Eleonora C. V. Costa

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Abstract Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.

Predictors of consistent condom use among Portuguese women attending family planning clinics.

ABSTRACT Women account for 30% of all AIDS cases reported to the Health Ministry in Portugal and most infections are acquired through unprotected heterosexual sex with infected partners. This study analyzed socio-demographic and psychosocial predictors of consistent condom use and the role of education as a moderator variable among Portuguese women attending family planning clinics. A cross-sectional study using interviewer-administered fully structured questionnaires was conducted among 767 sexually active women (ages 18–65). Logistic regression analyses were used to explore the association between consistent condom use and the predictor variables. Overall, 78.7% of the women were inconsistent condom users. The results showed that consistent condom use was predicted by marital status (being not married), having greater perceptions of condom negotiation self-efficacy, having preparatory safer sexual behaviors, and not using condoms only when practicing abstinence. Living with a partner and having lack of risk perception significantly predicted inconsistent condom use. Less educated women were less likely to use condoms even when they perceive being at risk. The full model explained 53% of the variance in consistent condom use. This study emphasizes the need for implementing effective prevention interventions in this population showing the importance of taking education into consideration.

HIV Voluntary Testing among Portuguese Women Attending Family Planning Clinics: Implications for HIV Prevention Education and Testing

ABSTRACT Objectives: The aim of this article is to analyze the factors associated with HIV testing among 767 sexually active women. Methods: Participants were administered several self-report questionnaires that assessed behavioral and psychosocial measures. Results: Overall, 59.8% of the participants reported ever having tested for HIV. Results show that higher levels of education, being pregnant or having been pregnant, concern about AIDS, AIDS knowledge, self-efficacy in condom negotiation and perception of no risk in partner significantly predicted the likelihood of testing among women. Attending the mass was negatively associated with HIV testing. Conclusions: These findings provide information that can be used in the development of a focused gender sensitive HIV prevention program to increase HIV testing.

Safe-Sex Knowledge, Self-Assessed HIV Risk, and Sexual Behaviour of Young Portuguese Women

Background: Young women make up most cases of HIV infection in Portugal (e.g., 26% in 2012), but their sexual behaviour, ability to recognize sexually transmitted disease (STD) risk in partners, and knowledge and practice of safe sex are underresearched. Methods: We studied these issues in a group of 177 women from Northern Portugal, together with their social, educational, and religious background. The women filled out several self-report questionnaires developed in the USA that have been adapted and validated for use in Portugal. They assess HIV knowledge, risk perception, and sexual risk behaviour. Results: We documented good knowledge about HIV transmission and prevention, although there are still some myths; 79.9% of the women knew that condoms prevent HIV transmission, but only 46% of them declared to use them regularly. Thus, knowledge does not imply adequate preventive behaviour. Women lacking higher education had poorer knowledge of HIV biology and of partner HIV risk. Despite being aware of HIV cases in their communities, most women deemed themselves at little risk, especially those lacking higher education, with many arguing that monogamy protects them, and, importantly, many preferring to ignore their partners’ current and past behaviour when assessing their exposure. Conclusion: These results point to important intervention targets for campaigns to curb STD infections among young women.

Social Support and Self-Esteem Moderate the Relation Between Intimate Partner Violence and Depression and Anxiety Symptoms Among Portuguese Women

Psychological distress and alcohol abuse have been linked to intimate partner violence (IPV). However, not all victims develop these problems. This study analyses the impact of IPV severity, social support, and self-esteem on depressive and anxiety symptoms as well as on alcohol abuse, and tests social and personal resources as moderators of the abuse-psychological distress-substance abuse link in a sample of Portuguese women including victims and non-victims of IPV (N = 209). IPV severity contributed significantly to depression and anxiety symptoms as well as to alcohol abuse, after controlling for socio-demographic factors. Both social support and self-esteem were found to moderate the relation between IPV and depression and anxiety symptoms. However, moderation did not occur for the association between IPV and alcohol abuse. This study shows the impact of IPV on mental health and on alcohol abuse, and highlights the need to design effective interventions that promote social and personal resources in victimized women.

Predictors of emotional distress in pregnant women: the mediating role of relationship intimacy

Abstract Background: Assessment and treatment of emotional distress during pregnancy show that worries during pregnancy and interpersonal relationships with partners are the important factors determining psychological health. Aims: The present study aimed to investigate the impact of worries during pregnancy, relationship intimacy, and marital satisfaction on anxiety, depression, and stress symptoms in pregnant women, as well as to analyse the mediating effect of relationship intimacy between marital satisfaction and emotional distress. Method: During their second and third trimester of pregnancy, 200 Portuguese women were recruited during childbirth preparation consultations and completed the Cambridge Worry Scale (CWS), the Personal Assessment of Intimacy in Relationships Scale (PAIR), the Marital Life Areas Satisfaction Evaluation Scale (MLASES), and the Depression, Anxiety, and Stress Scale (DASS-21). Results: Hierarchical multiple regression analyses showed that being unemployed or on sick leave, being younger, having a history of miscarriage, having more worries during pregnancy, and declaring low-relationship intimacy were the main predictors of emotional distress. Relationship intimacy mediated the relation of marital satisfaction to anxiety and depression symptoms. Conclusions: This study highlights the importance of the worries during pregnancy and relationship intimacy in shaping pregnant women’s emotional distress, and identifies both as targets of intervention.

Comparison of Two Psycho-Educational Interventions Aimed at Preventing HIV and Promoting Sexual Health Among Portuguese Women

ABSTRACT This study compares the efficacy of 2 psychoeducational interventions—ACCENT skills-based and didactic information only—to prevent HIV among Portuguese women. At posttest and follow-up, participants in both intervention groups (n = 127) were more knowledgeable about HIV than at baseline. Although both intervention groups showed an increase in self-reported condom use over time, differences were marginally stronger in the ACCENT group. Both intervention groups showed more positive results than the non-intervention control group (n = 33). The study suggests that HIV prevention interventions can produce significant changes when they target a set of knowledge, social, and cognitive variables relevant to sexual behavior change.

Demographic Factors, Mental Health Problems and Psychosocial Resources Influence Women's AIDS risk

ABSTRACT The aim of this study was to examine how depressive mood, posttraumatic stress disorder (PTSD) symptoms, self-efficacy, and social support are associated with HIV risk behaviors. Participants were sexually active women (N = 1488) recruited when attending gynecological consultations in primary care settings. Standardized questionnaires were administered to assess for depressive mood, abuse/assault-related PTSD, social support, self-efficacy, stress, and sexual risk behavior. The resulting association models showed that demographic factors, mental health problems, and resources are associated with sexual risk behavior. Detecting and treating mental health problems and interventions that bolster womens psychosocial resources are warranted.

Resource Loss Moderates the Association Between Child Abuse and Current PTSD Symptoms Among Women in Primary-Care Settings

This study examined if abuse during childhood, rape in adulthood, and loss of resources predict a woman’s probability of reporting symptoms of posttraumatic stress disorder (PTSD), and whether resource loss moderates the association between reporting childhood abuse and PTSD symptoms. The sample included 767 women and was collected in publicly funded primary-care settings. Women who reported having been abused during childhood also reported more resource loss, more acute PTSD symptoms, and having suffered more adult rape than those who reported no childhood abuse. Hierarchical logistic regression yielded a two-variable additive model in which child abuse and adult rape predict the probability of reporting or not any PTSD symptoms, explaining 59.7% of the variance. Women abused as children were 1 to 2 times more likely to report PTSD symptoms, with sexual abuse during childhood contributing most strongly to this result. Similarly, women reporting adult rape were almost twice as likely to report symptoms of PTSD as those not reporting it. Resource loss was unexpectedly not among the predictors but a moderation analysis showed that such loss moderated the association between child abuse and current PTSD symptoms, with resource loss increasing the number and severity of PTSD symptoms in women who also reported childhood abuse. The findings highlight the importance of early assessment and intervention in providing mental health care to abused, neglected, and impoverished women to help them prevent and reverse resource loss and revictimization.