Depression and medication adherence among breast cancer survivors: Bridging the gap with the theory of planned behaviour

Evidence suggests that more depressed breast cancer patients will less likely adhere to treatment plans. This study presents evidence that the theory of planned behaviour mediates the relation between depression and intentions to adhere to treatment plans and between depression and lack of adherence to medication regime. Two hundred and thirteen women undergoing breast cancer treatment participated in this study. Measures of depressive symptoms and planned behaviour variables were collected at the first time point; measures of medication adherence were collected at the second time point. Structural equation models were utilised to fit the data to the proposed models. Depressive symptoms were significantly correlated to both intentions and medication adherence. In support of hypotheses, the relation between depressive symptoms and treatment intention was mediated by attitudes towards health maintenance plans. The relation between depressive symptoms and medication adherence was fully mediated by the planned behaviour process. Conditions under which treatment intentions and perceptions of control in adhering to treatment were most related to medication adherence were elucidated. The results point to avenues for interventions to increase medication adherence among breast cancer patients. Manipulating attitudes and perceptions of control towards treatment plans will potentially serve to increase medication adherence.     

Treating an HIV/AIDS Patient’s PTSD and Medication Nonadherence With Cognitive-Behavioral Therapy: A Principle-Based Approach

HIV/AIDS patients with medication adherence problems are vulnerable to developing drug resistance, immune system degradation, and opportunistic infections. Poor adherence to antiretroviral medication regimens can be aggravated by psychiatric problems, including depression and posttraumatic stress disorder. This article presents the case study of a patient with HIV/AIDS who was unable to adhere to his antiretroviral medication regimen primarily because of PTSD and depressive symptoms resulting from a sexual assault that had caused his seroconversion. Exposure-based cognitive-behavioral therapy was instrumental in helping the patient overcome his PTSD and depressive symptoms so that he could tolerate his HIV medications. The patient’s symptom relief was evidenced by improved scores on the Impact of Event Scale and Beck Depression Inventory. The article discusses the importance of accurate assessment, therapist flexibility, and principle-based treatment versus strict adherence to manual-based protocols.     

Effects of Patients' Age,Gender, and Depression on Medical Students' Beliefs,Attitudes, Intentions,and Behavior1

This study examines the effects of patient age, gender, and depression on 88 advanced medical students' beliefs, attitudes, intentions, and behavior. Each subject heard an audiotaped patient portrayal. Patient age (32 or 67 years), gender, and depressive symptoms varied in a 2 × 2 × 2 between-subjects factorial design. All of the patients reported the same symptoms except that half of them also presented symptoms of depression. Questionnaires assessed beliefs about the patient's condition, attitudes toward the patient, treatment intentions, and recall of patient information. Expectations of an age bias were not substantiated. Females were rated less seriously ill, less likely to require laboratory tests, and more likely to receive medication than males. Among depressed patients, counseling and reassurance were more likely for females, and a nonpsychiatric consult was more likely for males. Recall of the symptoms presented was better for depressed patients. The implications for medical practice are discussed.     

Examining the role of positive and negative metacognitive beliefs in depression

Many psychological models have been developed to explain the development and maintenance of depression. The most widely evaluated model is the cognitive model of depression, and it is against this model that emerging models should be compared. Accordingly, this cross‐sectional study examined whether metacognitive beliefs, as specified in the metacognitive model of depression, would explain additional variance in depressive symptoms over dysfunctional attitudes; the core feature of the cognitive model. Moreover, mediational relationships between metacognitive beliefs, rumination, and depressive symptoms, predicted by the metacognitive model were also explored, whilst controlling for dysfunctional attitudes. A sample of 715 students completed self‐report questionnaires measuring depressive symptoms, rumination, dysfunctional attitudes, and metacognitive beliefs. Regression analyses showed that metacognitive beliefs made a significant statistical contribution to depressive symptoms, after controlling for age, gender, rumination and dysfunctional attitudes. Furthermore, as predicted by the metacognitive model, the relationship between positive metacognitive beliefs and depressive symptoms was fully mediated by rumination, whilst the relationship between negative metacognitive beliefs about uncontrollability and danger and depressive symptoms was partially mediated by rumination. The results provide further empirical support for the metacognitive model of depression and indicate that positive and negative metacognitive beliefs play an integral role in the maintenance of depressive symptoms.     

Measuring the effectiveness of psychoeducation on adherence,depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial

Despite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.

     

Adult attachment,the transition to parenthood,and depressive symptoms

Testing a model suggested by J. Bowlby (1988), this study investigated how a personal vulnerability (attachment ambivalence) interacts with perceptions of deficient spousal support before and during a major life stressor (the transition to parenthood) to predict pre-to-postnatal increases in depressive symptoms. Highly ambivalent women who entered parenthood perceiving either less support or greater anger from their husbands experienced pre-to-postnatal increases in depressive symptoms at 6 months postpartum. The associations between these 2 prenatal interaction terms and pre-to-postnatal increases in depressive symptoms were mediated by perceptions of declining spousal support across the transition period. Moreover, for highly ambivalent women, the association between prenatal and postnatal depression scores was mediated by perceptions of the amount of support available from their husbands.     

How psychological resources mediate and perceived social support moderates the relationship between depressive symptoms and help-seeking intentions in college students

There is a high prevalence of depression among college students, which is linked to lower levels of help-seeking intentions. However, there has been a lack of research examining variables that may help explain this relationship. The present study aimed to address this gap by examining whether psychological resources (optimism and self-esteem) mediate the relationship between depressive symptoms and help-seeking intentions, and whether this relationship is moderated by perceived social support. Participants were 8121 college students (66% female) aged 17–25 years (M?=?20.42, SD?=?1.90), who completed the My World Survey Post-Second Level, a national survey on youth mental health. Linear regression analysis confirmed that depressive symptoms predicted lower informal help-seeking intentions. Moderated mediation indicated that social support moderated the direct relationship between depressive symptoms and informal help-seeking intentions and that optimism and self-esteem mediated this relationship, when gender was controlled for. Findings indicate that social support and psychological resources help further our understanding of the relationship between depressive symptoms and help-seeking in young people. Campaigns promoting help-seeking in college students should focus on the beneficial role of social support and on fostering optimism and self-esteem as facilitators of help-seeking intentions.     

Is the privacy paradox a relic of the past? An in‐depth analysis of privacy attitudes and privacy behaviors

The privacy paradox states that online privacy concerns do not sufficiently explain online privacy behaviors on social network sites (SNSs). In this study, it was first asked whether the privacy paradox would still exist when analyzed as in prior research. Second, it was hypothesized that the privacy paradox would disappear when analyzed in a new approach. The new approach featured a multidimensional operationalization of privacy by differentiating between informational, social, and psychological privacy. Next to privacy concerns, also, privacy attitudes and privacy intentions were analyzed. With the aim to improve methodological aspects, all items were designed on the basis of the theory of planned behavior. In an online questionnaire with N = 595 respondents, it was found that online privacy concerns were not significantly related to specific privacy behaviors, such as the frequency or content of disclosures on SNSs (e.g., name, cell‐phone number, or religious views). This demonstrated that the privacy paradox still exists when it is operationalized as in prior research. With regard to the new approach, all hypotheses were confirmed: Results showed both a direct relation and an indirect relation between privacy attitudes and privacy behaviors, the latter mediated by privacy intentions. In addition, also an indirect relation between privacy concerns and privacy behaviors was found, mediated by privacy attitudes and privacy intentions. Therefore, privacy behaviors can be explained sufficiently when using privacy attitudes, privacy concerns, and privacy intentions within the theory of planned behavior. The behaviors of SNS users are not as paradoxical as was once believed. Copyright © 2014 John Wiley & Sons, Ltd.     

Maternal Guilt and Shame: Relationship to Postnatal Depression and Attitudes towards Help-Seeking

Existing literature indicates that women can experience feelings of shame and guilt in relation to motherhood. This study investigated whether maternal feelings of shame and guilt were associated with postnatal depressive symptoms and attitudes towards help-seeking. A cross-sectional, correlational design was employed. Shame and guilt were measured as both dispositional factors and contextual factors i.e. in relation to motherhood (event-related shame and guilt). A UK community sample of 183 mothers with an infant between 4?weeks and 1?year of age completed a series of online questionnaires. The results indicated that shame proneness significantly predicted postnatal depressive symptoms once demographics and social support had been accounted for. Furthermore, shame proneness significantly predicted less positive attitudes towards help-seeking. Guilt proneness was not a significant predictor of postnatal depressive symptoms or attitudes towards help-seeking. These findings highlight the potential negative consequences of maternal feelings of shame in the postnatal period.     

Rates and Correlates of DSM-IV Diagnoses in Women Newly Diagnosed with Breast Cancer

Although the presence of psychological distress has been documented in women with breast cancer, previous studies have not established rates of DSM-IV diagnoses in this population, nor have prior investigations compared the utility of diagnostic interviewing vs. symptom checklists to assess distress. DSM-IV diagnoses of anxiety disorders and major depression, symptoms of anxiety and depression, and quality of life were examined in 207 women with newly diagnosed breast cancer. Eighteen percent of breast cancer patients met criteria for a current DSM-IV anxiety or depressive disorder and 54% met criteria for a disorder at some point in their lifetime. These rates are comparable to those found in recent community epidemiological studies (e.g., R. C. Kessler, K. A. McGonagle, S. Zhao, C. B. Nelson, M. Hughes, S. Esheman, et al., 1994). Sensitivity, specificity, and positive predictive value for anxiety and depression symptoms as predictors of DSM disorders were relatively poor. However, after accounting for demographic, treatment, and cancer variables, self-reported anxiety symptoms were significantly related to the presence of an anxiety disorder and self-reported depressive symptoms were significantly related to a diagnosis of a depressive disorder. Symptoms of anxiety and depression contributed significantly and uniquely to physical, medical, and sexual quality of life; DSM-IV diagnoses were not significantly related to quality of life after controlling for symptoms of depression and anxiety. The importance of measuring both symptoms of distress and psychiatric diagnoses in cancer patients and the clinical practice implications of the results are discussed.     

Why do citizens want to keep refugees out? Threats,fairness and hostile norms in the treatment of asylum seekers

A social identity framework was employed to understand why people support the exclusionary treatment of refugee claimants (‘asylum seekers’) in Australia. Over and above individual difference effects of social dominance orientation and individuals' instrumental threat perceptions, insecure intergroup relations between citizens and asylum seekers were proposed to motivate exclusionary attitudes and behaviour. In addition, perceived procedural and distributive fairness were proposed to mediate the effects of social identity predictors on intergroup competitiveness, serving to legitimise citizens' exclusionary behaviours. Support for these propositions was obtained in a longitudinal study of Australians' social attitudes and behaviour. Small and inconsistent individual‐level effects were noted. In contrast, after controlling for these variables, hostile Australian norms, perceived legitimacy of citizen status, and threatening socio‐structural relations were strongly and consistently linked to intentions to support the harsh treatment of asylum seekers, and exclusionary attitudes and action at Time 2. Moreover, perceived procedural and distributive justice significantly mediated these relationships. The roles of fairness and intergroup socio‐structural perceptions in social attitudes and actions are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Intention to Participate in Predictive Genetic Testing for Hereditary Cancer: The Role of Attitude toward Uncertainty

This study aimed to identify factors predictive of intentions to participate in genetic testing for hereditary cancer. Measures of the psychosocial influences on intention were based on the theories of reasoned action (TRA) and planned behaviour (TPB) and a new measure of Attitude toward Uncertainty. The participants (the breast cancer sample, n = 124; the colon cancer sample, n = 168) were recruited via a general practitioner's patient database and asked to complete postal questionnaires. The overall response rate was 57.4% (54.7% in the colon cancer sample, 61.4% in the breast cancer sample). In the colon cancer sample, 72% of respondents stated that they would choose to participate in genetic testing for colon cancer susceptibility. In the breast cancer sample, 77% of respondents stated that they would choose to participate in genetic testing for breast cancer susceptibility. The TRA components (attitudes and subjective norms) and Attitude toward Uncertainty emerged as the strongest predictors of intention. The Attitude toward Uncertainty appears to moderate intention in that participants with more negative attitudes toward uncertainty are more likely to undergo the test than those seeking more certainty.     

Rural breast cancer patients,coping and depressive symptoms: A prospective comparison study

Many studies have revealed that individual differences in coping responses to the diagnosis and treatment of breast cancer are associated with psychological adjustment. The vast majority of these studies, however, focus exclusively on urban breast cancer survivors despite that rural breast cancer survivors are likely to have distinct experiences both in general and in relation to breast cancer. The current study quantitatively examined the coping strategies employed by both rural and urban breast cancer patients while they were undergoing radiation therapy. Further, the influence of these coping behaviours on concurrent as well as subsequent depressive symptoms (3 and 6 months later) was examined. The results revealed that the rurality of breast cancer patients was unrelated to the ways in which they coped, but did influence the relationships between some coping responses and depressive symptoms. Specifically, active coping and positive reinterpretation were negatively related to depressive symptoms for more rural breast cancer patients, but not their relatively urban counterparts. Similarly, behavioural disengagement was more strongly related to depressive symptoms for more rural patients. Possible reasons for this pattern of results and implications are discussed.     

Mental health help-seeking intentions and organizational climate among military members

The psychological effects of war include anxiety, depression, alcohol misuse and Post-Traumatic Stress Disorder (PTSD). Military members that displayed symptoms of mental illness were thought to lack the strength and courage necessary to be soldiers. As a result, many military members who suffered from these symptoms would not seek help for mental health care. This paper investigates the mental health help-seeking intentions of military members using the Theory of Planned Behavior (TPB) and the role of leadership support climate and coworker support climate. This paper contributes to the literature in three ways. First, this paper applies a rigorously tested theoretical framework to the study of mental health help-seeking intentions in military members. Second, this paper incorporated the constructs of leadership support climate and coworker support climate into mental health help-seeking literature. Third, this paper introduces the concepts of leadership support climate and organizational support climate into the study of the theory of planned behavior. This study found that the personal attitudes of military members towards mental health help-seeking are positively related to their mental health help-seeking intentions. The study also found that mental health help-seeking attitudes mediated the relationship between leadership support climate and mental health help-seeking intentions. These results underscore the important role of leaders in setting a supportive organizational climate and influencing military members to seek help for mental health problems.     

A longitudinal analysis of the course of depressive symptomatology in geriatric patients with cancer of the breast, colon, lung, or prostate.

This study mapped the trajectory of depression and its components (depressive mood, somatic expression of depression, and lack of positive affect) for 1 year after an initial cancer diagnosis, revealing the complex nature of the psychological response to the cancer experience. The analysis was based on 4 waves of panel data from 860 older patients with incident breast, colon, lung, or prostate cancer. Predictors of depressive symptoms included cancer site; stage; comorbidities; sociodemographic characteristics; and indicators of physical functioning, symptom severity, and treatment. Patients' overall depressive symptoms declined, especially depressive mood and somatic indicators. By contrast, the sense of well-being did not recover; in fact, it would have deteriorated without improvements in physical functioning and physical symptoms. The present findings show the importance of psychological assessments and symptom management during cancer treatment.     

A pathway from neuroticism to depression: examining the role of emotion regulation

We examined whether the relation between neuroticism and the severity of depressive symptoms is mediated by emotion regulation. At the same time, we examined whether the type of emotion regulation strategy (maladaptive vs. adaptive) moderates the effects of neuroticism on depression severity. Community participants (N =?533; 235 women and 298 men) completed a set of questionnaires over the Internet. We used structural equation modeling to examine the mediational role of emotion regulation in linking neuroticism and the levels of depressive symptoms. The well-documented relation between neuroticism and depression is mediated by individual differences in the use of different emotion regulation strategies. More specifically, the use of maladaptive forms of emotion regulation, but not reappraisal, fully mediated the association between neuroticism and the severity of depressive symptoms.     

Autonomy and reactions to health-risk information

It has been suggested that autonomy promotes enhanced reflection on novel information and reduces defensive or biased information processing. This study investigated how autonomy affected people's reactions to known versus novel health-risk information in relation to three behaviours: sun exposure, alcohol consumption and salt intake. Participants (N = 321) completed a measure of autonomy, read either known or novel health-risk information and reported their relative autonomous motivation, attitudes, perceived behavioural control, subjective norm and intentions towards reducing the health-risk behaviour concerned. In line with our hypotheses, the results showed that higher autonomy participants reported greater relative autonomous motivation towards reducing health-risk behaviours than did lower autonomy participants; this effect was mediated by perceptions of the information as less freedom-threatening. The expected interaction between Autonomy and Information Type was not observed. The results indicate that autonomy is associated with greater relative autonomous motivation to engage in health behaviours, and that autonomous motivation may subsequently influence intentions to reduce health-risk behaviour following exposure to health-risk information.     

Mechanisms of Change in Brief Couple Therapy for Depression

The goal of the present study was to investigate potential mechanisms of previously documented treatment effects for a brief, 5-session, problem-focused couple therapy for depression in a sample of 35 depressed women and their nondepressed husbands. The primary treatment effects were reducing women’s depressive symptoms and their husbands’ psychological distress and depression-specific burden. Secondarily, treatment resulted in increased relationship satisfaction for both partners. Given these significant treatment changes observed in 5 sessions, we sought to examine the mechanisms of change by testing the following three factors as potential mediators: (a) negative behaviors and attitudes toward depression, (b) support provision, and (c) empathic communication towards the depressed female partners. Women’s depression and husbands’ depression-specific burden were alleviated by positive changes in their illness-related attitudes and behaviors. Improvements in women’s marital satisfaction were also mediated by positive change in their illness-related attitudes and behaviors, along with perceptions of increased positivity and support from their husbands. Findings highlight the importance of targeting specific treatment agents in a brief couple therapy for depression such as psychoeducation about depression and support-building to increase partners’ understanding and acceptance of the illness, and teaching communication skills to reduce negative behaviors and criticism that are replaced by more empathic communication towards the depressed individual.     

Depression, constructive thinking and patient satisfaction in cardiac treatment adherence

Many patients fail to adhere to prescribed treatment regimens, particularly patients who are depressed. This study examined the link between depression and adherence among 92 patients undergoing post-operative cardiac rehabilitation. Self-reported adherence was measured in terms of both general recommendations and specific health behaviours. Greater depression was associated with general - but not specific - adherence, and this relationship was mediated by lower satisfaction with their doctor - patient interactions. The link between depression and patient satisfaction was itself mediated by less constructive thinking among patients. These results suggest that adherence among cardiac rehabilitation patients may be enhanced by addressing patients' cognitive coping, and by improving the quality of their doctor - patient interactions.     

Specific Pathways from Parental Distress Reactions to Adolescent Depressive Symptoms: The Mediating Role of Youths’ Reactions to Negative Life Events

The current multimethod longitudinal study examines how parents’ distress reactions to adolescents’ negative emotions may shape youths’ own perceptions of negative life events and subsequent increases in depressive symptomology. Ninety adolescents (41 girls, 49 boys, average age?=?16.5 years old) and their parents were assessed over three timepoints. We found that greater parent-reported distress reactions to adolescents’ emotions predicted subsequent increase in youths’ own self-reported negative reactions to stressful experiences over a two-week period, which in turn predicted steeper increases in youth-reported depressive symptoms across this same two-week period. Moreover, youths’ negative reactions mediated the relation between parent emotion socialization and increases in adolescent depressive symptoms. These findings support the use of interventions that simultaneously target parent and child distress to prevent the onset of adolescent depression.