Jean-Claude Lasry

Depression and body image following mastectomy and lumpectomy

A twenty year debate about the appropriate surgery for breast cancer has resulted in two clinical trials comparing radical vs more conservative operations. Despite the favorable results of these trials, the majority of breast cancer patients in North America still undergo mastectomy. We investigated the psychological and social adjustment following total and partial mastectomy in a group of patients randomly assigned to one or the other operation (National Surgical Adjuvant Breast Protocol--B-06). Total mastectomy patients showed higher levels of depression and less satisfaction with body image. Partial mastectomy patients did not display any measurable increase in fear of recurrence. Patients undergoing radiation therapy showed surprising increase in depressive symptoms. Radiation therapy could well be more frightening to breast surgery patients than had been anticipated. These patients may benefit from some anticipatory counselling.

Use of health care services for psychological distress by immigrants in an urban multicultural milieu

Objective: Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canadas universal health care system. Methods: A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean (n = 264), Vietnam (n = 234), or the Philippines (n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events. Results: Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help. Conclusion: Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.

Fear of recurrence, breast-conserving surgery, and the trade-off hypothesis

Fear of recurrence has been at the heart of the controversy between surgeons favoring mastectomy versus those advocating a less radical operation. Breast‐conserving surgery is thought to result in a better body image, but patients are expected to worry more about a cancer recurrence because only a small part of the breast is excised. To assess survival rates after breast‐conserving intervention, patients were randomized into the National Surgical Adjuvant Breast Project (NSABP) prospective clinical trial (Protocol B06) with three treatment groups: total mastectomy, lumpectomy, and lumpectomy followed by radiation therapy. A fourth group was created to include patients who had a recurrence after their first operation and thus underwent a subsequent total mastectomy. Differences appeared, not according to the type of treatment, but with respect to the number of surgical interventions. Patients with multiple operations reported a greater fear of cancer recurrence and a worse body image, similar to those that underwent total mastectomy, Contrary to the trade‐off hypothesis, patients who underwent radical surgery did not manifest less fear of recurrence. These results show unequivocally that the expected trade‐off between breast conservation and fear of cancer recurrence does not occur. Those who undergo lumpectomy do not more express more fear of cancer than do patients who undergo mastectomy.

Ambulatory surgery for breast cancer patients

BackgroundLess than two decades ago, early discharge of mastectomy patients was found to be possible while the drains were still in place, without noticeable consequences for patients. Most reported studies focused on surgical complication rates and found no significant evidence of it. The objective of the present study was to compare inpatient to same-day discharge surgery for breast cancer, on unselected patients.MethodsAll interviewed patients (n=90) had routine level I and II axillary lymph node dissection under general anesthesia, combined with breast surgery for most of them. The outpatient group comprised 55 patients and the inpatient group 35. Psychological distress was assessed, as well as pain, anxiety, quality of life, emotional adjustment, recovery, social relations, stressful life events, and so on.ResultsThe sociodemographic characteristics of both surgery groups was quite similar, except that time from surgery to interview was about 1 year longer for inpatients. Outpatients and hospitalized patients report similar levels of pain, fear, anxiety, health assessment, and quality of life. Ambulatory patients manifest a significantly better emotional adjustment and fewer psychological distress symptoms. Inpatients reported that it took an average of 27 days to feel that they had recovered from surgery, about 10 days longer than outpatients. Inpatient return to usual activities was also about 11 days later.ConclusionsSame-day discharge patients are not at a disadvantage compared to hospitalized patients; i.e., they report faster recovery and better psychological adjustment. Outpatient surgery may thus foster patient emotional well-being better than routine hospitalization.

Correlates of illness worry in chronic fatigue syndrome

BACKGROUND Anxiety about illness leading to restriction of activity and physical deconditioning has been hypothesized to contribute to the chronicity of fatigue. Pathological symptom attributions, personality traits, and depression have all been hypothesized to contribute to illness worry. METHODS We compared 45 chronic fatigue syndrome (CFS) and 40 multiple sclerosis (MS) outpatients using a battery of psychometric instruments comprising the 12-item Illness Worry scale, the Symptom Interpretation Questionnaire (SIQ), the NEO Five-Factor Inventory (NEO-FFI), and a modified version of the SCL-90R Depression scale. RESULTS There was no difference between the two diagnostic groups on neuroticism, depressive symptoms, as well as the three scales of the SIQ. On the illness worry index, the CFS group had significantly higher scores than the MS group. This difference was due to items tapping vulnerability to illness and the perception that others are not taking their illness seriously. Somatic attributional style, neuroticism, depressive symptoms, and age were all significant predictors of illness worry in both CFS and MS patients. CONCLUSIONS Somatic attributions, neuroticism, and depression all contribute to illness worry in chronic illness. However, these factors do not account for the higher levels of illness worry in CFS as opposed to MS, which may be due to other specific cognitive and social interactional processes.

Religious Practice and Psychological Distress: The Importance of Gender, Ethnicity and Immigrant Status

The present study examined the relationship between religious practice and psychological distress in a culturally diverse urban population to explore how religious affiliation, gender, ethnicity, and immigrant status affect this relationship. Data were drawn from a study of health care utilization in Montreal. A stratified community sample of 1485 yielded four religious groups: Protestant (n = 205), Catholic (813), Jewish (201), and Buddhist (150), and a group with no declared religion (116). The sample was composed of five ethnocultural groups: Anglophone Canadian-born, Francophone Canadian-born, Afro-Caribbean, Vietnamese, and Filipino immigrants. Psychological distress was assessed with the 12-item version of the General Health Questionnaire (GHQ). Religious involvement was measured with three items: 1) declared religion; 2) frequency of attendance at religious meetings; and 3) frequency of religious rituals performed at home. Multiple regression models examined the relationship of religious practice to distress, controlling for sociodemographic variables including ethnicity. Overall, attendance at religious services was associated with a lower GHQ score. Attendance at religious services also was inversely related to psychological distress for females, Protestants, Catholics, Filipinos, and Afro-Caribbeans; but not for males, Buddhists or Jews. Religious practice at home was not associated with level of distress for any group. The ‘no declared religion’ group had the highest mean GHQ score of all the groups. Results confirm the association between attendance at religious services and lower levels of distress, but reveal ethnospecific and gender effects indicating the need to understand the impact of religious practice on mental health in social and cultural context.

Psychological correlates of functional status in chronic fatigue syndrome

BACKGROUND The present study was designed to test a cognitive model of impairment in chronic fatigue syndrome (CFS) in which disability is a function of severity of fatigue and depressive symptoms, generalized somatic symptom attributions and generalized illness worry. METHODS We compared 45 CFS and 40 multiple sclerosis (MS) outpatients on measures of functional ability, fatigue severity, depressive symptoms, somatic symptom attribution and illness worry. RESULTS The results confirmed previous findings of lower levels of functional status and greater fatigue among CFS patients compared to a group of patients with MS. Fatigue severity was found to be a significant predictor of physical functioning but not of psychosocial functioning in both groups. In CFS, when level of fatigue was controlled, making more somatic attributions was associated with worse physical functioning, and both illness worry and depressive symptoms were associated with worse psychosocial functioning. CONCLUSIONS Our findings support the role of depression and illness cognitions in disability in CFS sufferers. Different cognitive factors account for physical and psychosocial disability in CFS and MS. The SF-36 may be sensitive to symptom attributions, suggesting caution in its interpretation when used with patients with ill-defined medical conditions.

Mental health and occupational mobility in a group of immigrants

Abstract Studies on occupational mobility and mental disorders are reviewed. Failure to study homogeneous types of mental disorder, to include adequate status controls and to provide supporting theoretical and empirical evidence are frequent methodologic errors. Evidence that schizophrenia is linked to downward mobility appears to be fairly consistent; on the other hand, mild psychiatric disorder seems to be linked to upward mobility. For the present study, a sample of North African Jewish immigrants to Montreal was interviewed in 1972. With appropriate status controls, the presence of mild psychiatric symptoms was also weakly associated with upward mobility. However, the correlation increased in strength for those who had changed jobs more recently. A similar pattern was obtained for a measure of job satisfaction. The results indicate that job stresses involved in upward mobility can lead to mild psychiatric symptoms.

Psychiatric private practice profiles in Quebec and Ontario

A questionnaire study of psychiatrists’ private practices in Quebec and Ontario demonstrated differences between the two provinces and between opted-in and opted-out psychiatrists in Ontario. The results suggest that there continues to be two kinds of psychiatry practiced: analytically oriented psychiatry and general psychiatry. The private practice sector seems to be more accessible to the educated.

Sephardim and ashkenazim in montreal

ConclusionThe first factor, one inherent in the adaptation process of the successive waves of immigrants, disappears as the newcomers integrate into the community and join the Establishment The second factor, the Arabic component of the North African personality, is changing from a tension-inducing factor to a source of pride The linguistic difference, a deep divisiveness between North African Jews and the Anglicized old timers, is also bound to disappear with time, as Francization generalizes in Québec and as its inevitability becomes certain Some communal institutions have already carried out programs to promote the acceptance of Francization. For some Anglophone Jewish community leaders, Norm African Jews may be slowly perceived as a blueprint of their own Jewish future m a French QuébecAt the attitude level, the marked preference of our respondents for “Canadian Jews” rather man “Ashkenazim” implies a clear distinction between bora concepts As Canadian Jews will take over from the European-born Ashkenazim the controls of business and community affairs, relations between them and Norm African Jews should improve Selection of Canadian Jews as friends for rae respondents’ children supports this predicton