Charles K. Burnett

Impact of irritable Bowel syndrome on quality of life

The aims of this study were to determine the impact of irritable bowel syndrome on quality of life using a well-standardized measure, the SF-36, and to determine whether apparent impairments may be due to neuroticism. Undergraduate students with irritable bowel syndrome who had consulted a physician (41 females, 42 males), students with irritable bowel who had not consulted a physician (91 females, 74 males), and asymptomatic controls (52 females, 70 males) completed questionnaires on quality of life, neuroticism, and psychological distress. Patients showed greater impairment in quality of life than nonconsulters, who in turn showed greater impairment than controls. Neuroticism and psychological distress were correlated with all quality-of-life measures. However, when neuroticism and psychological distress were statistically partialed out, irritable bowel syndrome still had a significant negative impact. The SF-36 may be a useful outcome measure in treatment studies, but investigators will need to correct for confounding influences of neuroticism.

Hypnosis treatment for severe irritable bowel syndrome: investigation of mechanism and effects on symptoms.

Hypnosis improves irritable bowel syndrome (IBS), but the mechanism is unknown. Possible physiological and psychological mechanisms were investigated in two studies. Patients with severe irritable bowel syndrome received seven biweekly hypnosis sessions and used hypnosis audiotapes at home. Rectal pain thresholds and smooth muscle tone were measured with a barostat before and after treatment in 18 patients (study I), and treatment changes in heart rate, blood pressure, skin conductance, finger temperature, and forehead electromyographic activity were assessed in 24 patients (study II). Somatization, anxiety, and depression were also measured. All central IBS symptoms improved substantially from treatment in both studies. Rectal pain thresholds, rectal smooth muscle tone, and autonomic functioning (except sweat gland reactivity) were unaffected by hypnosis treatment. However, somatization and psychological distress showed large decreases. In conclusion, hypnosis improves IBS symptoms through reductions in psychological distress and somatization. Improvements were unrelated to changes in the physiological parameters measured.

Altering the course of marriage: The effect of PREP communication skills acquisition on couples' risk of becoming maritally distressed.

This longitudinal study predicted marital outcome from communication skills gained from participation in the Prevention and Relationship Enhancement Program (PREP; H. J. Markman, S. L. Blumberg & S. M. Stanley, 1989; Stanley et al., 2001) by 39 women and 38 men. Results were in the expected direction for men but not for women. Mens pre- to posttest decrease in negative communication and increase in positive communication predicted decreased risk of marital distress onset in men. Womens pre- to posttest increase in positive communication, which was related to self-reported avoidance of problem solving, predicted an increased risk of male and female distress onset. Couples with men relatively high on premarital risk factors demonstrated a greater benefit from mens positive communication skills acquisition.

Insurance, employment, and psychosocial consequences of a diagnosis of hereditary hemochromatosis in subjects without end organ damage

OBJECTIVES:Asymptomatic individuals with hereditary hemochromatosis (HH) may experience difficulties in obtaining employment or insurance, despite their good health. The extent to which these difficulties occur is unclear. The aim of this study was to assess the insurance, employment, and psychosocial consequences of a diagnosis of HH in subjects with no end organ damage.METHODS:In three outpatient clinics specializing in the treatment of HH, we performed a survey of individuals diagnosed with HH who were without end organ damage secondary to iron overload, along with their unaffected siblings. A review of the medical records of subjects with HH was performed. Main outcomes were attaining and keeping employment; health, disability and life insurance; and scores on the SF-36, a quality of life measure, and the SCL-90-R, a measure of psychological well-being.RESULTS:Of 130 eligible subjects with HH, 126 (97%) responded. Of the 55 eligible controls, 46 (84%) responded. Of the 126 subjects with HH, 25 (20%) described 28 incidents of insurance denial or increased premium rates, which they attributed to their diagnosis HH. Of the 28 incidents, 16 (57%) involved life insurance, eight (29%) involved health insurance, and four (14%) involved disability insurance. One subject reported an employment refusal. Five of the 25 subjects (20%) reporting insurance denial or increased premiums had significant comorbid conditions. One of 46 sibling controls (2%) reported an increased rate for life insurance (p = 0.003). No differences were noted in either the SF-36 or the SCL-90-R scores between subjects with HH and unaffected siblings. Overall rates of active health, disability, and life insurance were similar between the groups.CONCLUSIONS:Insurance denial and increased premium rates are reported commonly among individuals with HH without end organ damage. However, the overall proportion of those with active insurance, the quality of life, and the psychological well-being of these subjects were similar to those of unaffected siblings.

Family size and child mental disorders in Bahia, Brazil

The relationship between family size and child mental disorders was assessed through a prevalence study conducted in an urban neighborhood of Salvador, Brazil. From a representative sample of 828 children aged between 5 and 14 years, 23.3% were diagnosed as exhibiting varying degrees of mental disorders. Diagnoses were based on psychiatric interviews, following screening using the QMPI (a Portuguese-language screening questionnaire). Results supported the hypotheses that: (1) children from smaller families would exhibit higher prevalence of mental disorders than those from larger families; and (2) prevalence of neurotic and psychosomatic disorders would be lower for children from larger families than from smaller ones. Significant associations were also found between family size and diagnosis and severity of child mental disorders. Controlled analyses indicated that these relationships were not confounded by age or sex of the child, family social class, or family type.