Ann R. Peden

Factors influencing medication adherence in patients with heart failure

BACKGROUND The purpose of this study was to explore factors influencing adherence to the prescribed medical regimen in patients with heart failure (HF). METHODS A convenience sample of 7 women and 9 men with HF participated in in-depth interviews. The interviews were audio-taped, transcribed, and checked for accuracy. Content analysis strategies were used to analyze the data. RESULTS The desire to be healthy was the primary motivator in the decision to take medications as prescribed. The process of making connections enhanced medication adherence. Participants connected knowledge of their illness and their symptoms with their medications effectiveness in decreasing these symptoms. Connections to a health care provider and family enhanced treatment adherence. Participants relied on environmental cues as reminders to take their medications, resulting in a habit of daily medication use. CONCLUSIONS Education that helps clients understand their illness, particular symptoms and how medications help them may be beneficial in promoting adherence. A positive working relationship with the health care provider may result in improved adherence.

Preventing Depression in High-Risk College Women: A Report of an 18-month Follow-up

Abstract The authors tested the long-term effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in 92 college women aged 18 to 24 years who ere at risk for clinical depression. The women were randomly assigned to either an experimental or a no-treatment control group. The experimental group participated in a 6-week cognitive-behavioral intervention that targeted identification and reduction of negative thinking, using such techniques as thought stopping and affirmations. Data on depressive symptoms, self-esteem, and negative thinking were collected before the intervention and at intervals of 1, 6, and 18 months postintervention. The women in the intervention group experienced a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem than those in the control group. The beneficial effects continued over an 18-month follow-up period. These findings support the importance of thought stopping and affirmations as prevention interventions with at-risk college women.

Patient–provider communication: Understanding diabetes management among adult females

OBJECTIVE The purpose of this study was to explore how adult women manage their diabetes. Recommendations for improving adherence and opportunities to maximize communication between the healthcare provider and individuals who have type 2 diabetes also were described. METHODS An exploratory qualitative descriptive design was used to describe the experience of living with type 2 diabetes in adult females. Data were obtained via individual in-depth interviews with five women over age 50 with type 2 diabetes. Participants were interviewed individually and participated in a focus group. RESULTS Participants clearly identified three major themes affecting adherence to treatment regimens: communication with the healthcare provider, knowledge of diabetes, and the consequences of poor glycemic control. For these participants, patient-provider communication was the most important factor affecting diabetes adherence. CONCLUSION Individual autonomy asserted in day-to-day management is often perceived as non-compliance by the healthcare provider; while providers descriptions of potential severe complications are viewed as scare tactics by the patients. PRACTICE IMPLICATIONS Improved communication offers the clinician the opportunity to develop a partnership with patients to build mutually acceptable treatment plans and reach mutually agreed upon goals. Empowering the individual with skills needed to negotiate treatment regimens will encourage positive health decisions and improved outcomes.

Negative thinking mediates the effect of self-esteem on depressive symptoms in college women.

BACKGROUND One of every three women between 18 and 24 years of age may be significantly depressed. Younger women have shown increasing rates of unipolar depression since the 1950s, and the average age of onset continues to decline. OBJECTIVES To examine the prevalence and correlates of high depressive symptoms in single college women 18 to 24 years of age. Negative thinking was posited to mediate the relationship between self-esteem and depressive symptoms. METHODS A sample of 246 women was recruited from a university student body. Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-esteem Scale, the Crandell Cognitions Inventory, and the Automatic Thoughts Questionnaire. RESULTS Of the women, 35% had high depressive symptoms. Negative thinking mediated the relationship between self-esteem and depressive symptoms. However, self-esteem also showed a weak direct effect on depressive symptoms. CONCLUSION The findings suggest that negative thinking may play an important role in the development of depressive symptoms in college women.

PARENTAL BONDING: A KEY FACTOR FOR MENTAL HEALTH OF COLLEGE WOMEN

The purpose of this study was to investigate the relationship of parental bonding to the mental health of college women aged 18 to 24 years. A cross-sectional study of a volunteer sample of 246 college women was conducted. Data on depressive symptoms, negative thinking, self-esteem, and parental bonding were collected via self-report. Maternal care was the strongest predictor of all four mental health indices. Paternal overprotection predicted scores of three of the four mental health measures. Women with optimal maternal and paternal bonding profiles (high care/low overprotection) had fewer depressive symptoms, less negative thinking, and higher self-esteem than women with other bonding profiles. The findings have implications for prevention, screening, and intervention to enhance the mental health of college women.

Sense of Coherence and Recovery From Major Depression: A 4-Year Follow-up

The aim of this longitudinal exploratory study was to identify and follow persons with the first episode of major depression (MD) to determine whether sense of coherence (SOC) changes over time. An additional purpose was to assess whether SOC is associated with depressive symptoms, aggression, and functional status either immediately after diagnosis or at 4 years postdiagnosis. The study design was longitudinal; participants participated in semistructured interviews and completed surveys every 6 months starting at diagnosis and concluding 4 years later. The sample consisted of 33 adult patients who were being treated for the first episode of MD according to the Diagnostic and Statistical Manual of Mental Disorders. Twenty-two participants completed all nine sessions. SOC was measured using the SOC scale; depressive symptoms using the Montgomery Asberg Depression Rating Scale; aggression, including the total score and subscales of anger and hostility, using the Aggression Questionnaire-revised Swedish version; and functional status using the Global Assessment of Functioning (GAF) scale and the 36-item Short-Form Health Survey (SF-36). At baseline, SOC was significantly correlated with total aggression (r = -45) and the hostility subscale (r = -.73); baseline SOC was unrelated to depressive symptoms or functional status. SOC increased significantly over time (P < .0001). At the 4-year follow-up, SOC was significantly related to depressive symptoms (r = -.60), the aggression summary score (r = -.65), the anger subscale (r = -.52), the hostility subscale (r = -.77), the GAF (r = .64), and the physical and mental health components of the SF-36 (r = .74 and .72, respectively). The finding that SOC increases as patients recover from MD suggests that treatment of depression may also bolster the patients ability to cope, in addition to lowering depressive symptoms. The relationship between SOC and aggression in MD, with higher SOC correlated with lower aggression, needs to be examined further.

Substance Abuse Treatment for Women Offenders: A Research Review

Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in recidivism. Although women offenders have different reasons for drug use, drug use patterns, life circumstances, and parental responsibilities than men, treatment approaches for women offenders have been largely developed from studies of treatment for incarcerated men and non-offending women in the general community. The purpose of this article is to summarize the recent literature on the treatment needs of women offenders with substance abuse problems and critically examine the six empirical studies that evaluate gender-specific programmatic interventions designed for women offenders. A systematic review of these six empirical studies assessed design, methods, measures, and outcomes. While these studies contribute to the knowledge base, five areas were identified to advance research and improve treatment outcomes for women offenders: 1) randomized controlled design,...

A Community-Based Depression Prevention Intervention With Low-Income Single Mothers

BACKGROUND: There is growing support that cognitive-behavioral interventions may prevent the onset of clinical depression in at-risk individuals. OBJECTIVES: This article describes the long-term effects of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income single mothers at risk for clinical depression. STUDY DESIGN: One hundred thirty-six women were randomly assigned to either an experimental or no-treatment control group. The experimental group participated in a 6-hour cognitive-behavioral group intervention targeting identification and reduction of negative thinking. Data were collected on depressive symptoms, negative thinking, and chronic stressors at 1, 6, and 12 months postintervention. RESULTS: The women in the intervention group experienced a greater reduction in depressive symptoms, negative thinking, and the perception of chronic stressors. These positive effects continued over a 12-month period. CONCLUSIONS: Negative thinking can be reduced using thought stopping and affirmations. These interventions are also cost-effective and easy to administer.

Predictors of Retention of Women Offenders in a Community-Based Residential Substance Abuse Treatment Program

&NA; Substance abuse is a major contributing factor to women being incarcerated in the United States, and substance abuse is a critical factor in the high recidivism rates of women offenders (50–70% within one year). Understanding factors that enhance and deter women from retention in substance abuse treatment will facilitate tailored interventions to improve treatment outcomes. This prospective study examined the relationship of substance use characteristics, childhood trauma, current trauma‐related symptoms, motivation to treatment, and socio‐demographic characteristics, in predicting the retention of women offenders in an urban, residential substance abuse program as they re‐enter the community from incarceration. All women were interviewed within the first week of admission to the residential program using the following measures: the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), and the Trauma Symptom Inventory (TSI), and socio‐demographic characteristics. Length of stay was tracked for all study participants (n = 105). Using multiple regression analysis, substance use characteristics did not predict retention. Age, current use of prescribed pain medication, sexual concerns, employment problems, and importance of drug treatment were significant predictors. Specifically, women remained in treatment longer if they were older, were not taking any prescription pain medication, reported concerns about employment, reported concerns about sexual problems, and reported lower importance of drug treatment, yet higher personal commitment to recovery. Higher scores for childhood emotional trauma, emotional neglect, and physical neglect were correlated with retention, but not statistically significant. These findings suggest the need to tailor individualized treatment to address the medical, employment, sexual and interpersonal relationships, and emotional trauma needs in this vulnerable population of women.

Negative thoughts of women with depression

Abstract Background : For women with depression, negative thinking is a difficult symptom to overcome and may maintain the depressed mood. Not reflected in the literature are womens descriptions of negative thoughts that accompany the illness of depression or strategies to decrease negative thoughts. Objectives : The purposes of this research were to describe negative thoughts experienced by women with major depression, examine their origins, and identify strategies to manage them. Design : A descriptive and exploratory study guided by Peplaus process of practice-based theory development. Six women with a diagnosis of major depression who experienced negative thinking participated in a series of six audiotaped group interviews. Results : Negative thoughts originated in childhood. The women described interpersonal patterns that resulted from negative thinking and identified strategies to manage them. Conclusions : Negative thinking has a tremendous impact on depressed women and contributes to interpersonal patterns that perpetuate depression.