M. Graça Pereira

Impact of family environment and support on adherence, metabolic control, and quality of life in adolescents with diabetes

Background: Diabetes is a common disease in pediatric populations. Family functioning has been related to child adaptation to diabetes. Purpose: To determine the impact of family factors on diabetes, particularly the influence of family support and family environment on adherence to treatment, quality of life, and metabolic control in Portuguese adolescents with type 1 diabetes, taking in consideration age, sex, duration of disease, and social class. Method: This study used a cross-sectional design. A sample of 157 Portuguese diabetic patients filled disease-specific measures on adherence and quality of life and family functioning measures. Hypotheses were that family support and an organized family environment (high cohesion and low conflict) would be positively associated with better adherence, metabolic control, and quality of life. Results: This study’s results confirmed that adherence was predicted by family support for females and lower-class patients while metabolic control was predicted by family conflict for upper-class patients. Quality of life was predicted by lack of family conflict and family social support for both males and females as well as lower-class patients. Conclusion: The results highlight the importance of studying family variables in adolescents’ diabetes care within the wider cultural factors affecting the patient.

Anxiety, depression, traumatic stress and quality of life in colorectal cancer after different treatments: A study with Portuguese patients and their partners

PURPOSE This study examines the impact of different modes of treatment on depression, anxiety, traumatic stress and quality of life in colorectal cancer patients and their partners. METHODS The sample was comprised of 114 oncology patients and 67 partners. All patients were diagnosed with colorectal cancer. Participants were recruited from an Oncology Hospital in the North of Portugal and had been submitted to three modes of treatment: surgery, surgery plus chemotherapy or surgery followed by radiotherapy. RESULTS The results showed that patients who received only surgery, as treatment, had lower levels of depression, anxiety and traumatic stress symptoms when compared with patients who received surgery and chemotherapy or surgery plus radiotherapy. Partners of surgical patients presented lower levels of state anxiety and traumatic stress symptoms when compared with the other two groups. Patients with more depression had partners also more depressed. No relationship was found between anxiety and traumatic stress symptoms in patients and partners. Patients who received a diagnosis longer than 12 months had more traumatic stress, intrusion and hypervigilance. Patients with illness recurrence showed more traumatic symptoms. Anxiety and depression were the main predictors of patients quality of life. Traumatic stress was a predictor of symptom distress - pain/bowel pattern. CONCLUSION This study highlights the importance of providing psychological interventions for cancer patients and their partners. Chemotherapy patients and those diagnosed over a year, as well as their partners, are more at risk.

Psychological morbidity, illness representations, and quality of life in female and male patients with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder that affects both women and men. The aim of this study was to characterize and investigate the differences in terms of anxiety, depression, illness perception, and quality of life between female and male OSAS patients from a total of 111 patients (33 women and 78 men) who were recently diagnosed with OSAS in an outpatient clinic of a University Hospital in Portugal. They underwent a standardized protocol that included evaluation to assess of psychological morbidity (anxiety and depression – Hospital Anxiety and Depression Scale), illness representations (Brief Illness Perception Questionnaire), and quality of life (Sleep Apnea Quality of Life Index). The most significant differences between female and male OSAS patients result of apnea/hypopnea index (AHI), after controlling for body mass index (p < 0.05); anxiety (p = 0.000) and depression (p < 0.005); consequences (p < 0.005), identity (p = 0.000), coherence (p < 0.01), and emotional representation (p < 0.005) of OSAS; and for daily functioning (p = 0.000), emotional (p = 0.001), and symptoms (p < 0.05) domains of quality of life. Data suggest that women revealed more psychological morbidity associated with OSAS. Therefore, it seems extremely important to look at women as potential patients for sleep apnea and avoid looking up for a pattern of symptoms that rely on men as a norm to which women are compared.

Dyadic adjustment, family coping, body image, quality of life and psychological morbidity in patients with psoriasis and their partners.

BackgroundPsoriasis is an incurable and chronic disease that includes unpredictable periods of remission and relapse requiring long-term therapy.PurposeThis paper focuses on the relationship among family coping, psychological morbidity, body image, dyadic adjustment and quality of life in psoriatic patients and their partners.MethodOne hundred and one patients with psoriasis and 78 partners comprised the sample. They were regular users of the Dermatology Service of a Central Northern hospital in Portugal and a private dermatology clinic. Patients with psoriasis were assessed on anxiety, depression, body image, quality of life, dyadic adjustment and family coping. Partners were assessed on the same measures except body image and quality of life.ResultsA positive relationship among dyadic adjustment, psychological morbidity and family coping in patients and their partners was found. Also, patients with lower levels of quality of life had partners with higher levels of depressive and anxious symptoms. Better dyadic adjustment predicted family coping in the psoriatic patient. High levels of dyadic adjustment in patients and low partners’ trait anxiety predicted better dyadic adjustment in partners.ConclusionThe results highlight the importance of incorporating family variables in psychological interventions in psoriasis’ care, particularly family coping and dyadic adjustment as well as the need for psychological intervention to focus both on patients and partners.

Quality of life in women with urinary incontinence

The aim of this study is to examine the relationship among psychological, clinical and sociodemographic variables, and quality of life in women with urinary incontinence. The sample consisted of 80 women diagnosed with urinary incontinence (UI) followed in a Northern Central Hospital in Portugal. Participants answered the Incontinence Quality of Life (I-QOL); Satisfaction with Sexual Relationship Questionnaire (SSRQ); Hospital Anxiety and Depression Scales (HADS) and the Brief Cope. The results revealed that women with higher quality of life considered their symptoms of urine loss as mild or moderated compared to those with severe urine loss. The less severe urine loss was associated with greater sexual satisfaction and less use of religion and self-blame as coping strategies. In terms of coping, women who considered the loss of urine as severe expressed more feelings regarding UI. Stress urinary incontinence, high sexual satisfaction, and less use of denial, distraction, and religion as coping strategies, predicted higher quality of life. According to the results, UI has an impact on womens sexual satisfaction and quality of life. Therefore, intervention programs should target these women, including their partners, helping them to adjust to their condition and teaching effective coping strategies in order to improve their sexual satisfaction and quality of life.

Factors Contributing to Posttraumatic Growth and Its Buffering Effect in Adult Children of Cancer Patients Undergoing Treatment

This study examined relationships among demographic, clinical, and psychosocial variables in adult children of cancer patients. Two hundred and fourteen participants completed measures of posttraumatic growth (PTG), distress, posttraumatic stress disorder (PTSD) symptoms, social support, and family functioning. Significant gender differences in all PTG dimensions were found, as well as associations among PTG, gender, parental dependency, distress, PTSD, and family functioning. Social support was not a mediator in the relationship between gender and PTG. Gender, education, disease duration, dependency, distress, and family flexibility predicted PTG. Finally, PTG had a moderating effect in the relationship between distress and PTSD/social support. These results may guide psychosocial interventions in this population.

Growth and the Cancer Caregiving Experience: Psychometric Properties of the Portuguese Posttraumatic Growth Inventory

The purpose of the present study was to investigate the psychometric properties of the Portuguese version of the Posttraumatic Growth Inventory (PTGI) and relate posttraumatic growth with psychological morbidity. This is a cross-sectional study with a sample of 214 adult children of cancer patients. Additionally, a comparison group was recruited with 78 participants without a chronically ill parent. Measures of distress, posttraumatic stress disorder (PTSD) symptoms, and posttraumatic growth were collected. The original five-factor structure of the PTGI was maintained, with satisfactory internal consistency. The reorganization of the items in five factors was similar to the solution found in the original PTGI study, except for four items. Positive correlations between posttraumatic growth and PTSD symptoms/distress were significant. Women showed significantly higher posttraumatic growth. Adult children with parental cancer, and with probable PTSD, showed higher scores on the PTGI. Regression analysis revealed that PTSD symptoms were associated with higher posttraumatic growth, after controlling for demographic and clinical variables. Analysis with the comparison group showed that differences in posttraumatic growth were observed as a function of a shattered experience. This study confirmed the multidimensionality of the posttraumatic growth construct, underscoring the importance of considering the subjective nature of the shattered event, and the experience of emotional distress with parental cancer.

War exposure and post-traumatic stress as predictors of Portuguese colonial war veterans' physical health

Abstract The relationship between war exposure and post-traumatic stress disorder (PTSD) has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure and psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue, and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes.

Illness perceptions are the main predictors of depression and anxiety symptoms in patients with chronic pain

Abstract Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient’s illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.

Obstructive sleep apnea representations, self-efficacy and family coping regarding APAP adherence: a longitudinal study

Adherence is still an important issue considering new advances in Obstructive Sleep Apnea (OSA) treatment, as automatic positive airway pressure (APAP). The aim of the present study was to identify and explore relationships between identified predictors of adherence, over time. After overnight sleep study and OSA diagnosis and during a six-month APAP treatment period, a total of 153 patients underwent a three time psychological protocol evaluation. Generalized estimating equations were applied to analyzed repeated measurements in the same individuals. Results show that 40% of patients were poorly adherent and 60% were adherent after six months of treatment. The results confirmed a predictive value of age, self-efficacy, decisional balance index and health-related quality of life (HRQoL) in APAP adherence. Furthermore, the results revealed an interaction between time and illness cognitive representations, and self-efficacy and family coping, in explaining adherence patterns over time. Therefore, understanding the causality of theoretically derived constructs is crucial to predict the continuity of APAP adherence.