Quality of Life in Women Following Various Surgeries of Body Manipulation: Organ Transplantation, Mastectomy, and Breast Reconstruction

This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health.     

Impact of organ transplantation in heart,lung and liver recipients: Assessment of positive life changes

Objective: The majority of psychological studies with organ transplant recipients have examined negative psychological effects. This study aimed to further investigate the positive effects of organ transplantation and to construct a specific measurement instrument.

Design: The initial pool of 14 items for the Positive Effects of Transplant Scale (PETS) was derived from organ recipient interviews. A cross-sectional postal study included 87 heart, 46 lung and 193 liver transplant recipients. The PETS was subjected to principal components analysis (PCA) using varimax rotation, and associations with other measures investigated.

Main outcome measures: PETS and an open-ended item about positive effects.

Results: Coding of the open-ended item revealed that the majority of recipients attributed positive life changes to the transplant experience. PCA of the PETS indicated three factors that accounted for 58.82% of the variance. The 12-item questionnaire assesses improvements in: (1) life philosophy, (2) gratitude and (3) health. The total PETS scores exhibited adequate internal consistency and validity.

Discussion: Most transplant patients report positive psychological effects, which suggests this may be an understudied area. The initial development of an assessment tool provides researchers and clinicians a way to assess the degree and nature of these life changes.     

Leisure-Time Physical Activity and Perceived Health in People Living with Osteoporosis

Leisure-time physical activity (LTPA) represents an important factor contributing to the development and management of osteoporosis yet research linking LTPA with perceived health markers has been limited in this cohort. The purpose of this study was to test the relationship between LTPA and perceived health controlling for select demographic factors and chronic conditions in people living with osteoporosis. Population-health survey data from cycle 2.2 of the Canadian Community Health Survey were used in conjunction with linear multiple regression models. Participants were 1538 (n _female = 1371) adults who reported living with osteoporosis. Demographic factors, chronic conditions, and more frequent participation in LTPA accounted for variance in diverse indices representing perceived health. LTPA was the only predictor to account for unique variance in each marker of perceived health. Overall, it would appear that increased use of LTPA as an adjunct to therapeutic interventions may be a viable aid to enhancing self-perceived health amongst Canadians living with osteoporosis.     

Health-Related Quality of Life and Perceived Need for Mental Health Services in Adolescent Solid Organ Transplant Recipients

The purpose of the current investigation was to assess interest in mental health services among parents of adolescent solid organ transplant recipients and the relationship between parent perceived need for mental health services and patient health-related quality of life (HRQOL). Sixty-three parents rated interest in receiving 10 mental health services, and patient HRQOL ratings were gathered from adolescent transplant recipients and their parents. Ninety-four percent of parents expressed some level of interest in at least one of the proposed services, with over 40 % indicating maximum interest. Parents’ perceived need for mental health services was inversely related to adolescent and parent reports of HRQOL on the behavior, mental health, family cohesion, and parental impact-emotional domains. Results suggest that parents of adolescent solid organ transplant recipients are interested in receiving mental health services for their families. Assessment of need for mental health services and HRQOL may inform the medical team of families requiring intervention.     

School Competence among Adolescents in Low-Income Families: Does Parenting Style Matter?

In the present study, we investigated parenting styles and self-perceived school competence among low-income adolescents in Norway. The purpose of the study was threefold: (1) to identify differences, if any, in self-perceived school competence between low-income ethnic Norwegians and low-income ethnic minorities; (2) to determine differences, if any, in the perception of parenting styles between the groups; and (3) to determine if parenting styles predict self-perceived school competence in the two groups. The sample consisted of 253 adolescents 12–18 years of age; 130 adolescents were ethnic Norwegians, and 123 were from ethnic minorities. Self-perceived school competence was measured using the Scholastic Competence subscale of Harter’s Self-Perception Profile for Adolescents. Perception of parenting style was measured with the following three scales: support, monitoring and neglect. An independent-samples t-test revealed that ethnic minorities reported higher levels of self-perceived school competence than did ethnic Norwegians. No significant difference between the groups in their perception of parenting styles was observed. Support and monitoring were positively correlated with school competence, whereas neglect was negatively correlated with school competence. When all three parenting styles were entered separately into standard multiple regression analyses for the two groups, a high degree of perceived neglect significantly predicted low self-perceived school competence in both groups. This finding indicates how schools and policy makers can explore the types of support that families may need to adopt better upbringing styles.     

Approaching Religiosity/Spirituality and Health from the Eudaimonic Perspective

Religiosity/spirituality (RS) has been linked to positive health outcomes across a large number of studies, with these effects seen most strongly among disadvantaged groups such as minorities, women, and those of lower socioeconomic status (SES). Given that disadvantaged groups typically have worse health outcomes and not better, it is not clear why the effects of RS are stronger for disadvantaged groups. A key difficulty in understanding the relationship between RS and health lies in the theoretical perspectives used in research. Health and well‐being is typically assessed from the hedonic perspective which emphasizes pleasure and happiness as important outcomes and assumes that difficult life situations contribute to negative health. The eudaimonic perspective, on the other hand, emphasizes meaning and relationships, and assumes that difficult life situations can contribute to increased meaning in life and stronger relationships. The eudaimonic perspective provides a better framework for understanding why RS leads to better health for disadvantaged groups for three reasons. First, having meaning in life and strong relationships are related to positive health outcomes and buffer the negative effects of stress. Second, in addition to being more religious, disadvantaged groups report lower hedonic well‐being and report higher eudaimonic well‐being. Third, low SES religious individuals have better than expected health outcomes and low SES materialistic individuals have worse than expected health outcomes. Overall, the eudaimonic perspective better accounts for the research findings in RS and health and provides a strong foundation for future research in this area.     

Mental health and quality of life in non-binary transgender adults: a case control study

Abstract

Background: The social challenges that non-binary people experience, due in part to social intolerance and the lack of validation of non-binary gender identities, may affect the mental health and quality of life of this population. However, studies that have distinguished between non-binary and binary transgender identities are lacking.

Aim: To compare the mental health and quality of life of a community sample of non-binary transgender adults with controls (binary transgender people and cisgender people) matched on sex assigned at birth.

Method: A total of 526 participants were included. Ninety-seven were classified as non-binary and were compared with two control groups: 91 people classified as binary and 338 cisgender people. Only transgender people not on gender affirming hormone treatment or who had not undergone gender affirming surgery were included. Participants were invited to complete an online survey that included mental health and quality of life measures.

Results: Non-binary people reported significantly better mental health than binary transgender people, but worse than cisgender people. Overall, there were no significant differences in quality of life between non-binary and binary transgender participants assigned male at birth and transgender females, but non-binary assigned males at birth had better scores on the psychological and social domains of quality of life than transgender males. Quality of life was better across all domains in cisgender people than transgender groups.

Conclusion: There is an inequality with regard to mental health and quality of life between non-binary (and binary) transgender people and the cisgender population that needs to be addressed. The better mental health scores in non-binary people may reflect lower levels of body dissatisfaction among the non-binary population. Mental health problems and poor quality of life are likely to have social causes and hence legislative measures and broader government-led inclusive directives should be put in place to recognize and to validate non-binary identifying people.     

Active Coping and Perceived Social Support Mediate the Relationship Between Physical Health and Resilience in Liver Transplant Candidates

Without a transplant, end-stage liver disease is associated with significant morbidity and mortality. Transplant candidates endure physical and psychological stress while awaiting surgery, yet little is known about the relationship between physical health and psychological resilience during the wait-list period. This study examined predictors of psychological resilience and mediators of the relationship between physical health and psychological resilience in liver transplant candidates. Wait-listed candidates (N?=?120) from a single Northeast transplant center completed assessments of physical functioning, coping, perceived social support, and resilience. Findings revealed that physical functioning, active coping, and perceived social support were positively associated with resilience; maladaptive coping was negatively associated with resilience. Perceived social support and active coping partially mediated the relationship between physical functioning and resilience. Transplant center care providers should promote active coping skills and reinforce the importance of effective social support networks. These interventions could increase psychological resilience among liver transplant candidates.     

Health Locus of Control After Lung Transplantation: Implications for Managing Health

Health locus of control (HLC) beliefs may influence the health behaviors that patients perform on their own behalf. Likewise, the HLC beliefs that clinicians consider desirable may influence how active they encourage patients to be in managing health. It remains unclear how involved lung recipients want to be and how involved transplant clinicians believe they should be. The aims of this study were to describe HLC beliefs and behaviors manifested by recipients and clinicians in the setting of lung transplantation. Mixed-methods were used, including quantitative techniques to measure demographics, clinical characteristics, and HLC using the Multidimensional Health Locus of Control Scale (MHLC), and qualitative techniques to explore how HLC beliefs were manifest in the clinical setting. Nearly all participants manifested behaviors consistent with high internality and externality, highlighting the importance of holding ‘dual health locus of control’ beliefs for optimal health management and lending support for recipients and clinicians to share responsibility for managing post-transplant health.Funded by the Nursing & Social Sciences Council of the International Society of Heart and Lung Transplantation.     

Mental Health of Parents of Children with Congenital Zika Virus Syndrome in Brazil

This study aims to analyze the potential impact of taking care of a child with congenital Zika virus syndrome (CZS) on the mental health of parents. Specifically, three objectives were formulated: (a) to assess the level of mental health of the parents; (b) to examine the influence of subjective well-being and fatigue as predictors of parents’ mental health; and (c) to identify the impact of sociodemographic variables on parents’ mental health. Sixty-nine mothers (M_age?=?26.38; SD?=?6.23) and 17 fathers (M_age?=?31.41; SD?=?7.57) of children diagnosed with CZS took part in this study. They answered a questionnaire containing measures of positive and negative affects, life satisfaction, fatigue, mental health, as well as sociodemographic questions. The results indicated that approximately 7% of the participants had low levels of mental health and probable emotional disorder. In addition, higher levels of fatigue and negative affects and lower levels of life satisfaction significantly predict a lower level of mental health. Finally, comparative analysis showed significant differences between fathers and mothers: mothers reported experiencing fewer positive and more negative affects, a lower level of satisfaction with life, a higher level of fatigue and worse mental health. In summary, this article presents an overview of the mental health of mothers and fathers of children with CZS and points the way to devising strategies for psychological intervention that promote the adaptation of parents to this kind of developmental disability in the family.     

MMPI Profiles of Liver and Heart Transplant Candidates With and Without Significant Histories of Heavy Alcohol Use

This study compared the Minnesota Multiphasic Personality Inventory (MMPI) profiles of liver and heart transplant candidates with (n = 104) and without (n = 253) significant histories of heavy alcohol consumption. The alcohol and nonalcohol groups had similar overall mean profiles with significant or marginally significant (i.e., T 69) clinical elevations on Scales 1, 2, and 3. However, significantly higher proportions of those in the liver transplant group than in the heart transplant group scored within the clinical range on Scales F, 4, 6, and 8. In addition, the proportions of respondents obtaining clinically elevated scores were significantly higher for the alcohol than for the nonalcohol group on Scale 4 and the MacAndrew Scale; the proportion was higher for the nonalcohol than for the alcohol group on Scale K. The overall similarity of the mean profiles indicates that candidates for liver or heart transplantation with and without histories of heavy alcohol use generally display similar psychological presentations. The observed differences between the liver and the heart transplant groups may reflect impairments in mental status among liver transplant candidates due to metabolic consequences of liver disease. The differences between the alcohol and the nonalcohol groups may be more a reflection of past behavioral patterns than present psychological status.     

Group Psychotherapy in France

This article discusses group therapy as part of a multidisciplinary approach to the management of the various psychological and physical rehabilitation concerns posed by kidney and liver transplant candidates and recipients at Howard University Hospital in Washington, DC. The group's history, format, intervention foci, and roles of clinicians and patients attending the group are described and evaluated. Given the relative paucity of research literature in this area, the authors offer recommendations for empirical evaluation of the benefits of multidisciplinary group psychotherapy in ameliorating physical and emotional suffering and prolonging life among transplant patients.     

Epidemiology of Insomnia in College Students: Relationship With Mental Health,Quality of Life,and Substance Use Difficulties

The purpose of this study was to evaluate the prevalence and correlates of insomnia using rigorous diagnostic criteria and a comprehensive assessment battery. In a large sample (N = 1,074) of college students (mean age 20.39 years), participants were asked to complete a week-long sleep diary and comprehensive questionnaire packet assessing recommended daytime functioning domains (i.e., fatigue, quality of life, depression, anxiety, stress, academic performance, substance use) during the academic year. A significant portion of this sample of college students met proposed DSM-5 criteria for chronic insomnia (9.5%). The chronic insomnia group reported significantly worse sleep, fatigue, depression, anxiety, stress, and quality of life, and greater hypnotic and stimulant use for sleep problems. There were no differences between groups on excessive daytime sleepiness, academic performance, or substance use. This was a rigorous and comprehensive assessment of the prevalence and psychosocial correlates of insomnia. Insomnia is a significant problem in college students and should be regularly assessed. More research is also needed to guide treatment in this population.     

Health disparities between binary and non binary trans people: A community-driven survey

Abstract

Background: Genderqueer and nonbinary () people have remained largely invisible in health research. Previous research shows worse outcomes on health indicators for trans people when compared with cisgender controls, but the differences between binary trans and GQNB individuals are inconclusive.

Aims: To compare overall health and well-being of GQNB people with controls of trans men and trans women, taking into account the impact of the additive effect of their socio-economic position, as well as their current need for gender affirming medical interventions.

Methods: A community-driven survey was conducted in 2016 in five countries (Georgia, Poland, Serbia, Spain, and Sweden). Self-reported health and general well-being were analysed for differences between binary trans and GQNB respondents. The effects of multiple control variables (age, economic situation, educational level, belonging to an ethnic, religious, sexual or ability minority group, sex assigned at birth) as well as the current need for gender affirming medical interventions were controlled for.

Results: The sample consisted of 853 respondents aged 16 and older, with 254 trans women (29.8%), 369 trans men (43.2%), and 230 GQNB people (26%). GQNB respondents showed significantly worse self-reported health and worse general well-being in comparison to binary trans respondents. Additional negative impacts of having a lower educational level, having more economic stress, and belonging to a disability minority group were found. Being in need of gender affirming medical interventions contributed significantly to worse self-reported health, whereas being younger contributed to worse general well-being.

Discussion: In understanding health disparities between binary trans and GQNB people, it is necessary to take into account the additive effect of multiple socio-economic positions, and the current need for gender affirming medical interventions. The high proportion of GQNB respondents who report worse health outcomes highlights the need for policy makers and health-care providers in creating nonbinary-inclusive environments.     

Family caregiver's self-perceived health status and its relation to burden

The study aims to analyze how health is self-perceived by a sample of caregivers of dependant relatives and how it compares with general Spanish population scores. The study also focuses on the relations between self-perceived health and burden. The sample comprised 1,257 caregivers living in Biscay who completed the protocol including sociodemographic data, measures of health-related quality of life (SF-36) and burden (Zarit Burden Inventory). Results show that the health perception of the caregivers taking part into the study reached lower scores in comparison to general Spanish population and that this perception was lower in mental than in physical health. Correlational data supports previous findings indicating that high levels of burden are associated with a worse perception of mental and physical health and provide information on how to guide interventions to improve family caregivers' quality of life.     

Body-image,quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.     

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.     

The role of religion in heart-transplant recipients' long-term health and well-being

While religion has long been recognized clinically to provide important coping strategies in the face of serious health problems, there has been little systematic consideration of its role in organ transplant recipients' long-term reactions and adjustment to this experience. This study examines these issues through qualitative and quantitative evaluation of longitudinal data collected from 40 adult heart recipients followed during their first year post-transplant. Large proportions of recipients expressed strong beliefs and were able to increase religious participation over the 12-month study period. They delineated specific ways in which their faith had provided them support, as well as ways in which the transplant experience itself further strengthened their beliefs. We found empirical evidence that recipients with strong beliefs who participated in religious activities had better physical and emotional well-being, fewer health worries, and better medical compliance by the final 12-month assessment. The findings suggest the development of specific nursing, social-service, or pastoral-involvement strategies, continuing staff education about the role of religion in patient care. The implications of such interventions for maximizing quality of life in transplant recipients are discussed.This study was funded by grants from the National Institute of Mental Health.     

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility

Background/ObjectiveThe Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis.MethodA total of 342 community participants (61.6% women; M_age = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; M_age = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive.ResultsThe original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis.ConclusionsThe SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults.     

Psychological assessment of quality of life following liver transplantation

Administered measures of functional status, psychological distress, and quality of life to a consecutive series of 48 liver transplant recipients in follow-up clinic. Results showed that nearly total functional recovery was the norm. Thirty-six patients (75%) had a Karnofsky Performance Status (KPS) score of 80–100. Twelve transplant recipients had KPS scores below 80; none were employed, and most had been transplanted within 1 year. In spite of their impaired financial status, eight of these 12 reported being mostly satisfied on the self-report Quality-of-Life Scale (QLS). For the posttransplant sample as a whole, 83% were mostly satisfied with their quality of life. Pre- and posttransplant patient samples were not significantly different in reporting mild emotional distress. Results for the small subgroup with significant objective or subjective problems in achieving acceptable quality of life following liver transplantation were reviewed. Higher than normal emotional distress on the Symptom Checklist (SCL-90-R) was consistently reported by these patients. Prospective studies are needed to identify predictor variables of quality-of-life problems and to develop prevention and rehabilitation interventions.