Edvin Bru

Depressed Mood and Subjective Health Symptoms as Predictors of Mortality in Patients with Congestive Heart Failure: A Two-Years Follow-up Study:

Objective: The present study was undertaken in order to evaluate the relationship between depressed mood (depression, emotional distress) and disease-specific subjective health symptoms upon mortality risk among patients with congestive heart failure (CHF). Methods and Results: Proportional hazard models were used to evaluate the effects of selected biomedical, subjective health and psychological variables on mortality among 119 clinically stable patients (71.4% men; mean age 65.7 years +/− 9.6) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the twenty-four-month period of data collection, all from cardiac causes. Results indicated that depressed mood was a significant predictor of mortality with a hazard ratio of 1.9, p .002. In contrast, subjective health was not a significant predictor of mortality in a Cox regression model that included depressed mood. The hazard ratio for a 1-point increase in Zung Depression Scale score was equal to 1.08 based on the multivariate model. Conclusions: Results indicate that depressed mood is significantly related to increased mortality risk among heart failure patients. This finding is of concern to clinicians and should have implications for treatment of patients with congestive heart failure.

Social relationships and mortality in patients with congestive heart failure.

The present study was undertaken to evaluate the possible effects of social relationships (perceived social support, and perceived social isolation) upon mortality risk among patients with congestive heart failure (CHF). Proportional hazard models were used to evaluate the effects of different social factors on mortality among 119 clinically stable patients (71.4% men; mean age 65.7+/-9.6 years) with symptomatic heart failure, recruited from an outpatient cardiology practice. Twenty deaths were registered during the 24-month period of data collection, all from cardiac causes. Results indicated that social isolation was a significant predictor of mortality (relative risk, 1.50, confidence interval (CI), 1.00 to 2.19; P<.038), controlling for depressive symptoms, heart failure severity, and functional status and age. Perceived intimate network support was marginally significantly associated with increased risk of mortality in this population of CHF patients (relative risk, 0.60, CI, 0.35-1.02; P<.06). However, the sample is small and caution in drawing conclusions should be exercised. Further research is required in order to either deny or confirm these findings, and to illuminate the mechanisms behind the relationships between social isolation and mortality.

School-Related Stress and Psychosomatic Symptoms among Norwegian Adolescents

This study examines the relationships between school-related stress, gender and psychosomatic symptoms in a sample of 531 adolescents pupils in years (grades) 8, 9 and 10 (aged 13-16 years) from two compulsory schools in Norway. Results showed that 18.1 percent reported being ‘very much’ affected by at least one of the assessed psychosomatic symptoms. Girls reported significantly more psychosomatic symptoms than did boys. Tests of the dimensionality of the school-related stress that was assessed in the present study showed four main categories: (1) difficulties with peers at school; (2) worries about school achievement; (3) schoolwork pressure and (4) conflicts with parents and/or teachers. Results from multiple regression analyses showed that scores for the different stressors were significantly associated with psychosomatic symptoms. Findings suggest that frequency of psychosomatic symptoms might be related to how well or otherwise pupils adapt to the demands of school and to the interpersonal climate of the school. Gender seems to play a differentiating role here. Girls reported significantly more stress that was related to worries about school achievement, whereas boys reported significantly more stress arising from conflicts with parents and/or teachers. Finally, stress due to difficulties with peers at school was more closely correlated with psychosomatic symptoms among boys than among girls.

Functional Status and Depression among Men and Women with Congestive Heart Failure

Objective: The study was designed 1) to examine the prevalence of depression in patients with congestive heart failure (CHF); 2) to explore associations between the physicians rating of functional status (NYHA class) and patients assessment of functional status (physical limitation, dyspnea) with symptoms of depression; and 3) to explore gender related differences in relation to physicians rating and patients rating of function status, and symptoms of depression. Method: A sample of 119 clinically stable heart failure patients (85 males and 34 females) was recruited from an outpatient cardiology hospital practice. The patients underwent a physical examination and completed a set of questionnaires. Prevalence of depressive symptoms and the association of these symptoms with NYHA class and patients perceived functional status was studied. Results: Findings indicate that depressive symptoms were not predominant among this sample of CHF patients. Path analyses showed non-significant direct associations between NYHA class as well as patients perception of dyspnea with depression. In contract, the subjective indicator of physical limitations was strongly associated with symptoms of depression among the males, but this relation was not significant among the females. Conclusions: Results suggest that men and women respond differently to the burden of heart failure. However, interpretation of the results from the present study should be considered as tentative and additional research is required to examine mechanisms that explain gender differences in response to heart failure.

The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes

AIM This article is a report of a cross-sectional study examining the degree to which clinical indicators, coping styles and perceived support from healthcare professionals and family are related to diabetes-related distress. BACKGROUND Many people with type 2 diabetes experience high levels of distress stemming from concerns and worries associated with their disease. Diabetes-related distress has predominantly been studied in relation to diabetes management and metabolic control, and to some extent in relation to coping styles and perceived social support. To date, little is known about the relative contribution of clinical indicators, coping styles and perceptions of social support to perceived distress among people with type 2 diabetes. METHODS A sample comprising 425 Norwegian adults, aged 30-70, with type 2 diabetes, completed questionnaires assessing coping styles, perceived social support from health professionals and family and diabetes-related distress assessed by the Problem Areas in Diabetes Scale. Demographical and clinical data were collected by self-report. Data were collected in October 2008. FINDINGS   Results from the regression analyses showed a greater variance in emotional distress accounted for by coping styles (21·3%) and perceived support (19·7%) than by clinical indicators (5·8%). CONCLUSION FINDINGS may indicate that healthcare providers should pay more attention to non-clinical factors such as coping styles and social support, when addressing diabetes-related distress. They should also be aware that interventions based on psychosocial approaches may primarily influence distress, and not necessarily metabolic control.

Perceived Social Support at School and Emotional and Musculoskeletal Complaints among Norwegian 8th Grade Students

Abstract Results from the present study indicate that a majority of Norwegian 8th grade students experience satisfactory support from teachers and relations with peers. However, about 6% of the sample reported being harassed on a weekly basis. Moreover, results indicate that there is room for improvement, especially regarding the teachers’ emotional support of students, as well as their ability to prevent students from being harassed. Twelve per cent of the sample reported more severe emotional complaints, whereas 10% of 8th grade students reported more severe musculoskeletal complaints. Results showed significant associations of teacher support and peer relations with emotional as well as musculoskeletal complaints (EM complaints). Exposure to harassment at school and a perceived lack of academic support from teachers showed the strongest associations with EM complaints. Associations were stronger for students reporting learning difficulties than for students not reporting learning difficulties. This was...

Perceived support from healthcare practitioners among adults with type 2 diabetes.

AIM This paper is a report of a study of how adults with type 2 diabetes perceive different attributes of support provided by healthcare practitioners and how various attributes of support can influence peoples motivation to self-manage their disease. BACKGROUND Motivational problems seem to be a major reason for poor diabetes management. According to well-known theories of motivation, expectations of being able to perform certain behaviours are a key element. Different attributes of support from healthcare practitioners are likely to influence such expectations. To date, no researchers have specifically examined how people with type 2 diabetes perceive different attributes of support from healthcare practitioners and how these may influence their motivation to manage their disease themselves. METHODS A descriptive/explorative qualitative design and focus groups were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data were collected in 2007 and analysed using qualitative content analysis. FINDINGS Five themes were identified, reflecting perceived attributes of support from healthcare practitioners: (1) an empathetic approach, (2) practical advice and information, (3) involvement in decision-making, (4) accurate and individualized information and (5) ongoing group-based support. CONCLUSION Healthcare practitioners may strengthen the self-management motivation among adults with type 2 diabetes by enhancing expectations of being able to perform the necessary diabetes care, and through the provision of empathetic, individualized, practical and ongoing group-based support.

Social Support, Negative Life Events and Emotional Problems Among Norwegian Adolescents.

Relationships between negative life events, perceived social support and emotional problems were assessed in a national representative sample of 1053 adolescents in eighth grade. Thirty-one percent of the adolescents reported that they had experienced at least one negative life event during the last year. Serious illness or injury among close relatives or friends was reported as the most prevalent negative life event. Negative life events were significantly associated with emotional problems among both female and male adolescents. Moreover, support from parents, friends and teachers was directly, negatively associated with emotional problems in both sexes. Finally, results indicate that support from parents moderate the relationship between negative life events and emotional problems among adolescent girls.

Coping styles among adults with Type 1 and Type 2 diabetes

This study identified and compared different coping styles among adults with Type 1 and Type 2 diabetes. A sample comprising 534 Norwegian adults with both types of diabetes aged between 25-70 participated in the study. Diabetes-related coping styles were assessed by self-reports, using the Diabetes Coping Measure and sub-scales from the COPE scale. A clear majority of the respondents reported to integrate their diabetes. Other encouraging findings indicated that only a small minority responded to diabetes-related problems by denial and/or mental disengagement and resignation. On the other hand, a substantial proportion of the respondents reported that they seldom used active task-oriented coping, such as seeking social support, seeking knowledge and planning. This lack of active task-orientation was more evident among people with Type 2 diabetes than among those with Type 1. The differences found between types of diabetes and coping were mainly related to higher age and lower educational level among people with Type 2 diabetes. Moreover, 40% of the respondents reported that they often blamed themselves. In addition, self-blame correlated significantly with both the active and passive coping styles. The present results indicate that there is ample potential for improving active task orientation among adults with diabetes. It should, however, be of some concern that improving active coping may be associated with an increase in self-blaming.

The personality and quality of life in HNSCC patients following treatment

The aim of the present study was to investigate the association between self-reported quality of life (QoL) and personality in successfully treated primary head and neck squamous cell carcinoma (HNSCC) patients. We determined QoL using the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ) C30/H and N35, and personality by the Eysenck Personality Inventory (EPI). All patients younger than 80 years who had been diagnosed with HNSCC in Western Norway in the period from 1992 to 1997, and who had survived until 1999, were sampled. 96 patients (a 90% response rate) were included. Questionnaires were also mailed to all Norwegian laryngectomised patients; 104 patients returned the questionnaires (a 50% response rate). The neuroticism scores were test re-test reliable as determined by the neuroticism scores measured at the primary HNSCC diagnosis for a sub-sample (N=22) of the included patients. High neuroticism was associated with a low QoL in both patient samples. The neuroticism score was associated with the QLQ-C30 scales (common variance: 17-25%) and all QoL scores in the laryngectomised group (common variance: 11-25%), and the H and N35 symptom scores in the laryngectomised sample. The associations could still be shown when adjustments were made for gender, age, marital status, educational level, number of children and level of treatment. Extraversion was associated with general QoL, physical and emotional scores in the HNSCC patient sample. Radiation therapy in the HNSCC sample was associated with the H and N35 symptom scores, but different ones to those associated with neuroticism. In conclusion, high neuroticism, but not extraversion, is associated with a lowered QoL.