Predictors of psychological outcomes in a longitudinal study of Latina breast cancer survivors

Objective: This study sought to investigate the unique contributions of socio-ecological, cultural and cancer treatment-related factors in predicting depressive symptoms and cancer-specific distress among Latinas. Design: Participants were 140 English or Spanish-speaking Latinas (M_age = 50.6) with non-metastatic breast cancer who were assessed within two years of diagnosis (Time 1) and three months later (Time 2).

Main Measures: Hierarchical regression analyses identified predictors of depressive symptoms and cancer-specific distress at Time 1 and 2.

Results: Most women scored above the clinical cut-offs for depressive symptoms and cancer-specific distress. After adjusting for socio-ecological factors, greater Latino enculturation, measured by Latino ethnic identity, was significantly associated with greater cancer-specific distress at Time 1 (β = .20, p < .05). A significant interaction (p < .01) revealed that among women high on Latino identity, lower English language use was associated with more cancer-specific distress than higher English language use. After adjusting for socio-ecological factors, greater satisfaction with surgical treatment predicted improved depressive symptoms and cancer-specific distress across time (β_s range from ?.31 to ?.18, p_s < .01).

Conclusions: Findings elucidate the complex relationship between culture and psychological outcomes in the breast cancer context and suggest that treatment satisfaction might be an important intervention target for Latinas.     

Understanding behavioural clusters: Identifying differences between clusters of health behaviours on key constructs

Objective: To uncover the rationale underlying the perceived distinction between clusters of health behaviours by identifying cognitive constructs that differentiate among them, and creating a ‘cognitive profile’ for each behavioural cluster. Thus, different determinants and characteristics of health behaviours (e.g. ‘perceived behavioural control’, ‘impact on health’, ‘effort’, ‘non-health rewards’, ‘habit’) were used to compare health behaviour meta-clusters (physical and psychosocial) and clusters (e.g. nutrition behaviours, substance abuse, medical practices).

Methods: A sample of lay people (N = 1956) judged items representing behavioural clusters delineated in the Health Behaviour Taxonomy on 14 constructs.

Results: Significant differences emerged between the physical and psychosocial meta-clusters, as well as among their sub-clusters. For example, physical behaviours were higher on ‘perceived behavioural control’ and ‘impact on health’ compared to psychosocial behaviours, and nutrition was perceived highest on ‘effort’ and ‘non-health rewards’ compared to the other clusters of the physical meta-cluster.

Conclusion: The findings increase our understanding of the logic underlying lay people’s cognitive schema of health behaviour clusters. ‘Cognitive profiles’ that explain differences between the clusters were identified, which can be used to design health messages and interventions targeting multiple health behaviours.     

Psychosocial discontinuities introduced by the new reproductive technologies

The introduction of the new reproductive technologies has brought about a separation of the experience of reproduction from a previously necessary act of sexual intercourse between a fertile male and a fertile female. This has brought in its train the need for new ways of thinking about the relationship between procreation, reproduction and parenting. Psychosocial research into child–parent, male–female and kin relationships resulting from the use of the new reproductive technologies has value both in terms of its own intrinsic interest and also in terms of insights provided into what has been traditionally portrayed as the ‘normal’ reproductive process. This contribution to the Special Issue serves as a general introduction to the topic by presenting a ‘discontinuity’ model intended to provide a context in which psychosocial research into the provision and use of the new reproductive technologies could be explored. © 1998 John Wiley & Sons, Ltd.     

Qualitative Cancer Genetic Counseling Research, Part I: Ethnography in a Cancer Clinic

This is a report of the experience of several months' ethnographic research by a genetic counselor researcher in a cancer treatment clinic. One goal of the exercise was to directly experience a method of qualitative research known as ethnography, which relies heavily on participant-observation, in an applied clinical setting. Another goal was to explore a previously undescribed research area in the genetic counseling literature, namely, the meaning of cancer and cancer treatment for affected individuals and their support companions. Here we report on a personal account of the experiences of conducting and publishing the research. The preliminary analysis and results of this field experience are published elsewhere (Peters et al. (2001) J Genet Counsel 10(2):151–168.). These initial findings support the feasibility of genetic counselors, who are trained in specific social science methodologies, to conduct qualitative research pertinent to genetic counseling practice.This work was completed at the University of Pittsburgh before employment at the National Cancer Institute (NCI) and does not represent the views of the NCI, the National Institutes of Health, the Department of Health and Human Services, or the Federal Government     

A Psychometric Normative Database for Pre-Lung Transplantation Evaluations

This study describes the quality of life and psychological characteristics of a large sample (N = 201) of adult patients evaluated for lung transplantation. In light of the interdisciplinary nature of pre-lung transplant evaluations, establishing norms for measures commonly used in the assessment of transplant candidates has been a priority for the University of Florida transplant programs. Forty-eight percent of the patients reported symptoms of mild to moderate depression. Although quality of life indices were associated with disease severity and exercise tolerance, psychosocial measures generally were not. These data contribute uniquely to the transplant literature and provide valuable normative information on the largest lung transplant cohort reported to date.     

Involving Family in Psychosocial Interventions for Chronic Illness

ABSTRACT— Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.     

Walls and Holes in Psychosocial Research: From Psychoanalysis to Critique

This commentary reflects on the different innovative motifs introduced into psychosocial research by the contributions to this special issue: the risk of oversubjectification in research placing undue emphasis on the individual reasoning or feeling subject, the attempt to link the “feelings” and “talk” about emotion in one interpretative framework, the place of the interview in research which questions rather than reinforces “identity,” the location of subjects in a “place-assemblage” rather than in their own selves, and the reconfiguration of “mindfulness” so that it opens out to social relations rather than evades them. Focussing on the role of psychoanalysis in psychosocial research, I situate these motifs within the analysis of the machinery of “facialization” offered by Deleuze and Guattari, in which the “white wall” of signification is complemented and locked in place by the “black hole” of subjectivity.     

School-Based Intervention for Social Skills in Children from Divorced Families

Divorce is an increasingly prevalent occurrence in society that has the potential to result in many adverse short- and long-term consequences for children and their parents. Social skills, such as those with peers, are one of the problems that may emerge for children of divorce. Despite this growing problem, there is a paucity of research available to effectively address the social skills needed to build and maintain positive peer interactions and subsequent relationships in students whose parents are no longer married. It was hypothesized that a social skills training program would be effective in remediating social skill deficits related to building relationships with peers in students from divorced families. The purpose of this study was to employ COPE, a school-based social skills program, to examine the effect on social skills in elementary students whose parents are divorced. Results of the social skills intervention indicated that the treatment was effective for most participants, but generalization of the COPE program had mixed results.     

The role of shared social identity in mutual support among refugees of conflict: An ethnographic study of Syrian refugees in Jordan

In the midst of an unprecedented refugee crisis and the shortfall of aid organization resources, a shift toward utilizing the capacity for collective resilience in refugee communities could be helpful. This paper explores experiences of psychosocial social support among a community of Syrian urban refugees in Jordan, especially the kind of support that helps them deal with secondary stressors. We were specifically interested in the role of shared social identity as a basis of support and the sources of such shared identity. We conducted an 8‐month ethnography that included observations and semistructured interviews with 13 refugees. We found many examples of support among refugees, on both personal and collective levels. Some of this support was based on sharing the identity of “refugee” that stemmed from a sense of common fate. This is similar to the process identified in the literature on disasters. Psychological membership in the refugee group is stigmatic, but it can also lead to positive outcomes in line with the social cure perspective. However, we also found examples of support that were value‐based or based on pre‐existing interpersonal networks. Implications of the findings for models of group processes in stressful situations and the practical question of refugee support are discussed.     

Pre-liver transplant psychosocial evaluation predicts post-transplantation outcomes

Psychosocial factors greatly impact the course of patients throughout the liver transplantation process. A retrospective chart review was performed of patients who underwent liver transplantation at Hadassah-Hebrew University Medical Center between 2002 and 2012. A composite psychosocial score was computed based on the patient’s pre-transplant evaluation. Patients were divided into two groups based on compliance, support and insight: Optimal psychosocial score and Non-optimal psychosocial score. Post-liver transplantation survival and complication rates were evaluated. Out of 100 patients who underwent liver transplantation at the Hadassah-Hebrew University Medical Center between 2002 and 2012, 93% had a complete pre-liver transplant psychosocial evaluation in the medical record performed by professional psychologists and social workers. Post-liver transplantation survival was significantly higher in the Optimal group (85%) as compared to the Non-optimal group (56%, p = .002). Post-liver transplantation rate of renal failure was significantly lower in the Optimal group. No significant differences were observed between the groups in other post-transplant complications. A patient’s psychosocial status may impact outcomes following transplantation as inferior psychosocial grades were associated with lower overall survival and increased rates of complications. Pre-liver transplant psychosocial evaluations are an important tool to help predict survival following transplantation.