Gerald M. Devins

Measuring depressive symptoms in illness populations: Psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) Scale

Abstract Psychometric properties of the Center for Epidemiologic Studies Depression (CES-D) scale were examined among five groups that vaned in physical health and illness. Participants included 175 healthy undergraduates, 176 individuals attending family physicians, 107 progressive renal disease, 135 end-stage renal disease, and 120 cancer patients. Individual item and total CES-D scores were relatively symmetrically distributed and varied across the entire range of potentially obtainable scores. Reliability analyses yielded internal consistency (alpha) coefficients ranging from 0.63 to 0.93 across the groups. Test-retest reliability (3-month lag) was 0.61. The CES-Ds factorial composition was highly similar to that observed among community volunteers. Varimax-rotated principal-components analyses extracted four factors, corresponding to “depressive affect”, “positive affect”, “somatic and retarded activity”, and “interpersonal”. Moreover, this pattern did not change despite differences in physical heal...

Illness intrusiveness and quality of life in end-stage renal disease: comparison and stability across treatment modalities.

Investigated the degree to which chronic, life-threatening illness and its treatment interfere with continued involvements in valued activities and interests--that is, illness intrusiveness--and its impact on quality of life in end-stage renal disease. Data were collected on two occasions separated by a lag of 6 weeks. Mixed analyses of variance indicated that life domains were affected differentially across treatments. Perceived illness intrusiveness correlated significantly with treatment time requirements, uremic symptoms, intercurrent nonrenal illnesses, fatigue, and difficulties in daily activities. Significant quality-of-life differences were observed across treatment modalities for satisfaction/happiness and pessimism/illness-related concerns but not for depression/distress. Perceived illness intrusiveness correlated significantly with each of these quality-of-life measures. Results were stable over time. These findings substantiate the construct of illness intrusiveness as a mediator of the psychosocial impact of chronic, life-threatening illness.

Recurrent pain, illness intrusiveness, and quality of life in end-stage renal disease

&NA; Repeated episodes of headache and muscle cramp were hypothesized to contribute to increased patient perceptions of illness intrusiveness and to compromised quality of life. Standard measures of pain, illness intrusiveness, and quality of life were obtained on 2 occasions, each 6 weeks apart, from 100 end‐stage renal disease patients. The impact of recurrent muscle cramps on perceptions of illness intrusiveness was conditional upon the occurrence of headache symptoms. Perceptions of illness intrusiveness were significantly higher when both muscle cramp and headache symptoms occurred during one or more assessment intervals as compared to when muscle cramps or headaches, only, occurred. Illness‐related concerns and general feelings of pessimism were also significantly higher among patients who experienced recurrent episodes of muscle cramp. Although no direct relations were observed between pain and other quality of life indicators, previous research has documented a relation between illness intrusiveness and quality of life. Recurrent pain problems, thus, appear to contribute to increased illness intrusiveness and to reduced quality of life in end‐stage renal disease patients.

MARITAL ROLE STRAIN, ILLNESS INTRUSIVENESS, AND THEIR IMPACT ON MARITAL AND INDIVIDUAL ADJUSTMENT IN END-STAGE RENAL DISEASE

Abstract A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that inc...

Self-efficacy and smoking reduction in chronic obstructive pulmonary disease

Abstract Banduras social cognitive theory (SCT) was applied to an analysis of smoking reduction among individuals with chronic obstructive pulmonary disease (COPD). Self-efficacy was hypothesized to be the most important contributor, of all SCT variables, to effective smoking self-change. Consistent with the SCT perspective, outcome expectations, motivation to stop smoking, and the availability of a repertoire of behavioral stop-smoking techniques were postulated to contribute only via their interactions with self-efficacy. A standardized interview was administered to 45 COPD patients who currently smoked. Smoking levels were measured simultaneously with the SCT predictors and were reassessed at I- and 3-month post-tests. As hypothesized, hierarchical multiple regression analyses, controlling for age, sex, initial smoking levels, and number of years as a smoker, indicated that perceived self-efficacy was the only significant SCT predictor of reduced smoking at the 1- and 3-month post-tests. Also as predicted, each of the ‘non-efficacy’ SCT variables contributed to smoking reductions via their interactions with self-efficacy but not independently of it.

The kidney disease questionnaire: A test for measuring patient knowledge about end-stage renal disease

Two studies report on the development of the Kidney Disease Questionnaire (KDQ) as a test for measuring patient knowledge about end-stage renal disease and its treatment. The KDQ is available in a 26-item version or as two parallel 13-item tests. Psychometric evaluations indicate that all versions show high levels of reliability. Initial validity tests are also promising. The KDQ is able to discriminate individuals well informed about kidney disease and its treatment from those who are not so well informed. It is also sensitive to the effects of an experimental education program and to ESRD-related knowledge that is acquired as a result of starting dialysis. Data and issues related to the administration, readability, demographic correlates, and a French translation of the KDQ are also presented and discussed.

Transplant failure does not compromise quality of life in end-stage renal disease.

Data from three separate quality of life studies of end-stage renal disease patients investigated the hypothesis that those patients who have previously experienced the failure of a transplanted kidney are characterized by lower levels of life quality than are patients who have not Multivariate data analyses uniformly failed to support this hypothesis. Likely explanations for the discrepancy between these and other contradictory findings as well as clinical and research implications are presented.

Denial as a defense against depression in end-stage renal disease : An empirical test

End-stage renal disease (ESRD) is recognized as imposing severe psychosocial stresses upon patients with the result that depression is believed to be highly prevalent. A number of studies have reported low levels of depression, however, and this contradictory finding has been explained via the construct of defensive denial-i.e., patients may minimize the impact of illness-related experiences upon their overall experiences of life. The present study tested this hypothesis in a sample of seventy ESRD patients. Participants rated a series of twelve life dimensions (e.g., work, family and marital relations, recreation) in terms of perceived intrusiveness and control as well as indicating their perceived similarity using a card sort task. Standard measures of depression, positive and negative moods, somatic symptoms of distress, self-esteem, and life happiness were also obtained via structured interviews. A multidimensional scaling analysis applied to the card sort data indicated that ESRD patients do, indeed, perceive illness-related and nonillness aspects of life as independent. However, an analysis of partial variance-controlling for age and nonrenal health-failed to provide evidence of defensive denial. The suggestion is forwarded that previous findings of a high prevalence of depression in ESRD may be in error due to the misidentification of uremic symptoms as symptoms of depression.

The prevalence of fears, phobias and anxiety disorders and their relationship with depression in women attending family physicians

Abstract An investigation of 437 women, who were attending their family physicians and who had moderately high scores on a self-report scale of depression, indicated high 1-month prevalences of fears, phobias and anxiety disorders. For instance, 20.6% reported phobias (i.e. intense fear with some avoidance) and 7.6% reported mild generalized anxiety . More severe forms of these disorders were less common: e.g. 2.3% reported severe phobias with generalized avoidance, and 1% reported intense generalized anxiety . Women with separation or nature fears, separation, social, animal or nature phobias. mild or intense generalized anxiety or panic attacks, whether infrequent or frequent, also showed a greater likelihood of depression when compared with women who did not have the fear, phobia or anxiety disorder. The implications of these findings for clinical and research psychopathologists are discussed.