Hanspeter Mörgeli

Sense of Coherence – A Mediator between Disability and Handicap?

Background: The aim of this study was first to analyze the associations between disability and handicap and Antonovsky’s concept of sense of coherence (SOC); secondly, to find out how the SOC concept could be integrated in the WHO model of impairments, disabilities, and handicaps (ICIDH). Methods: Data from two studies were used: one on patients with rheumatoid arthritis, one on severely injured accident victims. Objective measures of the illness or the injury were conceptualized as indicator variables for disability, whereas variables related to the patients’ subjective judgement were conceptualized as indicator variables for handicap. Correlations were calculated between both sets of variables and the SOC scale total score. Results: SOC showed no significant correlation with ‘disability variables’ (rheumatoid arthritis: HAQ, SF36 physical functioning; accidental injuries: ISS, GCS). However, significant correlations were found between SOC and all ‘handicap variables’ (rheumatoid arthritis: HAD, SF36 social functioning; accidental injuries: CAPS-2, IES, SCL-90-R depression subscale). Conclusions: SOC is related to the psychosocial effects of health problems. It may be understood as a mediator between disability and handicap. Prospective studies are needed to clarify whether the SOC scale can be used as an outcome predictor with regard to psychosocial adaptation, in acute as well as in chronic health problems.

Grief and Post-Traumatic Growth in Parents 2–6 Years after the Death of Their Extremely Premature Baby

Objective: To assess grief and post-traumatic growth in parents 2–6 years after the death of a premature baby (24–26 weeks’ gestation) and to evaluate Pictorial Representation of Illness and Self-Measure (PRISM) in the assessment of bereavement. Method: Fifty-four parents were assessed for their experiences during hospitalization and by questionnaires regarding grief (MTS), post-traumatic growth, affective symptoms and the visual representation of the baby and the self of the parents (PRISM). Results: Even 2–6 years after the loss of their extremely preterm infant the parents still suffer a lot from their bereavement, mothers more so than fathers (Mann-Whitney U test, U = 230.5, p < 0.05). Having another child reduced the level of grief (U = 119.0, p < 0.05). Mothers showed more post-traumatic growth than fathers (U = 140.5, p < 0.001). For all parents a shorter distance between the baby and the self (PRISM) correlated with greater grief (ρ = –0.62, p < 0.001); in multiple regression analysis MTS explained 38% of the SBS-variance. Conclusions: Clinicians should be aware that the death of an extremely premature infant triggers not only a painful long-term process of mourning but also of individual personal growth. Adaptation processes after the death differ depending on gender, with mothers experiencing more intense grief but also more growth than fathers. The modified PRISM test is recommended as a visual, non-verbal and easy-to-use instrument to assess bereavement.

Dyadic coping, quality of life, and psychological distress among chronic obstructive pulmonary disease patients and their partners

Background Successfully coping with a chronic disease depends significantly on social support, particularly that of a significant other. Thus, it depends on the ways of dealing with stress within a couple (dyadic coping). In this study, the relationship between dyadic coping and well-being was investigated among couples in which one partner suffers from chronic obstructive pulmonary disease (COPD). Methods A total of 43 couples participated. They were mailed questionnaires on anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (World Health Organization Quality of Life Questionnaire-BREF), and dyadic coping (Dyadic Coping Inventory). Results Low scores of positive and high scores of negative dyadic coping were associated with poorer quality of life and higher psychological distress among couples. Delegated coping (assistance with daily tasks) was higher among partners. When estimated by patients, high delegated partner coping (frequent provision of support by partners) and low delegated personal coping (low provision of support by patients) were associated with poorer quality of life for both patient and partner. COPD patients suffering from depression were supported more often and attributed deficits in dyadic coping primarily to themselves, whereas partners with higher scores of depression provided higher estimates of both their own negative coping and the negative coping of their partner. Conclusion The higher the patient perceived the imbalance in delegated dyadic coping, the lower the couple’s quality of life. More negative and less positive dyadic coping were associated with lower quality of life and higher psychological distress. Psychotherapeutic interventions to improve dyadic coping may lead to better quality of life and less psychological distress among COPD patients and their partners.

Shared or Discordant Grief in Couples 2–6 Years After the Death of Their Premature Baby: Effects on Suffering and Posttraumatic Growth

BACKGROUND The loss of a baby causes severe short- and long-term distress to parents and their marital relationship, but little is known about how this distress is shared between spouses. The authors hypothesized that the grief-related concordance within a couple 2 to 6 years after the loss of a premature baby could be an indicator of shared emotional distress within a couple. OBJECTIVE The authors investigated the long-term grief experience among couples. METHOD A group of 44 parents (22 couples) were assessed by questionnaire regarding grief, suffering, posttraumatic growth, and affective symptoms, and semistructured interviews with 6 couples added qualitative information about processes within couples. RESULTS The extent of grief concordance was found to be related to different patterns of suffering and posttraumatic growth within couples. CONCLUSION The emotional exchange between partners after the loss of the child appears to be crucial for a process of concordant grief, which in turn is associated with a more synchronous process of individual posttraumatic growth.

Dopamine-Related Deficit in Reward Learning After Catecholamine Depletion in Unmedicated, Remitted Subjects with Bulimia Nervosa

Disturbances in reward processing have been implicated in bulimia nervosa (BN). Abnormalities in processing reward-related stimuli might be linked to dysfunctions of the catecholaminergic neurotransmitter system, but findings have been inconclusive. A powerful way to investigate the relationship between catecholaminergic function and behavior is to examine behavioral changes in response to experimental catecholamine depletion (CD). The purpose of this study was to uncover putative catecholaminergic dysfunction in remitted subjects with BN who performed a reinforcement-learning task after CD. CD was achieved by oral alpha-methyl-para-tyrosine (AMPT) in 19 unmedicated female subjects with remitted BN (rBN) and 28 demographically matched healthy female controls (HC). Sham depletion administered identical capsules containing diphenhydramine. The study design consisted of a randomized, double-blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were reward learning in a probabilistic reward task analyzed using signal-detection theory. Secondary outcome measures included self-report assessments, including the Eating Disorder Examination-Questionnaire. Relative to healthy controls, rBN subjects were characterized by blunted reward learning in the AMPT—but not in placebo—condition. Highlighting the specificity of these findings, groups did not differ in their ability to perceptually distinguish between stimuli. Increased CD-induced anhedonic (but not eating disorder) symptoms were associated with a reduced response bias toward a more frequently rewarded stimulus. In conclusion, under CD, rBN subjects showed reduced reward learning compared with healthy control subjects. These deficits uncover disturbance of the central reward processing systems in rBN related to altered brain catecholamine levels, which might reflect a trait-like deficit increasing vulnerability to BN.

Therapiewünsche und Behandlungszufriedenheit bei ambulanten Krebspatienten und deren Ehepartnern

Zielsetzung: Ziel dieser Untersuchung war es bei ambulanten Krebspatienten und deren Ehepartnern die Zufriedenheit mit der medizinischen und psychosozialen Betreuung sowie das Ausmass von bisher ni...

Hilfreiche und belastende Faktoren im Umgang mit COPD bei Patienten und ihren Partnern - eine qualitative Studie

OBJECTIVE To investigate helpful and stressful factors in coping with COPD of patients and their partners. METHOD Nine COPD patients and their partners (9 couples) were interviewed. All interviews were audio taped and later transcribed and analysed using qualitative content analysis. RESULTS Patients as well as partners reported high satisfaction with the professional support. The most helpful factor for COPD patients was the social support by the partner. In terms of stressful factors patients and partners reported psychological problems and physical complaints. Partners additionally reported about relationship conflicts. CONCLUSION Partners of COPD patients are very important for patients to cope with the disease. Partners themselves are suffering from psychological stress and should therefore be included regularly in care programs.

Hilfreiche und belastende Faktoren im Umgang mit COPD bei Patienten und ihren Partnern

OBJECTIVE To investigate helpful and stressful factors in coping with COPD of patients and their partners. METHOD Nine COPD patients and their partners (9 couples) were interviewed. All interviews were audio taped and later transcribed and analysed using qualitative content analysis. RESULTS Patients as well as partners reported high satisfaction with the professional support. The most helpful factor for COPD patients was the social support by the partner. In terms of stressful factors patients and partners reported psychological problems and physical complaints. Partners additionally reported about relationship conflicts. CONCLUSION Partners of COPD patients are very important for patients to cope with the disease. Partners themselves are suffering from psychological stress and should therefore be included regularly in care programs.

Psychische Belastung und Lebensqualität bei COPD-Patienten und bei deren Partnern

OBJECTIVE To investigate psychological distress, quality of life, and satisfaction with medical support of patients with COPD and their spouses. METHOD Questionnaires concerning psychological distress and quality of life were sent by mail to 97 patients and 54 spouses (43 couples). RESULTS We found increased scores of anxiety and depression. In terms of quality of life the patients reported significantly lower scores than their spouses. Patients as well as their spouses reported a high satisfaction about the given medical support. CONCLUSION Spouses of COPD patients are at increased risk for psychiatric morbidity und should therefore be included regularly in care programs.

Swimming against the Tide

Accessible online at: http://BioMedNet.com/karger The independent and uncoventional attitude of this journal is now well known to our readers. The publication of the 1997 impact factors of journals listed in the Science Citation Index by the Institute for Scientific Information seems to support our quest. Our impact factor of 1.80 places Psychotherapy and Psychosomatics in the top 10 psychological journals and at the 24th position in the psychiatry ranking. The progress of the journal is depicted by figure 1, which also shows how psychosomatic medicine is alive and well at the turn of the century by including the other 4 leading psychosomatic journals. Such psychosomatic prominence is also supported by other psychosomatic journals which are included in the Science Citation Index (International Journal of Psychiatry in Medicine, Stress Medicine, Journal of Psychosomatic Obstetrics and Gynecology, Zeitschrift für Psychosomatische Medizin und Psychoanalyse). The journal’s progress has been the result of the joint effort of several factors. One factor has certainly been the expert advice of our reviewers (such as the ones listed below who supplemented the Editorial Board during 1998). In 1998 we introduced a new policy in our review process. All reviewers are asked to disclose