Amy Y. Zhang

Ethnic characteristics of mental disorders in five U.S. communities

The study examined the ethnic ratio of 16 DSM-III mental disorders among White, Black, Hispanic, and Asian Americans. A total of 18,126 residents from 5 sites and 2,939 residents from the Epidemiological Catchment Areas Los Angeles site were studied separately. Logistic regression analysis was performed. Results showed that Blacks were significantly less likely than Whites to have major depressive episode, major depression, dysthymia, obsessive-compulsive disorder, drug and alcohol abuse or dependence, antisocial personality, and anorexia nervosa, but they were significantly more likely than Whites to have phobia and somatization. Lifetime prevalence rates of schizophrenia, obsessive-compulsive disorder, panic, and drug abuse or dependence were significantly lower among Hispanics than among Whites. Asians also had significantly lower rates than Whites of schizophreniform, manic episode, bipolar disorder, panic, somatization, drug and alcohol abuse or dependence, and antisocial personality. Compared with the overall findings, ethnic differences at the Los Angeles site were lessened between Blacks and Whites, enhanced between Hispanics and Whites, and basically unchanged between Asians and Whites.

The Cancer Communication Assessment Tool for Patients and Families (CCAT-PF): a new measure.

Objectives: Caregivers and cancer patients frequently have conflicting and unmet communication needs. The Cancer Communication Assessment Tool for Patients and Families (CCAT‐PF) is a new instrument that assesses congruence in patient–family caregiver communication for both research and clinical purposes.

Effects of combined pelvic floor muscle exercise and a support group on urinary incontinence and quality of life of postprostatectomy patients.

PURPOSE/OBJECTIVES To examine the effect of combined pelvic floor muscle exercise (PFME) and a support group on postprostatectomy urinary incontinence and quality of life. DESIGN Pilot study of a randomized, controlled clinical trial. SETTING Two metropolitan hospitals in northeastern Ohio. SAMPLE 29 men with postprostatectomy urinary incontinence. METHODS The participants learned PFME through biofeedback and were randomized to the control group (n = 15) or the support group (n = 14). The control group practiced PFME at home, whereas the support group attended six biweekly group meetings facilitated by a health psychologist. Assessment of urinary incontinence and quality of life was conducted at baseline and three months. MAIN RESEARCH VARIABLES Urinary incontinence and disease-specific quality of life. FINDINGS Eighty-six percent of the support group participants versus 46% of the control group participants practiced PFME four to seven days per week. The support group had a lower rating of urinary incontinence based on a 0- to 10-point visual analog rating scale than the control group (X = 3.2 versus 4.7), and fewer support group participants used pads (50%) than control group participants (85%) at three months. The support group also scored significantly lower on the severity of incontinence problems than the control group at three months, especially in relationship with spouse and social outing, despite no group difference in these areas at baseline. CONCLUSIONS The study provided promising evidence regarding the effect of the proposed intervention on adherence to PFME, urinary incontinence, and quality of life. IMPLICATIONS FOR NURSING Reports regarding nursing practice are lacking with respect to PFME. This study suggests that practicing PFME in a group with patients with incontinence who have undergone prostatectomy can be a useful nursing intervention.

Differential Patient-Caregiver Opinions of Treatment and Care For Advanced Lung Cancer Patients

This study examined the differences of opinion between cancer patients and caregivers with regard to treatment and care decisions. 184 advanced lung cancer patients and 171 primary caregivers were recruited as a convenience sample from hospitals in Cleveland, Ohio. A telephone interview was conducted to collect data using a semi-structured questionnaire. Nonparametric tests and regression analysis were performed. The findings showed that patients and caregivers reported significant disagreement on three main issues: trade-off between treatment side effects and benefits; reporting treatment side effects to physicians, and hospice care. Caregivers were more concerned about patients quality of life and more willing to discuss hospice issues than were patients (p < or = 01). Perceived family disagreement is associated with depression in both patients and caregivers (p < or = 01; R(2)=8%). The study provided empirical evidence for patient-caregiver disagreement about treatment and care decisions and its significant adverse impact on both patients and caregivers.

Intervention of urinary incontinence and quality of life outcome in prostate cancer patients.

Abstract This study examined the effect of combined Pelvic Floor Muscle Exercises (PFME) and support group on quality of life of postprostatectomy patients. Twenty—nine participants learned PFME through biofeedback and were randomized to the control group (n = 15) and support group (n = 14). Assessment of quality of life was conducted at baseline and 3-month follow—up. The findings indicated a trend of increased functioning and reduced perception of illness intrusiveness in the support group, compared with the control group. Improved urinary continence was significantly associated with reduced depression and symptom distress over time. The findings suggest that an intervention focusing on urinary continence improves quality of life in these patients.

What It Would Take for Men to Attend and Benefit from Support Groups After Prostatectomy for Prostate Cancer : A Problem-Solving Approach

ABSTRACT Twenty-nine incontinent prostate cancer patients learned Pelvic Floor Muscle Exercises through biofeedback and were randomly assigned to a control group or a support group entailing six meetings over 3 months. The obtained consent rate (50%) is much higher than the previously reported rate for men (13%). The reasons for refusal were mainly due to actual barriers (48%) and less frequently due to psychological concerns (10.3%). Most support group participants (71.5%) attended five to six group meetings. The findings suggest that men are willing to attend support groups that focus on solving problems and that social supports help men improve continence and quality of life.

Recognition of Depression and Anxiety among Elderly Colorectal Cancer Patients.

This study investigated the ICD-9 diagnostic rates of depressive and anxiety disorders, including major depression, neurotic depression, adjustment disorder with depressed mood, depressive disorder NOS (not elsewhere classified), and anxiety states, among elderly Medicare beneficiaries (age ≥ 65) who received a colorectal cancer diagnosis between 1998 and 2002 in U.S. The Seer-Medicare data, representing 14–25% of the U.S. population, was used to examine ICD-9 diagnostic rates of depressive and anxiety disorders among 56,182 colorectal cancer outpatients and 265,382 noncancer outpatients, respectively. The findings show that the ICD-9 diagnoses ranged from 1.5% to 1.8% for depressive disorders and 0.8% to 1.2% for anxiety states in the colorectal cancer outpatients, and from 2% to 2.5% for depressive disorders and 1.1% to 1.5% for anxiety states in the noncancer outpatients over five years. More than 70% of colorectal cancer outpatients with a depressive diagnosis were diagnosed for depressive disorder NOS. The findings suggest that the difficulty in recognizing depressive symptoms in colorectal cancer patients may contribute in part to the low ICD-9 diagnostic rates of depressive disorders. They call for research attention to the investigation of depressive symptoms for improving the recognition and treatment in this patient population.

The impact of realignment on utilization and cost of community-based mental health services in California.

Decentralization of Californias public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited Californias public mental health services during a 6-year period (FY 1988–1990 and FY 1992–1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.

The long-term relationships between the motivation for change and alcohol use severity among patients with severe and persistent mental illness.

Abstract This study examined the long-term relationship of changes in the motivation to remedy alcohol abuse to alcohol use severity among patients with a dual diagnosis of substance abuse disorder and severe and persistent mental illness. Linear regression analyses showed that patients who increasingly recognized alcohol use problems over a 9-month period exhibited significantly greater alcohol use severity at 9 months and a significant increase in alcohol use severity over time. Moreover, patients who became increasingly determined to take actions against alcohol use over a 9-month period exhibited significantly lower alcohol use severity at 9 months and a significant decrease in alcohol use severity over time. The findings support Prochaska et al.s transtheoretical model of the motivation for change. They suggest that the recognition of alcohol use problems comes along with learning adverse consequences of alcohol use and that increased determination to take actions is critical to the long-term behavioral changes in alcohol use.

Effects of Patient Centered Interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment: A Randomized, Controlled Trial

PURPOSE We examined whether an intervention combining pelvic floor muscle exercise and symptom self-management would improve urinary continence and quality of life in patients with prostate cancer. MATERIALS AND METHODS In a randomized, controlled, longitudinal clinical trial 279 patients with prostate cancer with persistent urinary incontinence were randomized to 1 of 3 groups, including biofeedback pelvic floor muscle exercise plus a support group, the biofeedback exercise plus telephone contact and usual care without intervention. The biofeedback plus support and plus telephone groups received 1 session of biofeedback assisted exercise and 6 biweekly sessions of problem solving therapy. This delivered symptom management skills through a peer support group or telephone contacts for 3 months. All subjects were assessed in blinded fashion at baseline, and 3 and 6 months for urinary leakage frequency, leakage amount and disease specific quality of life. RESULTS A total of 244 subjects completed the study. The biofeedback plus support and biofeedback plus telephone groups had a lower frequency of daily urinary leakage than the group with usual care without intervention at 3 months (p=0.019 and p≤0.001, respectively) but not at 6 months. The biofeedback plus support group but not the biofeedback plus telephone group had 13.3 gm lower leakage at 6 months than the usual care group (p=0.003). Overall the biofeedback plus support and plus telephone groups reported less symptom severity (p≤0.001) and fewer incontinence problems (p≤0.01) than the usual care group at 6 months. CONCLUSIONS Study findings show that pelvic floor muscle exercise practice plus symptom self-management in a peer support setting can significantly improve urinary continence and quality of life in patients with prostate cancer.