Using Marital Status and Continuous Marital Satisfaction Ratings to Predict Depressive Symptoms in Married and Unmarried Women with Systemic Sclerosis: A Canadian Scleroderma Research Group Study.
Arthritis Care Res (Hoboken). 2015 Nov 25;
Authors: Levis B, Rice DB, Kwakkenbos L, Steele RJ, Hagedoorn M, Hudson M, Baron M, Thombs BD, Canadian Scleroderma Research Group
BACKGROUND: Married persons have, on average, better mental health than non-married persons. Among married persons, marital satisfaction is associated with better mental health. Studies that have compared mental health among married and non-married persons and considered marital satisfaction have categorized patients as satisfied versus unsatisfied, which reduces statistical power and does not generate clinically useful information on mental health across the marital satisfaction spectrum.
OBJECTIVE: To demonstrate a novel regression approach to evaluate mental health in women with systemic sclerosis (SSc), comparing married and unmarried women, accounting for continuously measured marital satisfaction.
METHODS: Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and marital satisfaction with the Dyadic Adjustment Scale-7. A single multiple linear regression model was used to predict CES-D scores from marital status and, among married women, continuously measured marital satisfaction, controlling for demographic and clinical characteristics.
RESULTS: Of 725 women, 494 (68%) were married or living as married. On average, married women had CES-D scores 2.0 points (0.19 standard deviations [SDs]) lower than unmarried women (p=0.013). Among married women, 1.0 SD increases in marital satisfaction were associated with 2.2 point (0.21 SDs) decreases in CES-D scores (p<0.001). Married women below the 19th percentile of marital satisfaction had greater predicted depressive symptoms than unmarried women. Married women’s predicted CES-D scores ranged from 6.7 points lower to 6.9 points higher than unmarried women, depending on marital satisfaction.
CONCLUSION: Comparisons of mental health in married and unmarried rheumatic disease patients should include continuously measured marital satisfaction. This article is protected by copyright. All rights reserved.
PMID: 26605870 [PubMed - as supplied by publisher]
Feasibility and effectiveness of an asthma/COPD service for primary care: a cross-sectional baseline description and longitudinal results.
NPJ Prim Care Respir Med. 2015;25:14101
Authors: Metting EI, Riemersma RA, Kocks JH, Piersma-Wichers MG, Sanderman R, van der Molen T
BACKGROUND: In 2007, an Asthma/chronic obstructive pulmonary disease (COPD) (AC) service was implemented in the North of the Netherlands to support General Practitioners (GPs) by providing advice from pulmonologists on a systematic basis.
AIMS: To evaluate the feasibility and effectiveness of this service on patient-related outcomes.
METHODS: We report baseline data on 11,401 patients and follow-up data from 2,556 patients. GPs can refer all patients with possible obstructive airway disease (OAD) to the service, which is conducted by the local laboratory. Patients are assessed in the laboratory using questionnaires and spirometry. Pulmonologists inspect the data through the internet and send the GP diagnosis and management advice.
RESULTS: A total of 11,401 patients were assessed by the service, covering almost 60% of all adult patients with projected asthma or COPD in the area. In all, 46% (n = 5,268) of the patients were diagnosed with asthma, 18% (n = 2,019) with COPD and 7% (n = 788) with the overlap syndrome. A total of 740 (7%) patients were followed up after 3 months because the GP advised them to change medication. In this group, the proportion of unstable COPD patients (Clinical COPD Questionnaire (CCQ) ⩾ 1) decreased from 63% (n = 92) at baseline to 49% (n = 72). The proportion of patients with uncontrolled asthma (Asthma Control Questionnaire (ACQ) ⩾ 1.5) decreased from 41% (n = 204) to 23% (n = 115). In all, 938 (8%) patients were followed up after 12 months. From these patients, the proportion of unstable COPD patients (CCQ ⩾ 1) decreased from 47% (n = 115) to 44% (n = 107). The proportion of patients with uncontrolled asthma (ACQ⩾1.5) decreased from 16% (n = 95) to 14% (n = 85).
CONCLUSION: The AC service assessed a considerable proportion of patients with OAD in the area, improved patients’ outcomes, and is considered to be feasible and effective.
PMID: 25569634 [PubMed - indexed for MEDLINE]
A randomized controlled trial of web-based cognitive behavioral therapy for severely fatigued breast cancer survivors (CHANGE-study): study protocol.
BMC Cancer. 2015;15(1):765
Authors: Abrahams HJ, Gielissen MF, Goedendorp MM, Berends T, Peters ME, Poort H, Verhagen CA, Knoop H
BACKGROUND: About one third of breast cancer survivors suffer from persistent severe fatigue after completion of curative cancer treatment. Face-to-face cognitive behavioral therapy (F2F CBT), especially designed for fatigue in cancer survivors, was found effective in reducing fatigue. However, this intervention is intensive and treatment capacity is limited. To extend treatment options, a web-based version of CBT requiring less therapist time was developed. This intervention is aimed at changing fatigue-perpetuating cognitions and behaviors. The efficacy of web-based CBT will be examined in a multicenter randomized controlled trial.
METHODS: In total, 132 severely fatigued breast cancer survivors will be recruited and randomized to either an intervention condition or care as usual (ratio 1:1). Participants will be assessed at baseline and 6 months thereafter. The intervention group will receive web-based CBT, consisting of three F2F sessions and maximally eight web-based modules over a period of 6 months. The care as usual group will be on a waiting list for regular F2F CBT. The total duration of the waiting list is 6 months. The primary outcome of the study is fatigue severity. Secondary outcomes are functional impairments, psychological distress and quality of life.
DISCUSSION: If web-based CBT is effective, it will provide an additional treatment option for fatigue in breast cancer survivors. Web-based CBT is expected to be less time-consuming for therapists than regular F2F CBT, which would result in an increased treatment capacity. Moreover, the intervention would become more easily accessible for a larger number of patients, and patients can save travel time and costs.
TRIAL REGISTRATION: Dutch Trial Registry – NTR4309.
PMID: 26500019 [PubMed - as supplied by publisher]
Long-term effects of goal disturbance and adjustment on well-being in cancer patients.
Qual Life Res. 2015 Oct 7;
Authors: Janse M, Sprangers MA, Ranchor AV, Fleer J
PURPOSE: To investigate the impact of personal goal disturbance after cancer diagnosis on well-being over time, and a possible moderating role of goal adjustment tendencies and actual goal adjustment strategies.
METHODS: Participants (n = 186) were interviewed three times: within a month, 7 months (treatment period), and 18 months (follow-up period) after being diagnosed with colorectal cancer. Participants were asked to freely mention three to ten personal goals. Goal disturbance was assessed by the patients’ ratings of the amount of hindrance experienced in goal achievement. Goal adjustment tendencies were assessed using the Goal Disengagement and Re-engagement Scale and actual goal adjustment (i.e. goal flexibility) by the number of goal adjustment strategies used. Outcome measures were overall quality of life and emotional functioning, assessed with the cancer-specific EORTC QLQ-C30.
RESULTS: Hierarchical regression analyses showed that goal disturbance predicted well-being over both the treatment and the follow-up period. Additionally, the negative effect of goal disturbance on well-being was less for patients who scored higher on goal disengagement and not significant for patients who were more flexible in their use of actual goal adjustment strategies.
CONCLUSIONS: The present study is the first to test the theoretical assumption that goal adjustment is beneficial after goal disturbance. Whereas these findings need to be confirmed in future research, the possibly beneficial role of goal disengagement and actual goal adjustment strategies can be used for psychological interventions.
PMID: 26446093 [PubMed - as supplied by publisher]
The Role of Patients’ Age on Their Preferences for Choosing Additional Blood Pressure-Lowering Drugs: A Discrete Choice Experiment in Patients with Diabetes.
PLoS One. 2015;10(10):e0139755
Authors: de Vries ST, de Vries FM, Dekker T, Haaijer-Ruskamp FM, de Zeeuw D, Ranchor AV, Denig P
OBJECTIVES: To assess whether patients’ willingness to add a blood pressure-lowering drug and the importance they attach to specific treatment characteristics differ among age groups in patients with type 2 diabetes.
MATERIALS AND METHODS: Patients being prescribed at least an oral glucose-lowering and a blood pressure-lowering drug completed a questionnaire including a discrete choice experiment. This experiment contained choice sets with hypothetical blood pressure-lowering drugs and a no additional drug alternative, which differed in their characteristics (i.e. effects and intake moments). Differences in willingness to add a drug were compared between patients <75 years (non-aged) and ≥75 years (aged) using Pearson χ2-tests. Multinomial logit models were used to assess and compare the importance attached to the characteristics.
RESULTS: Of the 161 patients who completed the questionnaire, 151 (72%) could be included in the analyses (mean age 68 years; 42% female). Aged patients were less willing to add a drug than non-aged patients (67% versus 84% respectively; P = 0.017). In both age groups, the effect on blood pressure was most important for choosing a drug, followed by the risk of adverse drug events and the risk of death. The effect on limitations due to stroke was only significant in the non-aged group. The effect on blood pressure was slightly more important in the non-aged than the aged group (P = 0.043).
CONCLUSIONS: Aged patients appear less willing to add a preventive drug than non-aged patients. The importance attached to various treatment characteristics does not seem to differ much among age groups.
PMID: 26445349 [PubMed - in process]
Caregivers’ attentional bias to pain: does it affect caregiver accuracy in detecting patient pain behaviors?
Pain. 2015 Jan;156(1):123-30
Authors: Mohammadi S, Dehghani M, Khatibi A, Sanderman R, Hagedoorn M
Attentional bias to pain among family caregivers of patients with pain may enhance the detection of pain behaviors in patients. However, both relatively high and low levels of attentional bias may increase disagreement between patients and caregivers in reporting pain behaviors. This study aims to provide further evidence for the presence of attentional bias to pain among family caregivers, to examine the association between caregivers’ attentional bias to pain and detecting pain behaviors, and test whether caregivers’ attentional bias to pain is curvilinearly related to patient and caregiver disagreement in reporting pain behaviors. The sample consisted of 96 caregivers, 94 patients with chronic pain, and 42 control participants. Caregivers and controls completed a dot-probe task assessing attention to painful and happy stimuli. Both patients and caregivers completed a checklist assessing patients’ pain behavior. Although caregivers did not respond faster to pain congruent than pain incongruent trials, caregiver responses were slower in pain incongruent trials compared with happy incongruent trials. Caregivers showed more bias toward pain faces than happy faces, whereas control participants showed more bias toward happy faces than pain faces. Importantly, caregivers’ attentional bias to pain was significantly positively associated with reporting pain behaviors in patients above and beyond pain severity. It is reassuring that attentional bias to pain was not related to disagreement between patients and caregivers in reporting pain behaviors. In other words, attentional bias does not seem to cause overestimation of pain signals.
PMID: 25599308 [PubMed - indexed for MEDLINE]
Posted in Pain
Tagged R. Sanderman
People with cancer use goal adjustment strategies in the first 6 months after diagnosis and tell us how.
Br J Health Psychol. 2015 Sep 28;
Authors: Janse M, Ranchor AV, Smink A, Sprangers MA, Fleer J
OBJECTIVES: Theory has offered suggestions on how people may adjust their personal goals after goal disturbance or altered life situations. However, the actual use of these goal adjustment strategies has rarely been studied. This study aimed to investigate whether the goal adjustment strategies identified in the literature are used in the first 6 months following a diagnosis of cancer and whether alternative strategies can be identified.
DESIGN: Exploratory design with a qualitative method of data collection.
METHODS: Patients were asked to list their current personal goals within a month after being diagnosed with colorectal cancer. Six months later, they were asked what had happened to each of these goals. For each goal, raters scored whether (1) it was achieved or being pursued as planned, (2) a known strategy was used, or (3) an alternative strategy was used.
RESULTS: Patients with colorectal cancer (n = 130) reported that more than half of their goals had been achieved or were being pursued as planned. The remaining goals (n = 210) required goal adjustment strategies. Patients used five of six known strategies that involved mostly limited adjustment. Additionally, they used combinations of goal adjustment strategies, and two alternative strategies were identified.
CONCLUSIONS: This study found that patients with cancer use goal adjustment strategies, and it provides illustrations on how these strategies are used, thus deepening and extending existing knowledge of and theory on goal adjustment. Future studies should take the newly identified strategies into account as well as the possible use of combinations of strategies. Statement of contribution What is already known on this subject? The successful pursuit of personal goals is important for maintaining well-being. However, an unexpected and serious illness such as cancer can lead to the need to adjust goals, either because they have become difficult or impossible to attain due to physical hindrance of the illness and/or its treatment, or because other goals have become important due to the confrontation with the fragility of life. Theories have proposed options of how people may deal with their personal goals, but whether these so-called goal adjustment strategies are actually used by cancer patients, and whether there are alternative strategies we need to take into account, is still unclear. What does this study add? This study employs a qualitative method of data collection to study what actually happens to cancer patients’ goals during the first 6 months after diagnosis. This study found that almost all goal adjustment strategies from theory are indeed used by cancer patients and that they mostly use strategies which involve only limited adjustment and a continued focus on the original goal. We found that patients with cancer use combinations of strategies and two alternative strategies, thereby complementing and expanding theories on goal adjustment.
PMID: 26412011 [PubMed - as supplied by publisher]
Assessment and Treatment of Pain during Treatment of Buruli Ulcer.
PLoS Negl Trop Dis. 2015 Sep;9(9):e0004076
Authors: de Zeeuw J, Alferink M, Barogui YT, Sopoh G, Phillips RO, van der Werf TS, Loth S, Molenbuur B, Plantinga M, Ranchor AV, Stienstra Y
BACKGROUND: Buruli ulcer (BU) is described as a relatively painless condition; however clinical observations reveal that patients do experience pain during their treatment. Knowledge on current pain assessment and treatment in BU is necessary to develop and implement a future guideline on pain management in BU.
METHODOLOGY: A mixed methods approach was used, consisting of information retrieved from medical records on prescribed pain medication from Ghana and Benin, and semi-structured interviews with health care personnel (HCP) from Ghana on pain perceptions, assessment and treatment. Medical records (n = 149) of patients treated between 2008 and 2012 were collected between November 2012 and August 2013. Interviews (n = 11) were audio-taped, transcribed verbatim and qualitatively analyzed.
PRINCIPAL FINDINGS: In 113 (84%) of the 135 included records, pain medication, mostly simple analgesics, was prescribed. In 48% of the prescriptions, an indication was not documented. HCP reported that advanced BU could be painful, especially after wound care and after a skin graft. They reported not be trained in the assessment of mild pain. Pain recognition was perceived as difficult, as patients were said to suppress or to exaggerate pain, and to have different expectations regarding acceptable pain levels. HCP reported a fear of side effects of pain medication, shortage and irregularities in the supply of pain medication, and time constraints among medical doctors for pain management.
CONCLUSIONS: Professionals perceived BU disease as potentially painful, and predominantly focused on severe pain. Our study suggests that pain in BU deserves attention and should be integrated in current treatment.
PMID: 26402069 [PubMed - as supplied by publisher]
Mindfulness-based cognitive therapy for seasonal affective disorder: a pilot study.
J Affect Disord. 2014 Oct;168:205-9
Authors: Fleer J, Schroevers M, Panjer V, Geerts E, Meesters Y
BACKGROUND: The best available treatment for seasonal affective disorder (SAD) is light therapy. Yet, this treatment does not prevent recurrence of depression in subsequent seasons. The aim of the study is to gain preliminary insight in the efficacy of Mindfulness Based Cognitive Therapy (MBCT) in the prevention of SAD recurrence.
METHODS: This is a randomized controlled pilot study, in which SAD patients in remission were randomly allocated to an individual format of MBCT or a control condition (i.e. treatment as usual). MBCT was given between May and June 2011, when there was no presence of depressive symptoms. The Inventory for Depressive Symptomatology Self-Report (IDS-SR), which patients received on a weekly basis from September 2011 to April 2012, was used to assess moment of recurrence (≥20) and severity at moment of recurrence.
RESULTS: 23 SAD patients were randomized to MBCT and 23 to the control condition. Kaplan-Meier survival curve showed that the groups did not differ in moment of recurrence (χ²(1).41, p=.52). T-tests showed no group difference in mean IDS-SR scores at moment of recurrence (t(31)=-.52, p=.61).
LIMITATIONS: The results are limited by small sample size (n=46) and missing data of weekly IDS-SR assessments.
CONCLUSION: The findings of this pilot RCT suggest that individual MBCT is not effective in preventing a SAD recurrence when offered in a symptom free period (i.e. spring).
PMID: 25063959 [PubMed - indexed for MEDLINE]
The Elusory Upward Spiral: A Reanalysis of Kok et al. (2013).
Psychol Sci. 2015 Jul;26(7):1140-3
Authors: Heathers JA, Brown NJ, Coyne JC, Friedman HL
PMID: 26025022 [PubMed - indexed for MEDLINE]