The psychometric properties of the Greek version of the State-Trait Anxiety Inventory in cancer patients receiving palliative care

Objectives: To validate the Greek version of the State-Trait Anxiety Inventory (STAI) in a sample of cancer patients. Design: The scale was administered twice, with a 3-day interval, to 99 eligible patients with cancer. Together with the Greek version of STAI scale, the patients also completed the anxiety subscale from the Hospital Anxiety and Depression scale (HAD). Observations: Factor analysis yielded a three-factor solution, explaining 47.143% of the variance. Cronbach α for three scales was between 0.729 and 0.852. Inter-scale correlations were moderate-to-high and ranged from 0.282 to 0.563 (p < 0.0005, p < 0.005). The assessment of the relationships among the Greek STAI scales and HAD-Anxiety showed statistically significant correlations between them (r ranged between 0.428 and 0.596, p < 0.0005). The test/retest reliability of scale (Pearson's ‘r’), showed that the coefficient agreement ranged between 0.85 and 0.90 (p < 0.0005). Univariate analysis revealed significant correlations between female gender, metastasis, performance status, chemotherapy, mild opioids and low education level with increased anxiety. Conclusions: These results support that the Greek version of STAI is an instrument with satisfactory psychometric properties, and is a valid research tool for Greek cancer patients.     

Does quality of sleep mediate the effect of depression on hopelessness?

The objectives of the study were to evaluate the relationship between sleep quality, depression, and hopelessness in advanced cancer patients and whether sleep quality mediated the effect of depression on hopelessness. The final sample consisted of 102 advanced cancer patients under palliative treatment. Patients completed the Greek Pittsburgh Sleep Quality Index, a sleep quality instrument, the Greek Beck Depression Inventory for measuring depression, and finally the Beck Hopelessness Scale. Patients' performance status was assessed by their overall physical functioning, as defined by the Eastern Cooperative Oncology Group. Depression was highly associated with hopelessness (r = .52, p<.001). Statistically significant associations were found between sleep quality with hopelessness (r = .37, p<.001), as well as with depression (r = .36, p<.001). Mediation analyses indicated that depression influenced hopelessness directly as well as indirectly by its effect on sleep quality. About 14.58% of the variation in hopelessness was explained by depression; 4% of the variance in hopelessness explained by depression was accounted for by the mediation pathway indicating that sleep quality mediated the relationship between depression and hopelessness. Similarly, in the reverse mediation analysis, depression mediated the relationship between sleep quality and hopelessness; 43% of the variation in hopelessness was explained by sleep quality. In conclusion, some of the effect of depression on hopelessness was mediated by sleep quality, but depression had a direct effect on hopelessness as well. Additionally, some of the effect of sleep quality on hopelessness was mediated by depression. The current findings are important because improving sleep quality by treating depression may contribute to decreased hopelessness scores and vice versa: Treating depression by improving sleep quality may also contribute to lower hopelessness scores.     

The influence of cancer impact on patients’ preparatory grief

The aims of this study were to investigate the preparatory grief and traumatic distress in advanced cancer patients in a palliative care unit. A total of 94 advanced cancer patients completed the Preparatory Grief in Advanced Cancer Patients (PGAC) scale and the Greek version of the Impact of Events Scale- Revised (IES-R-Gr). The Eastern Cooperative Oncology Group was used to measure patients’ performance status. Statistically significant associations were found between PGAC, patients’ performance status, and all the IES-R-Gr scales (avoidance, intrusion, hyperarousal) and IES-R-Gr total score. The multiple regression analysis revealed that preparatory grief was predicted by patients’ young age, poor performance status, as well as by their high levels of intrusion and hyperarousal, in a model explaining 51.5% of the total variance. Concluding, in advanced cancer patients, preparatory grief is significantly correlated with the impact of cancer and patients’ physical condition, and seems to be influenced by components of the event impact, patients’ age, and physical performance.     

Parent training in nonviolent resistance for adult entitled dependence

"Adult entitled dependence" is a condition characterized by the extreme dependence of grown children on their family and by levels of dysfunction, seemingly excessive in light of their apparent capacity to function. The family and the dependent adult become involved in an interaction in which the very attempts to alleviate the problem may aggravate it. Parent-training in nonviolent resistance (NVR) is an intervention that has been shown to be helpful to parents of behaviorally disturbed youth. Parent training in NVR offers parents means to shift away from a stance of helplessness toward realistic goals that are accomplishable without the collaboration of their offspring. We report on the parents of 27 entitled dependent grown children who participated in parent training in NVR. Additionally, we present 2 detailed case studies that exemplify the problem and the therapeutic process. Before treatment, the dependent adults were not working or studying, drew heavily on parental services (financial or otherwise), and were resistant to parental attempts to change the situation. Most parents succeeded in overcoming their helplessness and reducing the provision of parental services. In a considerable proportion of cases, the grown children started working or studying or moved to independent lodgings.