Esben Strodl

The relationship of adult attachment dimensions to depression and agoraphobia

We examined the unique relations between the five dimensions of the Attachment Style Questionnaire (ASQ; Feeney, Noller, & Hanrahan, 1994) and depression and agoraphobic behavior (i.e., avoidance of situations where high anxiety is experienced). In addition, we examined mediation models in an attempt to clarify the link between adult attachment and these two dimensions of psychopathology. In testing these models, we administered the ASQ, General Self-Efficacy Scale, Agoraphobic Catastrophic Cognitions Questionnaire, Beck Depression Inventory, and the Mobility Inventory for Agoraphobia (a measure of the degree to which situations are avoided that are typically anxiety provoking for people with agoraphobia) to 122 participants (44 with agoraphobia, 25 with a current major depressive disorder, and 53 with no current psychopathology). The results showed that the insecure attachment dimensions of need for approval, preoccupation with relationships, and relationships as secondary were uniquely associated with depression and that general self-efficacy partly mediated the relationship between need for approval and depression. In contrast, only preoccupation with relationships was uniquely associated with agoraphobic behavior, and catastrophic cognitions about bodily sensations partly mediated this association.

Perceived Stress as a Predictor of the Self-Reported New Diagnosis of Symptomatic CHD in Older Women

This article describes one aspect of a prospective cohort study of 10,432 women aged between 70 and 75 years. After a 3-year period, 503 women self-reported a new diagnosis by a doctor of angina or myocardial infarction (symptomatic coroary heart disease [CHD]). Time one psychosocial variables (Duke Social Support Index, time pressure, Perceived Stress Scale, Mental Health Index, having a partner, educational attainment, and location of residence) were analyzed using univariate binary logistic regression for their ability to predict subsequent symptomatic CHD. Of these variables, the Duke Social Support Index, Perceived Stress Scale and the Mental Health Index were found to be significant predictors of symptomatic CHD diagnosis. Only the Perceived Stress Scale, however, proved to be a significant independent predictor. After controlling for time one nonpsychosocial variables, as well as the frequency of family doctor visits, perceived stress remained a significant predictor of the new diagnosis of symptomatic CHD in this cohort of older women over a 3-year period.

The 5-Item Mental Health Index Predicts the Initial Diagnosis of Nonfatal Stroke in Older Women

BACKGROUND Relatively little is known about psychosocial risk factors for the onset of stroke. The aim of this paper is to identify independent psychosocial risk factors for subsequent reported new diagnoses of stroke in older women. METHODS A prospective cohort study of women initially aged between 70 and 75 years was first surveyed in 1996 and again in 1999. During this interval, from a final sample of 7839 participants, 174 women reported that a doctor had diagnosed them with stroke for the first time. A range of psychosocial risk factors measured in 1996 (life events, Mental Health Index [MHI-5], having a partner, Perceived Stress Scale, Duke Social Support Index, educational attainment, location of residence, feelings of time pressure) were entered into binary logistic regression models to examine which would predict the self-reported new diagnosis of stroke over the 3-year period after adjusting for a range of biomedical risk factors and the frequency of general practitioner visits in 1996. RESULTS Only the MHI-5 proved to be a significant predictor of self-reported new stroke diagnosis. The MHI-5 remained a significant risk factor (OR 1.61, 95% CI 1.01-2.55, p < 0.05) even after adjusting for a range of other possible risk factors (body mass index, physical activity, alcohol status, diabetes, heart disease, hypertension, nutritional risk) and frequency of general practitioner visits. CONCLUSIONS Poor mental health appears to be a risk factor for the self-reported new diagnosis of stroke in older women. The 5-item MHI may be a useful instrument for researchers investigating the relationship between psychosocial variables and stroke in older women and for clinicians who wish to identify those at risk for stroke.

WHY RENAL NURSES COPE SO WELL WITH THEIR WORKPLACE STRESSORS

BACKGROUND Previous studies have found significant stressors experienced by nurses working in haemodialysis units yet renal nurses appear to report less burnout than other nurses. OBJECTIVES This study aims to undertake an inductive process to better understand the stressors and the coping strategies used by renal nurses that may lead to resilience. METHOD Sixteen haemodialysis nurses from a metropolitan Australian hospital and two satellite units participated in open-ended interviews. Data were analysed from a grounded theory methodology. Measures of burnout and resilience were also obtained. RESULTS Two major categories of stressors emerged. First, due to prolonged patient contact, family-like relationships developed that lead to the blurring of boundaries. Second, participants experienced discrimination from both patients and staff. Despite these stressors, the majority of participants reported low burnout and moderately high-to-high levels of resilience. The major coping strategy that appeared to promote resilience was emotional distancing, while emotional detachment appeared to promote burn-out. CONCLUSION Assisting nurses to use emotional distancing, rather than emotional detachment strategies to engender a sense of personal achievement may promote resilience.

Anger and depression predict hospital use among chronic heart failure patients

Costly hospital readmissions among chronic heart failure (CHF) patients are expected to increase dramatically with the ageing population. This study investigated the prognostic ability of depression, anger and anxiety, prospectively, and after adjusting for illness severity, on the number of readmissions to hospital and the total length of stay over one year. Participants comprised 175 inpatients with CHF. Depression, anger, anxiety, and illness severity were measured at baseline. One year later, the number of readmissions and length of stay for each patient were obtained from medical records. Depression and anger play a detrimental role in the health profile of CHF patients.

Patient–practitioner relationships desired by overweight/obese adults

OBJECTIVE This study investigated the characteristics of the patient-practitioner relationship desired by overweight/obese individuals in weight management. The aim was to identify characteristics of the relationship which empower patients to make lifestyle changes. METHODS Grounded theory was used inductively to build a model of the patient-practitioner relationship based on the perspectives of 21 overweight/obese adults. RESULTS Emerging from the match between patient and practitioner characteristics, collaboration was the key process explicitly occurring in the patient-practitioner relationship, and was characterised by two subcategories; perceived power dimensions and openness. Trust emerged implicitly from the collaborative process, being fostered by relational, informational, and credible aspects of the interaction. Patient trust in their practitioner consequently led to empowering outcomes including goal ownership and perceiving the utility of changes. CONCLUSION An appropriate match between patient and practitioner characteristics facilitates collaboration which leads to trust, both of which appear to precede empowering outcomes for patients such as goal ownership and perceiving the utility of changes. Collaboration is an explicit process and precedes the patient trusting their practitioner. PRACTICE IMPLICATIONS Practitioners should be sensitive to patient preferences for collaboration and the opportunity to develop trust with patients relationally, through information provision, and modelling a healthy lifestyle.

A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults

BackgroundDieting has historically been the main behavioural treatment paradigm for overweight/obesity, although a non-dieting paradigm has more recently emerged based on the criticisms of the original dieting approach. There is a dearth of research contrasting why these approaches are adopted. To address this, we conducted a qualitative investigation into the determinants of dieting and non-dieting approaches based on the perspectives and experiences of overweight/obese Australian adults.MethodsGrounded theory was used inductively to generate a model of themes contrasting the determinants of dieting and non-dieting approaches based on the perspectives of 21 overweight/obese adults. Data was collected using semi-structured interviews to elicit in-depth individual experiences and perspectives.ResultsSeveral categories emerged which distinguished between the adoption of a dieting or non-dieting approach. These categories included the focus of each approach (weight/image or lifestyle/health behaviours); internal or external attributions about dieting failure; attitudes towards established diets, and personal autonomy. Personal autonomy was also influenced by another category; the perceived knowledge and self-efficacy about each approach, with adults more likely to choose an approach they knew more about and were confident in implementing. The time perspective of change (short or long-term) and the perceived identity of the person (fat/dieter or healthy person) also emerged as determinants of dieting or non-dieting approaches respectively.ConclusionsThe model of determinants elicited from this study assists in understanding why dieting and non-dieting approaches are adopted, from the perspectives and experiences of overweight/obese adults. Understanding this decision-making process can assist clinicians and public health researchers to design and tailor dieting and non-dieting interventions to population subgroups that have preferences and characteristics suitable for each approach.

Academic-related stress among private secondary school students in India

Purpose – The purpose of this paper is to examine the prevalence of academic stress and exam anxiety among private secondary school students in India as well as the associations with socio-economic and study-related factors. Design/methodology/approach – Participants were 400 adolescent students (52 percent male) from five private secondary schools in Kolkata who were studying in grades 10 and 12. Participants were selected using a multi-stage sampling technique and were assessed using a study-specific questionnaire. Findings – Findings revealed that 35 and 37 percent reported high or very high levels of academic stress and exam anxiety respectively. All students reported high levels of academic stress, but those who had lower grades reported higher levels of stress than those with higher grades. Students who engaged in extra-curricula activities were more likely to report exam anxiety than those who did not engage in extra-curricula activities. Practical implications – Private high school students in Ind...

Cognitive Behavior Therapy and Dialectical Behavior Therapy for Treating Obese Emotional Eaters

This study describes the treatment of obese individuals who rated high on emotional eating using four case studies that involved 22 sessions of either cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT). Outcomes measures relating to weight, body mass index, emotional eating, depression, anxiety, and stress were all assessed with each participant prior to each baseline (three weekly sessions), during treatment and posttherapy. At the 8-week follow-up, the two cases that had received DBT had lost 10.1% and 7.6% of their initial body weight, whereas the two cases that had received CBT had lost 0.7% and 0.6% of their initial body weight. The two DBT cases also exhibited reductions in emotional distress, frequency of emotional eating or quantity of food eating in response to emotions, whereas the two CBT cases showed no overall reductions in these areas. Important processes from all four cases are described as are the implications to clinicians for developing more effective interventions for obese clients who engage in emotional eating.

The impact of a self-development coaching programme on medical and dental students’ psychological health and academic performance: a randomised controlled trial

BackgroundPsychological distress is well-documented worldwide among medical and dental students. Few studies have assessed the impact of self-development coaching programs on the students’ psychological health. The aim of the study was to evaluate the effect of a self-development coaching programme on the psychological health and academic performance of preclinical medical and dental students at Umm Al-Qura University, Saudi Arabia.MethodsFour-hundred and twenty-two participants (n = 422, 20–22 years) fulfilled the study requirements and were invited into a parallel-randomised controlled trial that was partially blinded. Participants were stratified by faculty, gender, and academic year, and then randomised. A total of 156 students participated in the intervention group (IG) and 163 students participated in the control group (CG). The IG received the selfdevelopment programme, involving skills and strategies aimed to improve students’ psychological health and academic performance, through a two-day workshop. Meanwhile, the CG attended an active placebo programme focussing on theoretical information that was delivered through a five-hour workshop. Both programmes were conducted by the same presenter during Week 1 of the second semester of the 2012–2013 academic year. Data were gathered immediately before (T1), one week after (T2) and five weeks (T3) after the intervention. Psychological health was measured using the Depression Anxiety Stress Scale (DASS-21), the General Self-Efficacy (GSE), and the Satisfaction With Life Scale (SWLS). Academic performance was measured using students’ academic weighted grades (WG). Student cognitive and emotional perceptions of the intervention were measured using the Credibility/Expectancy Questionnaire (CEQ).ResultsData from 317 students, who completed the follow ups, were analysed across the three time periods (IG, n = 155; CG, n = 162). The baseline variables and demographic data of the IG and CG were not significantly different. The IG showed short-term significant reductions in depression and anxiety in compared to CG from T1 to T2. The short-term changes in stress, GSE and SWLS of the IG were not significantly different from those of the CG. While both groups showed a significant change on most of the psychological variables from T1 to T3, no significant differences were found between the groups in this period. In addition, no significant difference was found in WG between the IG and CG after the intervention. No harms relevant to the intervention were reported.ConclusionThe investigated self-development coaching programme showed only a short-term improvement on depression and anxiety compared with an active control. There was no effect of the intervention on academic performance.Trial registrationACTRN12614000896673