recruited from government-operated drug rehabilitation centres in Anhui province, China. Participants were assessed using the short form of Childhood Trauma Questionnaire and the Beck Depression Inventory-II for childhood abuse or neglect and depression symptoms.ResultsA total of 44.6% of people who use MA reported moderate/severe childhood abuse or neglect, and 56.9% of this sample were diagnosed with depression. Emotional abuse, sexual abuse, emotional neglect and physical neglect were revealed to increase the risk of depression. Multivariable regression analyses showed that depression scores were significantly predicted by gender, duration of drug use, sexual abuse and emotional neglect (model R² = .08, p < .001). The interaction between emotional neglect and duration of drug use on the depression was statistically significant.ConclusionsThese analyses indicate that sexual abuse and emotional neglect increase the severity of depression in individuals who use MA in drug rehabilitation centres of China.     

Characteristics of patients in routine psycho-oncological care,and changes in outcome variables during and after their treatment

Objective: The primary aim of this study was to determine the characteristics of clients and interventions in routine psycho-oncological care. The secondary aim was to determine the course of symptomatology during and after the psychological interventions.

Design: During a period of nine months, all clients who sought help in one of the seven psycho-oncological care institutes in the Netherlands were approached to participate in the present study (N = 483). Information was gathered with respect to demographic and medical characteristics, and type and duration of the interventions. In addition, depression, anxiety, well-being, quality of life, fatigue and daily function were determined before interventions and three and nine months later.

Results and conclusions: Compared to the Dutch cancer population, patients in psycho-oncological care were more often young and female. Compared to the general Dutch population, they were highly educated and were more likely to have a partner. Clinical levels of depression, anxiety and/or fatigue were found among 83% of the patients. After three months, only 23% had completed their intervention; this figure was 62% after nine months. Symptoms decreased significantly for all outcome variables. An importance difference with randomised controlled trials is the low session frequency and the long intervention time of patients in clinical care.     

The association between attention control,anxiety, and depression: the indirect effects of repetitive negative thinking and mood recovery

Background and objectives: Attention control deficits and repetitive negative thinking (RNT; i.e., rumination) may be key factors in the development and persistence of depression and anxiety, although their role in symptom development remains poorly understood. This represents a gap in the literature, as interventions targeting attention control and associated RNT may enhance interventions and prevent costly relapse. The current study was designed to examine the serial indirect effects of transdiagnostic RNT and negative affect recovery following a lab-induced stressor on the association between attention control deficits and trait anxiety and depression.

Methods: Participants were N?=?583 university students who completed validated measures of RNT, anxiety, depression, and mood ratings pre- and post-stressor. Stress was induced using a modified version of the Trier Social Stress Test.

Results: Results of cross-sectional indirect effects models indicated that RNT and mood recovery explained the association between attention control deficits and trait anxiety and depression. Results from reversed models indicated that only the indirect effect of RNT was significant.

Conclusions: Findings suggest that RNT and mood recovery processes play an important role in explaining anxiety and depression symptoms. Additional work is needed to examine their role in symptom development and maintenance over time.     

Depression and marital status determine the 10-year (2004–2014) prognosis in patients with acute coronary syndrome: The GREECS study

Background: The aim of the present work was to examine the association of depression and marital status, with the long-term prognosis of acute coronary syndrome (ACS), among a Greek sample of cardiac patients.

Methods: From October 2003 to September 2004, a sample of 2172 consecutive ACS patients from 6 hospitals was enrolled. In 2013–2014, the 10-year follow-up was performed in 1918 participants. Depressive symptoms were evaluated using the validated CES-D score (range 0–60), while marital status was classified as: single, married/cohabitants, divorced and widowed at the time of entry to the study.

Results: Patients in the upper tertile of CES-D (>20 score) had 41% (95%CI 14%, 75%) higher risk of ACS incidence as compared with those in the lowest (<7 score). In contrary, married patients had 29% lower risk (95%CI 6%, 46%) of ACS mortality compared with single, widowed or divorced. Multi-adjusted analysis revealed that among the ‘not married’ patients, 1-point increase in the CES-D score was associated with 2% (p = .02) and 4% (p = .001) higher risk of having non-fatal and fatal cardiac events, respectively.

Conclusions: The present study highlights the important role of depression in the context of marital relationships among ACS patients. Secondary public health care intervention programmes are needed to improve patient outcomes and minimise disease burden in clinical and community setting.     

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     

Does worry affect adjustment to bereavement? A longitudinal investigation

Background and objectives: Repetitive thought is a trans-diagnostic risk-factor for development of psychopathology. Research on repetitive thought in bereaved individuals has focused primarily on clarifying the role of rumination, repetitive thinking about past negative events and/or negative emotions. While detrimental effects of rumination have been demonstrated following bereavement, surprisingly few studies have aimed to clarify the role of worry, repetitive thinking about potential future negative events, in adjustment to loss. This study sought to fill this gap in knowledge. Methods/Design: One hundred eighty-three bereaved individuals (85.3% women) filled out questionnaires on sociodemographic and loss-related characteristics, worry, and symptom measures of depression, anxiety, and prolonged grief. After six months, 155 participants completed worry and symptom measures again. Using multiple regression analyses, concurrent and longitudinal associations between loss-related variables, worry, and symptoms of psychopathology were examined. Results: Main results were that worry was strongly positively associated with symptoms of anxiety, depression and prolonged grief concurrently and also predicted higher levels of anxiety, depression and prolonged grief longitudinally. Conclusions: Findings suggest that worry influences adjustment to bereavement negatively and may be a potential target in grief therapy, especially when aiming to reduce anxiety.     

Chronic pelvic pain: A meta-analytic review

Abstract

Chronic pelvic pain (CPP) in women of reproductive age is a common complaint; for many women no identifiable pathology can be found. Research has suggested that women who have chronic pelvic pain without obvious pathology differ on a range of psychological characteristics, such as anxiety and depression, compared with those with identified pathology. A meta-analysis of 22 studies was undertaken to clarify these issues. Results showed that there were no significant differences on a range of psychological variables between women who were identified, via laparoscopy and clinical judgement, as having organic disorders and those who were not so identified. When women with chronic pelvic pain were compared with pain-free groups a profile of elevated depression, anxiety, neuroticism and psychopathology was found which is consistent with findings from studies of other painful conditions.     

Dreamwork beyond psychoanalysis

Abstract

Dr. Montague Ullman's work with dream groups is the main subject of this paper. After detailing his method there follows an account of the author's experience in a dream workshop run by Dr. Ullman. The theoretical issues involved in this work are discussed, particularly the ideas of Trigant Burrow, an early American analyst who believed in species connectedness, and David Bohm's theory of implicate order. Dr. Ullman's intention to return to the healing process in dreams to ordinary people is connected with the author's paper “Thoughts on the Healing Process.” The implications for psychoanalysis of these holistic ideas are considered.     

Chronic Pain Syndromes and Violence Against Women

Abstract

Chronic pain is a common form of disability, and is often reported among women with a history of victimization. In the present study, we combine six pain symptoms into a measure of self-reported pain, and compare women who have experienced child or domestic abuse with those who do not report such a history. A sample of 110 female patients (57 abused, 53 non-abused controls) was drawn from an adult primary-care practice of 905 patients in a small, affluent, predominantly Caucasian community in northern New England. The subjects ranged in age from 18 to 88 (M = 47). Subjects completed a self-administered questionnaire that was used clinically as part of the new-patient work-up. Women who reported either child or domestic abuse were significantly more likely to report pain symptoms than women in the control group. There was no significant difference between women who had experienced domestic abuse vs. child abuse alone. These findings held true even after controlling for depression.