Anja Höcker

Angehörige und Patienten in der ambulanten psychoonkologischen Versorgung: Zugangswege, psychische Belastungen und Unterstützungsbedürfnisse

Supportive care needs of family members of cancer patients are often overlooked within psychosocial care. A screening measure was sent to 132 family members and 362 cancer patients (response rate > 95 %) after telephone registration at a specialized outpatient clinic for psycho-oncology at the University Medical Center Hamburg-Eppendorf. The majority of participants was informed about the outpatient clinic for psycho-oncology through advice by third parties. More than 90 % of family members and cancer patients show high levels of distress; 49 % of family members and 59 % of patients had moderate to high levels of depression; 58 % of family members and 61 % of patients had moderate to high levels of anxiety. No gender differences were observed in both groups. Most frequent supportive care needs in both groups refer to fear of recurrence, dealing with uncertainty, sadness and keeping a positive outlook. Our findings emphasize the need for specific psycho-oncological interventions.

Exploring spiritual needs and their associated factors in an urban sample of early and advanced cancer patients.

Although it is widely recognised that people turn to spirituality in times of crises, the interest in exploring the spiritual needs of cancer patients is just beginning to grow. The purpose of this study was to conduct a spiritual needs assessment with cancer patients living in a Northern European metropolitan region in order to (a) examine the relevance and nature of spiritual needs; (b) to clarify the role of demographic and clinical characteristics in spiritual needs; and (c) to identify their associations with dimensions of psychological distress. N = 285 outpatients with mixed cancer sites and of all tumour stages were surveyed cross-sectionally. Instruments included the Spiritual Needs Questionnaire (SpNQ) and measures of anxiety, distress, hopelessness and meaning-related life attitudes. Almost all patients (94%) reported at least one spiritual need. The needs for Inner Peace and Actively Giving emerged to be of greatest importance. Significant, but weak differences were found for age, gender and being in a partnership. No associations for medical characteristics were observed. Regression analyses revealed anxiety as the strongest predictor for the subscales Existential Needs, Inner Peace and Actively Giving. The results emphasise the relevance of spiritual needs in cancer patients. The call for spiritual assessment and interventions to meet spiritual needs in cancer patients is strengthened.

Does emotion dysregulation mediate the relationship between early maltreatment and later substance dependence? Findings of the CANSAS Study.

Background/Aims: Maltreatment in childhood and adolescence is a risk factor for substance use disorders (SUDs) in adulthood. This association has rarely been investigated in the light of emotion dysregulation. To fill this gap, this study examines emotion dysregulation and SUDs among adults with a history of early maltreatment. Methods: Comparison of emotion dysregulation in adults with a history of early abuse and neglect who developed either an SUD (n = 105) or no mental disorder (n = 54). Further, a mediation model for the association between the severity of early maltreatment and SUDs was tested. Participants completed research diagnostic interviews for psychopathology, the Difficulties in Emotion Regulation Scale, and the Childhood Trauma Questionnaire. Results: By using hierarchical regression techniques and mediational analyses controlling for age and gender, it was possible to provide evidence for the mediating role of emotion dysregulation between early emotional and physical maltreatment and later SUDs. Conclusions: Emotion dysregulation is a potential mechanism underlying the relationship between early emotional and physical maltreatment and the development of SUDs. In light of these findings, focusing on the early training of adaptive emotion regulation strategies after childhood maltreatment might be of considerable relevance to prevent the development of SUDs.

Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact?

A better understanding of the role of psychosocial resources and factors associated with participating in patient support groups appears to be important for the development and implementation of cancer survivorship care plans. We therefore investigated the frequency of participation in and satisfaction with patient support groups after completion of a rehabilitation programme and aimed to examine differences in demographic, medical and psychosocial characteristics between group participants and non-participants. We further aimed to identify predictors of participation in patient support groups. A total of 1281 eligible patients (75.5% participation rate) were recruited on average 11 months post diagnosis and assessed at the beginning (t1 ), at the end (t2 ) and 12 months after rehabilitation (t3 ). Study participants completed self-report measures assessing support-group participation and satisfaction, psychosocial distress (anxiety, fear of cancer recurrence, depression), social support, coping, quality of life, pain and treatment-related characteristics. Sixty-seven patients (7.6%) participated in a patient self-help group. Being unemployed, undergoing an increased number of overall treatments, and a higher active emotion-oriented coping style significantly predicted self-help group participation; the predictive power of the multivariate logistic regression model was rather weak (Nagelkerkes R(2) = 0.07). Our data provide evidence that self-help group participation in cancer patients may be largely related to other factors than medical or psychosocial distress.

Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect

Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.

Trauma, Resilienz und Emotionsregulation

Background: History of childhood abuse and neglect is considered to be a relevant risk factor for adult psychopathology. A functional emotion regulation (ER) can account for resilience despite of traumatic experiences in childhood. Materials & Methods: This study compares the habitual use of specific ER strategies among mentally healthy individuals with (n=61) and without (n=52) experience of childhood abuse and neglect by using the self-rating instrument Heidelberg Form for Emotion Regulation Strategies (H-FERST). SCID-I, ADP-IV, SCL-27, and BDI-II were used for assessment of psychopathological distress. Results: We found no group difference in the habitual use of ER strategies. Healthy individuals with childhood abuse and neglect showed significantly more subjective distress symptoms. Discussion & Conclusion: Considering the significantly higher psychopathological distress reported by the trauma group, the functional habitual use of ER strategies could serve as a path to explain the resilient development of adult individuals after childhood abuse and neglect.

Posttraumatische Belastung bei Krebspatienten: Validierung der deutschen Version der Posttraumatic Stress Disorder Checklist – Civilian Version (PCL-C)

Objective: Purpose was to evaluate factor structure, symptom clusters and psychometric properties of the German adaptation of the Posttraumatic Stress Disorder Checklist ‐ Civilian Version (PCL-C) in 1594 breast and prostate cancer survivors. Methods: Factor structure, internal consistency, concurrent and divergent validity were analyzed through measures of posttraumatic stress (IES-R), anxiety and depression (HADS) as well as HRQoL (SF-8). Results: Three factors were extracted using principal component analysis, which explained 60.5 % of the variance. The factors measure numbing and arousal (9 items) ( = 0.88), intrusion (5 items) ( = 0.88) and avoidance (3 items) ( = 0.74). Confirmatory factor analysis suggested good to acceptable fit indexes. Concurrent and divergent validity of the PCL-C was determined. Conclusion: Findings confirm a three-factor model of the PCL-C, however, symptom clusters suggest avoidance and numbing as two different dimensions, and feelings of numbness and arousal as one dimension. Findings support the use of the PCL-C as a reliable and valid instrument for cancer patients.

HPA axis stress reactivity and hair cortisol concentrations in recently detoxified alcoholics and healthy controls with and without childhood maltreatment

Childhood maltreatment (CM) is a strong risk factor for alcohol dependence (AD) and is associated with a more severe course of the disease. Alterations of the hypothalamic‐pituitary‐adrenal (HPA) axis may play an important role in this relationship. The aim of the present study was to systematically investigate potential alterations in HPA functioning associated with AD diagnosis and CM. Four study groups were recruited: AD patients with (n = 29; 10♀) and without (n = 33; 8♀) CM and healthy controls with (n = 30; 20♀) and without (n = 38; 15♀) CM. Cumulative cortisol secretion was measured by hair cortisol concentration (HCC). To measure HPA axis response to the Trier social stress test (TSST), saliva and blood samples were analysed for adrenocorticotropic hormone (ACTH) and cortisol. In the AD groups, the period of hair growth covered acute alcohol consumption and withdrawal. The TSST was scheduled after completion of withdrawal. Irrespective of CM, higher HCCs and reduced ACTH and cortisol levels before and after TSST were observed in AD patients. The analyses did not reveal any differences between AD patients with and without CM. Healthy controls with CM had lower plasma cortisol levels compared with those without CM. The results suggest that AD is strongly related to HPA axis functioning, which may superimpose possible differences between AD patients with and without CM. Future studies should investigate whether biologically different subtypes of AD with and without CM can be identified in earlier stages or before the development of AD.