Gina Magyar-Russell

The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: A systematic review

OBJECTIVE The implantable cardioverter defibrillator (ICD) is used to treat life-threatening ventricular arrhythmias and in the prevention of sudden cardiac death. A significant proportion of ICD patients experience psychological symptoms including anxiety, depression or both, which in turn can impact adjustment to the device. The objective of this systematic review was to assess the prevalence of anxiety and depression or symptoms of anxiety and depression among adults with ICDs. METHODS Search of MEDLINE®, CINAHL®, PsycINFO®, EMBASE® and Cochrane® for English-language articles published through 2009 that used validated diagnostic interviews to diagnose anxiety or depression or self-report questionnaires to assess symptoms of anxiety or depression in adults with an ICD. RESULTS Forty-five studies that assessed over 5000 patients were included. Between 11% and 28% of patients had a depressive disorder and 11-26% had an anxiety disorder in 3 small studies (Ns=35-90) that used validated diagnostic interviews. Rates of elevated symptoms of anxiety (8-63%) and depression (5-41%) based on self-report questionnaires ranged widely across studies and times of assessment. Evidence was inconsistent on rates pre- versus post-implantation, rates over time, rates for primary versus secondary prevention, and for shocked versus non-shocked patients. CONCLUSION Larger studies utilizing structured interviews are needed to determine the prevalence of anxiety and depression among ICD patients and factors that may influence rates of anxiety and depressive disorders. Based on existing data, it may be appropriate to assume a 20% prevalence rate for both depressive and anxiety disorders post-ICD implant, a rate similar to that in other cardiac populations.

From survival to socialization: a longitudinal study of body image in survivors of severe burn injury.

OBJECTIVE Little is known about the course of body image dissatisfaction following disfiguring injury or illness. The objective of this study was to test a proposed framework for understanding the trajectory of body image dissatisfaction among burn survivors and to longitudinally investigate the role of body image in overall psychosocial functioning. METHODS A sample of 79 survivors of severe burn injuries completed the Satisfaction with Appearance Scale (SWAP), the Importance of Appearance subscale of the Multidimensional Body-Self Relations Questionnaire, and the SF-36 in the hospital and at 6 and 12 months postdischarge (SWAP and SF-36). A repeated-measures analysis of covariance model was used to assess the course of body image dissatisfaction over time, and a path analysis model tested the role of body image dissatisfaction in mediating the relationship between preburn and postburn psychosocial functioning. RESULTS Female sex (P<.05), total body surface area burned (P<.01), and importance of appearance (P<.01) predicted body image dissatisfaction. From hospitalization to 12 months postdischarge, body image dissatisfaction increased for women (P<.01) and individuals with larger burns (P<.01) compared, respectively, to men and individuals with smaller burns. In the path analysis, body image dissatisfaction was the most salient predictor of psychosocial function at 12 months (beta=.53, P<.01) and mediated the relationship between preburn and 12-month psychosocial function. CONCLUSION Findings from this study suggest the importance of routine psychological screening for body image distress during hospitalization and after discharge.

Psychological distress after major burn injury

Objective: To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable inhospital symptoms predictive of long-term distress (physical, psychological, and social impairment). Method: We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI’s Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score ≥63). Attrition was unrelated to in-hospital GSI score. Results: Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated “alienation” and “anxiety” factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress. Conclusions: This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes. TBSA = total body surface area; BMS = burn model systems; PTSD = posttraumatic stress disorder; ASD = acute stress disorder; BSI = Brief Symptom Inventory; ROM = range of motion; GSI = Global Severity Index (of the BSI); OR = odds ratio; RCI = Reliable Change Index; SD = standard deviation; CI = confidence interval.

Post-traumatic growth and spirituality in burn recovery

For decades, research on long-term adjustment to burn injuries has adopted a deficit model of focusing solely on negative emotions. The presence of positive emotion and the experience of growth in the aftermath of a trauma have been virtually ignored in this field. Researchers and clinicians of other health and trauma populations have frequently observed that, following a trauma, there were positive emotions and growth. This growth occurs in areas such as a greater appreciation of life and changed priorities; warmer, more intimate relations with others; a greater sense of personal strength, recognition of new possibilities, and spiritual development. In addition, surveys of trauma survivors report that spiritual or religious beliefs played an important part in their recovery and they wished more healthcare providers were comfortable talking about these issues. Further evidence suggests that trauma survivors who rely on spiritual or religious beliefs for coping may show a greater ability for post-traumatic growth (PTG). This article reviews the literature on these two constructs as it relates to burn survivors. We also provide recommendations for clinicians on how to create an environment that fosters PTG and encourages patients to explore their spiritual and religious beliefs in the context of the trauma.

Approach–avoidance coping conflict in a sample of burn patients at risk for posttraumatic stress disorder

Background: Following an acute burn injury, higher distress is consistently observed among individuals exhibiting a conflict between approach coping (e.g., processing) and avoidance coping (e.g., suppression) relative to those individuals who use only one of these methods. Study objectives were to determine if contradictory coping messages would lead to such approach–avoidance coping conflict and to determine if experiment‐induced coping conflict is also associated with higher distress. Methods: Participants (n=59 adults hospitalized with acute burn injuries) were assigned randomly to experimental conditions differing in the order in which training was provided in two ways of coping with posttrauma re‐experiencing symptoms (i.e., process‐then‐suppress versus suppress‐then‐process). The primary dependent variable was coping behavior during the 24‐hr posttraining period. Coping behavior was categorized as approach coping (processing), avoidance coping (suppressing), or approach–avoidance coping conflict (both) on the basis of median splits on subscales assessing these behaviors. Secondary analyses examined the relationship between this experiment‐induced coping conflict and re‐experiencing symptoms. Results: Results indicated that participants in the process‐then‐suppress condition, relative to the suppress‐then‐process condition, were significantly more likely to exhibit approach–avoidance coping conflict (i.e., above median split on both processing and suppressing) during the next 24 hr. Furthermore, approach–avoidance coping conflict was associated with greater re‐experiencing symptoms assessed via self‐report and by blinded coding of recorded speech. Conclusions: It is concluded that the order of coping skill training can influence treatment outcome, success of coping methods, and overall levels of distress. therefore, training in stabilizing and calming methods should precede training in active processing following stressful life events. Depression and Anxiety, 2009.

Religious and Spiritual Appraisals and Coping Strategies among Patients in Medical Rehabilitation

This chapter examines the prevalence of religious and spiritual appraisals and coping strategies and their associations with anxiety, depression, and posttraumatic growth among 70 medical rehabilitation inpatients who sustained a major unanticipated physical health event. Hierarchical regression analyses reveals that sacred loss and desecration added unique variance in the prediction of symptoms of anxiety, depression, and posttraumatic growth. The results of a longitudinal study suggest that, although important, religious and spiritual appraisals do not influence outcomes in isolation. Instead, how individuals respond to, or cope with, their initial religious and spiritual appraisals may be fundamental to predicting psychological outcomes following inpatient medical rehabilitation. Practical directions for spiritually-sensitive and integrated approaches for facilitating the health and well-being of patients who are undergoing medical rehabilitation are discussed in the chapter. Keywords:anxiety; coping strategy; depression; medical rehabilitation; posttraumatic growth; religious appraisal; spiritual appraisal