Psychological consequences of positive results in cervical cancer screening

Abstract

This study was carried out to assess the psychological impact of abnormal cervical smear results. Existing literature contain only uncontrolled studies or controlled studies with non-standardised measures. Subjects were recruited from women attending two general practices for routine cervical smears over a six month period. A comparison was made between women with positive results who were referred for colposcopy, with mild abnormalities who were asked to return for a repeat smear in six months, or negative smear results. Psychometric assessment by postal questionnaire was carried out one week after receiving the result. The measures used were the 28-item General Health Questionnaire (GHQ-28), Spielberger State Anxiety (STAI), and a measure designed specifically for use in the study, the Cervical Screening Questionnaire (CSQ). Results indicated that women with positive smear test results who were referred for colposcopy had significantly higher scores on GHQ (p<.01) STAI-S (p<.05) and CSQ (p<.001) than women with mild abnormalities or negative results. Significant differences between the groups with mild abnormalities and negative results were found on the CSQ (p<.05). These findings suggest that positive results on cervical screening are associated with a significant psychological impact including a range of specific concerns about gynaecological health and cancer, increased anxiety and impaired well-being. Even mildly abnormal results, which involve a recommendation for early repeat screening, cause raised concern about cancer for the recipients. The procedures for providing smear results should be organised to minimise the level of distress.     

Living with Hereditary Haemorrhagic Telangiectasia: stigma,coping with unpredictable symptoms,and self-advocacy

Abstract

Objective: Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic condition causing frequent nose bleeds, skin lesions (telangiectasia) and arteriovenous malformations. Approximately, 50% of people experience life-threatening HHT symptoms including haemorrhages in the brain, lungs and liver. This study aimed to gain a qualitative understanding of the psychosocial impact of HHT over time. Design: Using a phenomenological framework, a rigorous narrative analysis was performed on 20 semi-structured interviews with individuals with HHT aged 20s–60s. Main outcome measures: Qualitative themes explaining life experiences prior to and following a clinical diagnosis of HHT. Results: Narratives highlighted four psychosocial themes: (i) the psychological impact of visible symptoms was significant and related to experiences of social stigma, (ii) individuals struggled to identify triggers of symptoms in order to reduce unpredictability, (iii) an illness identity was rejected by minimising HHT when talking about the present self, and by positive reframing as ‘lucky’ and (iv) self-advocacy was necessitated due to lack of expert coordinated care. Conclusion: HHT has a demanding impact on social, physical and psychological well-being. These findings have significant implications for health care, as narratives about interactions with health professionals often used the terms ‘frustrating’ and ‘not being heard’.     

Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Abstract

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

Predictors of quality of life enjoyment and satisfaction in individuals living with HIV and AIDS in a resource-constrained setting in South Africa

The burden of HIV disease is concentrated in sub-Saharan Africa, particularly in South Africa (SA). Whilst there have been many studies conducted on the biomedical and socio-psychological aspects of HIV and AIDS, insufficient attention has been paid to the quality of life of those infected with the virus. The primary purpose of the study was to determine the predictors of quality of life enjoyment and satisfaction (Q-LES) among individuals infected with HIV. A battery of questionnaires, which included the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), were administered to 121 participants. Data was analysed using SPSS. Of the total sample (n = 121), 74% were females. The study found that a large proportion (49.5%) of the sample within the age group 25–49 years old experienced psychological distress. Those who were not on antiretroviral treatment (ART) were significantly affected (66%). Psychological distress was significantly prevalent among HIV positive individuals and also the strongest predictor of Q-LES among these individuals.     

Development and Initial Validation of a General Psychological Well-being Scale (GPWS) in an African Context

This study aimed to develop and validate the General Psychological Well-being Scale (GPWS) in an African sample, based on the empirical overlap between hedonic and eudaimonic facets of well-being as found in previous research. The quantitative cross-sectional study was conducted in three phases: secondary data analysis (n = 2005), pilot study (n = 296) and main study (n = 459). The pilot and main study included the GPWS as well as other psychological well-being measures for criterion-related validity. The pilot study yielded satisfactory psychometric properties. The main study yielded a high, reliable Cronbach alpha of.89 and evidence of construct validity. The GPWS appears to be a unidimensional scale suitable for research use with Setswana-speaking people.     

A psychobiographical analysis of Dambudzo Marechera's personal development through his writings

This study applied psychobiography to explore the personal development of Zimbabwean novelist Dambudzo Marechera – and particularly focus on psychological disintegration. For the evidence, we examined primary and secondary works on his life history with special attention to his literary works. Findings indicate that his early writings were autobiographical in nature, chronicling lived poverty, war and violence experiences. Later writings were somehow surrealistic and unstructured, marking a culmination of significant personal disintegration that started in early childhood. Other ancillary biographical evidence suggests self-perceptions as a cult-like figure, and what appears to be a limited social interest.     

The Design and Evaluation of a Hope Enhancement Programme for Adults

The study evaluated the effectiveness of a hope enhancement programme for a group of adults and its impact on general psychological well-being. The intervention programme focused on participants' abilities to set feasible goals, planning ways to reach those goals (pathways) and increase determination and motivation (agency) to reach these goals. The workshop-format programme, consisted of six two-hour sessions conducted over five days. A pre and post-test design included an experimental group (n = 8), control group (n = 8) and ‘chat group’ (n = 8). Findings indicated that the programme increased hope levels of the experimental group as indicated by the Hope Scale and the Hopefulness Subscale of the Hunter Opinions and Personal Expectations Scale. Well-being also improved as indicated by a significant increase in sense of coherence along with a positive change in satisfaction with life. Recommendations for future research were made.     

Psychometric Properties of the Short Self-Regulation Questionnaire (SSRQ) in a South African Context

Self-regulation (SR), an important construct within the psychological well-being context, involves the ability to monitor behaviour, to contrast it with reference values and to introduce adjustments where necessary. A lack of validated measures of SR in the South African context has contributed to the current caveat in our knowledge of the potential importance of this construct. This investigation aimed to establish the utility of the Short Self-Regulation Questionnaire (SSRQ; Carey, Neal & Collins, 2004) in a South African context. This short version of the original Self-Regulation Questionnaire (SRQ; Brown, Miller & Lawendowski, 1999) was completed by a group of 385 undergraduate psychology students. Factor analysis produced 7 factors, all of which showed significant positive correlations with other measures of psychological well-being. This first step toward establishing the importance of SR in non-Western cultures reflected positively on the potential use of the SSRQ in large epidemiological studies.