The correlations of socioeconomic status,disease activity,quality of life,and depression/anxiety in Chinese patients with rheumatoid arthritis

This study aimed (i) to investigate the relationships among socioeconomic status, disease activity, quality of life, and the psychological status in Chinese rheumatoid arthritis (RA) patients; (ii) to explore the possible risk factors of anxiety and depression. A total of 160 RA patients underwent standardized laboratory examinations and completed several questionnaires. Independent samples t-tests, χ² analyses, and logistic regression modeling were used to analyze the data. We found 30.6% RA patients were anxiety, and 27.5% had depression, which were significantly higher than the control group (7.8 and 11.7%, respectively). And there were significant correlations among education, pain, disease activity, medication adherence, functional capacity, quality of life, and anxiety/depression. Meanwhile, logistic regression analysis revealed that poor quality of life and low education level were significantly associated with anxiety/depression in RA patients. In conclusion, there were significant relationships among education, quality of life, and anxiety/depression in Chinese RA patients.     

A causal analysis of chronic pain and depression

There is considerable controversy in the literature regarding the extent to which chronic pain and depression are associated and the possible causal relationship of such an association. The present study examines these issues with a sample of 243 patients diagnosed with rheumatoid arthritis (RA) who were mailed questionnaires for six waves of data collection. The results indicated that RA patients experience higher levels of depressive symptomatology than community samples. Using a two-latent-variable, cross-lagged design, covariance structural modeling was conducted on self-report measures of pain and depression over 6-month intervals. Results most strongly supported a causal model in which pain predicts depression during the last 12 months of the study.     

慢性腰背痛患者和抑郁症患者的情绪、睡眠及疼痛症状

本研究对慢性腰背痛患者、抑郁症患者和对照人群的疼痛、抑郁水平、焦虑水平和睡眠质量进行测评,发现慢性腰背痛患者的抑郁、焦虑程度增高,失眠较常见;抑郁症患者的焦虑和失眠现象严重,疼痛是其常见症状。结果提示临床上对慢性疼痛患者和抑郁症患者的疼痛、情绪和睡眠问题予以评定和治疗具有重要意义。     

Social Support and Depression in Rheumatoid Arthritis: A One-Year Prospective Study1

Previous research on patients with rheumatoid arthritis (RA) has suggested that social support is beneficial for helping patients to adjust psychologically to the chronic and unpredictable episodes of pain. This study addresses whether support buffers the adverse effects of arthritis pain or whether support results in a decrease in the severity of pain regardless of pain levels in 233 RA patients. The results indicated that patients who reported higher satisfaction with their emotional support when experiencing higher levels of pain were less likely to be depressed than patients who do not perceive such support. The results were obtained after controlling the effects of demographic variables, functional disability variables, and the direct effects of pain and social support. However, moderating effects of emotional support were not found when this relationship was examined over a 6-month period. Rather, causal modeling suggested that both pain and emotional support contributed to a change in depression over two 6-month intervals. The results also suggested that depression may have an adverse effect on change in emotional support over a similar time frame.     

Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology

A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 nonvideo) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.     

Self-blame, compliance, and distress among burn patients

This study addressed self-blame and adaptation by using data collected from 49 patients hospitalized for the treatment of acute burn wounds. Nurses and physical therapists rated patients' compliance with the therapeutic activities essential for proper healing, and they rated pain behavior. After controlling for burn severity and time since admission, regression analyses showed that behavioral self-blame for the burn accident was a significant predictor of poorer compliance with nurses, more pain behavior, and greater depression. People with a prior psychiatric history were also more depressed and more likely to blame themselves for the accident. These data are contrasted with research on the adaptive features of self-blame.     

Clinical Predictors of Depression in Patients with Low-Grade Brain Tumors: Consideration of a Neurologic Versus a Psychogenic Model

Few studies have examined quality of life issues in patients with brain tumors, though coping with cancer is stressful and is associated with heightened levels of depression. We used regression to examine the clinical factors that might predict depression in a group of 57 adults with low-grade brain tumors after surgery but prior to radiotherapy and chemotherapy. A neurological model comprised of tumor characteristics and treatment was compared with a psychogenic model comprised of both psychosocial and psychodynamic variables. Demographic variables and level of fatigue were also included. A model consisting primarily of fatigue (also clinically elevated) and secondarily of tumor location and aggressiveness of surgical treatment accounted for 33% of the depression score. In a small group at a later follow-up when patient depression was clinically elevated (4–6 years after baseline), fatigue, female sex, cognitive dysfunction, increased family support, and increased report of physical symptoms were associated with depression. The late out findings remain exploratory because of the small sample size, but they suggest that depression develops over time and results from a combination of neurological and psychosocial problems that ensue initial treatments. Treating these collateral problems may reduce the complications from depression.     

Chronic Medical problems,coping resources,and depression: A longitudinal study of rural Tennesseans

This analysis examined chronic medical problems as a risk factor for depressive symptomatology using longitudinal survey data from a sample of rural Tennesseans. Two waves of data (1977 and 1983) were collected on 532 rural Middle-Tennessee residents. An initial investigation found chronic medical problems a powerful predictor of depression. Furthermore, internal and external resources (personal resources and social support) operated as moderating factors between the stress of medical problems and psychiatric impairment. Panel regression analyses indicated that Time 1 depression level as well as medical problems at Time 2 (t2) were significant predictors of depression at t2 in rural areas of the mid-South. Finally, the buffering effects of both social support and personal resources were explored.     

Comparative effectiveness of CBT interventions for co-morbid chronic pain & insomnia: A pilot study

IntroductionChronic pain is difficult to treat and often precedes or exacerbates sleep disturbances such as insomnia. Insomnia, in turn, can amplify the pain experience. Both conditions are associated with inflammatory processes, which may be involved in the bi-directional relationship between pain and sleep. Cognitive behavioral therapy (CBT) for pain and CBT for insomnia are evidence based interventions for, respectively, chronic pain and insomnia. The study objectives were to determine the feasibility of combining CBT for pain and for insomnia and to assess the effects of the combined intervention and the stand alone interventions on pain, sleep, and mood outcomes compared to a control condition.MethodsTwenty-one adults with co-occurring chronic pain and chronic insomnia were randomized to either CBT for pain, CBT for insomnia, combined CBT for pain and insomnia, or a wait-list control condition.ResultsThe combined CBT intervention was feasible to deliver and produced significant improvements in sleep, disability from pain, depression and fatigue compared to the control condition. Overall, the combined intervention appeared to have a strong advantage over CBT for pain on most outcomes, modest advantage over both CBT for insomnia in reducing insomnia severity in chronic pain patients.DiscussionCBT for pain and CBT for insomnia may be combined with good results for patients with co-occurring chronic pain and insomnia.     

The Contribution of Attributional Style to Perceived Disability in Rheumatoid Arthritis: A Longitudinal Study

The current study investigated the influence of general causal attributions on self-reported physical disability over the course of 1 year in a sample of 42 patients with rheumatoid arthritis (RA). Participants completed measures of attributional style, pain, and disability; physician assistants completed objective measures of disability on two occasions, approximately 1 year apart. Results indicated that internal attributions for disease-unrelated negative events assessed at Time 1 were associated with lower perceived physical disability, whereas stable attributions for negative events were associated with greater perceived physical disability 1 year later. These findings are discussed in terms of behavioral and characterological self-blame models, respectively. Implications of our findings for clinical management of RA are also discussed.     

Hybrid cognitive-behaviour therapy for individuals with insomnia and chronic pain: A pilot randomised controlled trial

ObjectiveInsomnia is a debilitating comorbidity of chronic pain. This pilot trial tested the utility of a hybrid treatment that simultaneously targets insomnia and pain-related interference.MethodsChronic pain patients with clinical insomnia were randomly allocated to receive 4 weekly 2-h sessions of hybrid treatment (Hybrid Group; n = 10) or to keep a pain and sleep diary for 4 weeks, before receiving the hybrid treatment (Monitoring Group; n = 10). Participants were assessed at the beginning and end of this 4-week period. Primary outcomes were insomnia severity and pain interference. Secondary outcomes were fatigue, anxiety, depression and pain intensity. Ancillary information about the hybrid treatment's effect on psychological processes and sleep (as measured with sleep diary and actigraphy) are also presented, alongside data demonstrating the treatment's clinical significance, acceptability and durability after one and six months. Data from all participants (n = 20) were combined for this purpose.ResultsCompared to symptom monitoring, the hybrid intervention was associated with greater improvement in sleep (as measured with the Insomnia Severity Index and sleep diary) at post-treatment. Although pain intensity did not change, the Hybrid Group reported greater reductions in pain interference, fatigue and depression than the Monitoring Group. Overall, changes associated with the hybrid intervention were clinically significant and durable at 1- and 6-month follow-ups. Participants also rated highly on treatment acceptability.ConclusionThe hybrid intervention appeared to be an effective treatment for chronic pain patients with insomnia. It may be a treatment approach more suited to tackle challenges presented in clinical practice, where problems seldom occur in isolation.     

Child Sleep Problems and Parental Depression: Testing a Risk and Resistance Model

Although extensive studies demonstrate a link between infant sleep problems and parental depression, limited research explores this relation in parents of primary school aged children. Using cross-sectional data, we investigated direct, moderating and mediating risk and resistance factors in the relation between child sleep problems and parental depressive symptomatology in a sample of 145 Australian parents of primary school aged children. Parents completed the children’s sleep habits questionnaire, the short temperament scale for children, the perceived stress scale and the depression sub-scale of the depression, anxiety and stress–short form. Correlational analyses confirmed bivariate relations between parental stress and parental depressive symptomatology, and between child sleep problems and parental depressive symptomatology. Multiple regression analyses identified parental stress as a mediator of the relation between child sleep problems and parental depressive symptomatology, and the approach component of child temperament as a moderator of the relation between child sleep problems and parental depressive symptomatology. Findings suggest that parents of children with sleep problems experience increased stress levels and increased levels of depressive symptomatology and may be at increased risk of depression if their child has a difficult temperament characterized by low approachability. Implications for clinical intervention and future research are discussed.     

Persistent neuropsychological problems after 7 years of abstinence from recreational Ecstasy (MDMA): a case study

This case study concerns a 26-yr.-old male who had consumed large amounts of Ecstasy seven years previously. He stated that his increasingly intensive use of ecstasy over a 4-yr. period had led to the emergence of multiple psychiatric and psychological problems. Given these problems, he stopped using Ecstasy, but the problems had not resolved despite seven years of abstinence. The neurocognitive profile was very similar to that shown by current heavy Ecstasy users, with deficits in immediate and delayed verbal recall, moderately impaired memory function, but normal expressive language ability and perceptual functioning. Extremely high pathology was evident, including depression and phobic anxiety. Severe problems with sleep and sex were also reported. Further studies involving larger groups of abstinent former users are needed; adverse sequelae associated with intensive Ecstasy use may sometimes be enduring.     

Posttraumatic Growth Among HIV/AIDS Patients1

Correlates (n= 835 at Time 1) and predictors (n= 434 at Time 2) of posttraumatic growth (PTG; perceiving positive life changes stemming from diagnosis) over 1.6 years were examined among a diverse sample of HIV/AIDS patients. PTG was common–59% of participants reported to have experienced at least moderate positive changes since diagnosis. At Time 1, PTG had significant negative associations with age, alcohol use, depression, and pessimism; and positive associations with African American ethnicity (vs. White), female gender, eating a healthy diet, and optimism. At Time 2, religiosity was positively associated with PTG. The process of experiencing PTG over time was associated with lower levels of depression over time. Although the underlying process of PTG remains unclear, these results suggest that PTG is worthy of intervention focus.     

Personality and Reaction Time after Sleep Deprivation

The relationship between reaction time and both state and trait personality variables was investigated in 37 participants after 30 h of sleep deprivation. Regression analyses suggested that endorsement of greater Novelty Seeking, anger/hostility, and depression/dejection, and less confusion, was associated with greater reaction time declines on one Multi-Attribute Task Battery index after sleep deprivation. Further, greater Novelty Seeking and depression/dejection, and less vigor/activity, was associated with greater reaction time declines after sleep deprivation on another Multi-Attribute Task Battery index. Additional correlational analyses indicated that better reaction times were associated with greater Novelty Seeking and lower anger/hostility prior to sleep deprivation, and less confusion/bewilderment following sleep deprivation. Findings suggest that both state and trait personality variables are associated with reaction time performance following sleep deprivation.     

Pain Intensity,Psychological Inflexibility,and Acceptance of Pain as Predictors of Functioning in Adolescents with Juvenile Idiopathic Arthritis: A Preliminary Investigation

Juvenile Idiopathic Arthritis (JIA) is a chronic rheumatic disease associated with pain and maladjustment. This study investigated whether pain, acceptance of pain, and psychological inflexibility uniquely predicted functional disability, anxiety, general quality of life (QOL), and health-related quality of life (HQOL) among adolescents with JIA. Twenty-three adolescents with JIA and pain were recruited from a pediatric rheumatology clinic. Participants completed self-report measures pertaining to the key study variables. A series of multiple regression analyses demonstrated that higher pain uniquely predicted higher functional disability. Greater psychological inflexibility uniquely predicted higher anxiety, lower general QOL, and lower HQOL. Increases in acceptance of pain were found to be uniquely related to increases in general QOL. These data confirm prior findings that pain impacts functioning, and provide preliminary findings that psychological inflexibility and acceptance may be important targets of psychological intervention for youth with JIA and pain to improve functioning and QOL.     

A 2-year longitudinal study of depression among Alzheimer's caregivers.

Results from a 2-year (4 waves) longitudinal study show strong evidence for patient decline and high levels of depressive symptomatology among caregivers. Female caregivers reported high, stable rates of depressive symptomatology throughout the study, whereas male caregivers exhibited significant increases in depression over time. Cross-sectional multivariate analyses revealed significant positive relationships between depression and number of patient problem behaviors, negative social support, and concern about financial resources; negative relationships were found between depression and social support, quality of prior relationship, and satisfaction with social contacts. Three significant independent predictors of change in depression were found: Lower depression scores at Time 1 were related to increases in depression over time; men were more likely than women to experience increases; and a decline in social support resulted in increased depression.     

Health care utilisation in patients with non-cardiac chest pain: A longitudinal analysis of chest pain,anxiety and interoceptive fear

Chest pain can be a frightening experience that leads many to seek medical evaluation. The symptom results in costly health care utilisation. Over half of patients referred for cardiac evaluations of chest pain do not obtain definitive medical explanations for their symptoms; these cases are described as non-cardiac chest pain (NCCP). Some patients with NCCP are not reassured after being informed their chest pain is non-cardiac in origin and seek repeated medical evaluation. Co-morbid anxiety and mood disorders often coexist with NCCP and are associated with health care utilisation. The current study examined chest pain, general anxiety, interoceptive fear and health care utilisation in a sample of 196 chest pain patients near the time of cardiac evaluation (Time 1), and 70 of these patients one year later (Time 2). Results indicate that anxiety and interoceptive fear were significantly associated with health care utilisation at Time 1, and only interoceptive fear (at Time 1) predicted health care utilisation at Time 2. This study develops research in this area by examining the relation of anxiety and health care utilisation longitudinally in patients with NCCP.     

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients’ quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.     

The role of attachment security,temperament, maternal perception,and care‐giving behavior in persistent infant sleeping problems

This study investigates the relationship of etiological factors to infant sleeping problems during the first year, and at follow‐up during the second year of life. The relevant factors for concurrent sleeping problems (in order of importance) were problematic maternal cognition concerning setting limits on the infant, fussy–difficult infant temperament, maternal anxiety–depression, ambivalent attachment, and certain maternal care‐giving behaviors involving the use of active physical comforting (cuddling to sleep, settling on sofa or in parental bed, and giving a feed). High initial levels of sleeping problems largely explained the continuity in infant sleeping problems over time. However, this continuity was significantly mediated by the influence of both problematic maternal cognition and infant temperament on the parental use of active physical comforting to settle infants to sleep. In addition, ambivalent attachment had a small but significant independent contribution to persistent problems. Regarding discontinuity in infant sleeping problems over time, infants who developed sleeping problems were those whose parents used high levels of active physical comforting, whereas those infants whose sleeping problems recovered were more likely to have mothers with low depression–anxiety. The significance of these results is discussed with respect to developmental models of infant sleeping problems, and the assessment and treatment of infant sleeping problems. ©2003 Michigan Association for Infant Mental Health.