DeAnna L. Mori

The Boston Interview for Gastric Bypass: Determining the Psychological Suitability of Surgical Candidates

Morbid obesity is a rapidly escalating problem in the United States, one with serious health ramifications. Due to the lack of empirical support for the long-term efficacy of non-surgical interventions for obesity, gastric bypass surgery has been pursued with increasing frequency as a treatment for morbid obesity. Because surgery is a high-risk, invasive treatment option, medical, psychological and behavioral factors must be carefully considered in pre-surgical evaluations. Although psychological evaluations are requested by surgical teams, there is currently no commonly used, standardized protocol for this type of assessment. Further, there is little empirical data specifying which factors predict successful surgical outcomes. A general overview of a semi-structured interview for pre-surgical gastric bypass evaluation, developed by the Medical Psychology Service at the VA Boston Healthcare System, is provided in this paper. This standardized approach has many advantages: it ensures comprehensive assessment of relevant factors; it facilitates both research and training; and it facilitates patient education about the procedure.

Psychosocial Evaluation for Bariatric Surgery: The Boston Interview and Opportunities for Intervention

The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554–558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376–382, 2007; Lanyon and Maxwell in Obes Surg 17:321–328, 2007; Sogg and Mori in Obes Surg 14:370–380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455–463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient’s success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455–463, 2008) as the organizing framework.

Psychosocial Issues and Mental Health Treatment Recommendations for Patients With Hepatitis C

BACKGROUND Mental health needs of patients with HCV are increasingly being addressed in medical contexts. OBJECTIVE The authors review the psychosocial issues relevant to patients with hepatitis C and provide mental health treatment recommendations. FINDINGS Patients with HCV are faced with a number of challenges, including adjustment to a chronic medical illness, management of symptoms and treatment side effects, and making and maintaining lifestyle changes. Given these issues, mental health clinicians have the opportunity to make a significant contribution to patient care. CONCLUSION After reviewing the relevant research on these psychosocial issues, the authors have identified areas in which clinicians can intervene; these include adjustment to having a chronic medical illness, coping with stigma and relationship changes, management of side effects, and implementing healthy lifestyle changes.

Reasons Persons with COPD Do Not Walk and Relationship with Daily Step Count

Abstract Background: Physical activity (PA) is significantly reduced in persons with COPD. Assessing reasons why persons with COPD do not engage in PA can guide development of effective interventions to promote PA. Methods: We queried 102 participants with stable COPD about disease-related and general reasons why they do not walk more. The StepWatch Activity Monitor (Orthocare Innovations, Mountlake Terrace, WA, USA) assessed daily step count, a direct measure of PA. Regression models assessed daily step count by response categories, adjusting for age and FEV1 % predicted. Results: Subjects had mean age 72 ± 8 years and mean FEV1 1.48 ± 0.55 L (52 ± 19% predicted). COPD-related worries of becoming short of breath (SOB), needing to use inhalers, or oxygen level becoming low were endorsed by 31, 14, and 12 subjects, respectively. Controlling for age and FEV1% predicted, those who worried about becoming SOB walked an average of 1,329 fewer steps per day than those who did not worry (p = 0.020). Those who worried about needing to use inhalers walked an average of 1,806 fewer steps per day than those who did not worry (p = 0.016). Subjects who were the most motivated and confident walked significantly more than those who were the least motivated and confident. Conclusions: Presence of COPD-related reasons and lower motivation and confidence are associated with lower daily step count. Management of dyspnea and education about medication use during exercise, and strategies to increase motivation and confidence could facilitate walking in COPD.

Sleep Quality as a Potential Mediator Between Psychological Distress and Diabetes Quality of Life in Veterans With Type 2 Diabetes

OBJECTIVE The goal of this study was to explore sleep quality as a potential mediator between depression symptoms and diabetes quality of life (DQOL), and anxiety symptoms and DQOL. METHOD Participants were 83 male and 3 female veterans with type 2 diabetes (Mage = 62.4). Self-report measures were completed during the baseline assessment of a larger intervention study conducted at the VA Boston Healthcare System. RESULTS Depression symptoms, anxiety symptoms, and sleep quality were all associated with DQOL. Additionally, sleep quality had a partial indirect effect on the relationships between depression symptoms and DQOL, and between anxiety symptoms and DQOL. CONCLUSIONS These findings suggest that sleep quality may have an important role in the way that psychological distress affects diabetes quality of life.

A Telehealth Intervention for Veterans on Antiviral Treatment for the Hepatitis C Virus

The standard treatment for chronic hepatitis C (pegylated interferon and ribavirin) causes challenging physical and psychological side effects. The current pilot study evaluated the efficacy of a brief, telephone-based, cognitive-behavioral self-management intervention designed to address mood and quality of life within a sample of veterans on antiviral treatment for hepatitis C. Results from this pilot study support the feasibility of this telehealth intervention, showing that veterans were highly satisfied with the content of the intervention and compliant with the telephone calls. Findings further indicate that symptoms of depression and anxiety and mental health quality of life either remained stable or improved in those participants who received the brief telephone intervention, while those receiving usual care showed significant declines in mood and mental health quality of life. The findings from this study provide evidence that a brief, clinician-administered phone intervention may help individuals on antiviral therapy for hepatitis C to cope more effectively with the negative treatment side effects.

Promoting Physical Activity in Individuals With Diabetes: Telehealth Approaches

“Health is the vital principle of bliss, and exercise, of health.” —James Thomson, 18th century Scottish poet Exercise is considered a crucial component of disease management for individuals with type 2 diabetes, and it is associated with extensive health and mental health benefits. Although the benefits of exercise are well established, most people with diabetes do not engage in physical activity in a regular and sustained manner. To address this, it is important to develop interventions that are easily and broadly accessible and that address specific barriers that prevent individuals with diabetes from participating in physical activity. Several investigations have examined the efficacy of using various forms of technology to deliver or enhance interventions designed to promote regular physical activity. The outcomes have been promising, providing support for continued exploration of telehealth interventions that promote physical activity in the diabetic population. This article provides an overview of telephone, Internet-based, and home-based monitoring interventions that promote physical activity, with a focus on those with diabetes. It also discusses the potential advantages of using telehealth interventions in this context.

The Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV)

The purpose of this paper is to introduce the Structured Interview for the Treatment of the Hepatitis C Virus (SIT-HCV). This comprehensive interview expands upon a standard psychiatric interview by including those medical, psychological, and behavioral factors that are essential to determining a patient’s psychological appropriateness for interferon therapy. A detailed description of the SIT-HCV is provided, highlighting its utility in developing recommendations that positively impact patients’ treatment outcomes. The advantages of the SIT-HCV will be presented, including a discussion on how this approach can ensure comprehensive assessment and facilitate research, training, and patient education.

Feasibility, qualitative findings and satisfaction of a brief Tai Chi mind–body programme for veterans with post-traumatic stress symptoms

Objective To examine feasibility, qualitative feedback and satisfaction associated with a 4-session introduction to Tai Chi for veterans with post-traumatic stress symptoms. Design We observed and reported recruitment and retention rates, participant characteristics, adherence, and satisfaction across 2 cohorts. We also examined qualitative feedback provided by questionnaires, focus groups and individual interviews. Main outcome measures Rates of recruitment and retention, focus group and individual feedback interviews, self-reported satisfaction. Participants 17 veterans with post-traumatic stress symptoms. Results Almost 90% (17/19) of those eligible following the telephone screen enrolled in the programme. Three-quarters (76.4%) of the participants attended at least 3 of the 4 Tai Chi sessions. Qualitative data analysis revealed themes indicating favourable impressions of the Tai Chi sessions. In addition, participants reported feeling very engaged during the sessions, and found Tai Chi to be helpful for managing distressing symptoms (ie, intrusive thoughts, concentration difficulties, physiological arousal). Participants also reported high satisfaction: 93.8% endorsed being very or mostly satisfied with the programme. All participants (100%) indicated that they would like to participate in future Tai Chi programmes and would recommend it to a friend. Conclusions Tai Chi appears to be feasible and safe for veterans with symptoms of post-traumatic stress disorder (PTSD), is perceived to be beneficial and is associated with high rates of satisfaction. This study highlights the need for future investigation of Tai Chi as a novel intervention to address symptoms of PTSD.

Targeted recruitment of adults with type 2 diabetes for a physical activity intervention.

Recruiting sufficient numbers of participants for physical activity trials for individuals with diabetes can be difficult because there are often many behavioral demands for participants, and inclusion and exclusion criteria can be extensive. This study examined the recruitment strategies used for a randomized, controlled trial designed to investigate the efficacy of an automated telephone intervention to promote physical activity in adults with type 2 diabetes in an urban Veterans Administration health care system. Traditional recruitment approaches of posting flyers and obtaining referrals from clinicians did not yield sufficient numbers of interested patients. Using the electronic medical record system to identify patients with uncontrolled diabetes allowed staff to send targeted mailings to participants, and 77% of participants were recruited using this method. The targeted mailing approach elicited a positive response rate of 12% (328 of 2,764 potential participants identified) and appeared to produce a more representative and appropriate sample than other recruitment methods used. Lessons learned in this study may be helpful to researchers in future trials who attempt to recruit participants with diabetes for physical activity protocols.