Maria Cristina Canavarro

A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease

PURPOSE The research of body image among breast cancer patients is characterized by some limitations, such as the lack of longitudinal studies or the absence of a multidimensional perspective of body image. This study intends to overcome these limitations, by examining the evolution of body image dimensions (investment, emotions and evaluations) from the period of surgery (T1) to 6-months after the treatments ending (T2). It also aims to explore the predictors of body image at T2 and, simultaneously, the predictive role of initial body image to psychosocial adjustment at T2. METHODS A total of 56 breast cancer patients participated in both assessments and completed a battery of instruments that included measures of body image dimensions (appearance investment, self-consciousness of appearance, shame and appearance satisfaction) and psychosocial adjustment (quality of life and emotional distress). RESULTS Within the dimensions of body image, only shame increased over time. In general, initial levels of investment predicted subsequent body image dimensions and having a mastectomy done was associated with higher shame and lower appearance satisfaction at T2. Initial body image did not predict later adjustment, with the exception of depression, where appearance investment played a relevant role. CONCLUSIONS Our findings contributed to the advance of knowledge in this area, providing relevant data about the evolution of body image dimensions, its predictors and its predictive role on psychosocial adjustment among breast cancer patients. This study also suggested some clinical implications that can assist health professionals to implement strategies focused on body image throughout the disease.

Pathways for psychological adjustment in breast cancer: A longitudinal study on coping strategies and posttraumatic growth

This longitudinal study examined the role of coping strategies and posttraumatic growth (PTG) on the psychological adjustment to breast cancer trajectory. The participants were 50 women assessed at the time of surgery (T1), during adjuvant treatment (T2) and six months after the end of treatment (T3). Women completed questionnaires assessing coping strategies, PTG and psychological adjustment (psychological quality of life, anxiety and depression). Results showed that the greatest impact of breast cancer on womens adjustment occurred at T1, when patients were significantly more anxious than in the other phases of the disease. The type of surgery and adjuvant treatment did not account for the course of PTG and adjustment. Coping through seeking social support and using cognitive strategies at T1 were linked to psychological quality of life and depression at T3 via PTG dimension of personal resources and skills at T2. Findings emphasise the value of promoting adaptive coping strategies and PTG in order to improve psychological adjustment in breast cancer patients.

Examining the links between perceived impact of breast cancer and psychosocial adjustment: the buffering role of posttraumatic growth.

Objectives: Finding positive changes in the aftermath of breast cancer (BC) may protect women against impaired adjustment. This study examines posttraumatic growth (PTG) in a sample of women receiving treatment for BC and explores the buffering role of PTG on the links between perceived impact of BC and emotional distress and quality of life (QoL).

Parental psychological distress and quality of life after a prenatal or postnatal diagnosis of congenital anomaly: A controlled comparison study with parents of healthy infants

BACKGROUND Parental early adjustment to a prenatal or postnatal diagnosis of congenital anomaly has been studied mainly within a pathological and deterministic perspective, giving us an inadequate view of the impact of the diagnosis. OBJECTIVES Adopting a comprehensive approach on parental adjustment, we aimed to characterise the impact of the diagnosis on psychological distress and quality of life, in the early postdiagnosis stage. The effects of gender and the timing of the diagnosis were also examined. METHODS In this cross-sectional study, 42 couples with healthy infants and 42 couples whose infants were prenatal or postnatally diagnosed with a congenital anomaly responded to the Brief Symptom Inventory-18 and to the World Health Organization Quality of Life-Brief instrument. RESULTS In the early postdiagnosis stage, parents whose infants were diagnosed with a congenital anomaly presented higher levels of psychological distress than did the parents of healthy infants (F(2,79) = 6.23, p = .003), although they displayed similar levels of quality of life (F(4,78) = 0.62, p = .647). Mothers reported more adjustment difficulties than fathers in both groups. Receiving the diagnosis in the prenatal period was associated with higher maternal psychological quality of life (Z = -2.00, p = .045). CONCLUSION The occurrence of a diagnosis of congenital anomaly during the transition to parenthood adds to an accumulation of stress-inducing events and manifests itself in psychopathological symptoms. Maintaining a positive evaluation of well-being may be understood as a parental resource to deal with the diagnosis. The importance of adopting a comprehensive perspective on parental adjustment is highlighted.

Maternal adjustment to the birth of a child: Primiparity versus multiparity

Introduction: The literature has highlighted the birth of a first child as a crisis moment that implies change and reorganisation. None the less, the specificities of maternal adjustment to the birth of another child are not yet completely known. Goals: To understand differences in adjusting to the birth of a child, in primiparous and multiparous mothers. Specifically: (1) identify and describe differences in adjusting at two different moments: 2–5 days after the birth and 8 months post‐partum; (2) identify and describe differences or continuities among primiparous and multiparous mothers regarding the temporal evolution of adjustment. Method: 179 mothers (98 primiparous; 81 multiparous) were assessed in two different periods: 2–5 days after the birth and 8 months later, concerning adjustment and need for reorganisation. The assessment protocol included a social‐demographic data file, the Emotional Assessment Scale, the Brief Symptom Inventory, the Perceived Stress Scale, and adjectival scales. Results: Primiparous mothers report greater adjustment difficulties right after the birth. Multiparous mothers show a less positive adjustment trajectory, mainly reflected in increasing levels of negative emotional reactivity. Conclusion: Results support the existence of different adjustment trajectories for primiparous and multiparous mothers, suggesting the need for differentiated psychological intervention strategies regarding each group.

Family routines and rituals in the context of chronic conditions: A review

This paper is a systematic review of 39 empirical studies on family routines and rituals in the context of a chronic condition of a family member. The search strategy encompassed a wide spectrum of chronic conditions affecting family members from childhood/adolescence to adulthood. Twenty quantitative, 13 qualitative, 3 mixed-methods, and 3 intervention studies published between 1995 and 2012 were reviewed. A conceptual framework of routines and rituals as key elements of family health was adopted, resulting in three main findings. First, a chronic condition in a family member impacted the frequency and nature of familys routines and rituals. Second, these whole-family interactions held important functions for individuals and families, constituting strategic resources in the conditions management and opportunities for emotional support exchanges, and providing the family with a sense of normalcy amid the challenges posed by chronic conditions. Third, family routines and rituals were linked to positive health and adaptation outcomes for both patients and family members. Implications for future research include the need for the distinction between routines and rituals against a conceptual background, use of validated assessment methods, and empirical examination of predictors of changes in routines and rituals throughout the course of the condition and of the mechanisms linking these family events to positive outcomes. Conclusions support the inclusion of routines and rituals in a family-centered care approach to the understanding and treatment of chronic conditions.

Quality of Life and Adjustment in Youths with Asthma: The Contributions of Family Rituals and the Family Environment

This cross-sectional study explored the relationships among family ritual meaning, cohesion, conflict, and health-related quality of life (both specific to chronic health conditions and in general), and the emotional and behavioral problems reported by youths with asthma. Participants included 149 Portuguese children and adolescents between the ages of 8 and 18 who had been diagnosed with asthma and attended outpatient services at three public hospitals. The results showed that stronger family ritual meaning predicted a more positive family environment (i.e., higher cohesion levels and lower conflict levels), better health-related quality of life, and fewer emotional and behavior problems in youths. Furthermore, family cohesion and conflict mediated the links between family ritual meaning and health-related quality of life, and emotional and behavioral problems. These results did not change after controlling for participant age, gender, and asthma severity. The findings of this study suggest that family ritual meaning contributes to the adaptation of youths with asthma via its positive association with the family environment. The implications for multicontextual interventions with families are briefly discussed with regard to the positive role of family rituals and of their potential as a modifiable factor in families with increased health challenges.

The Portuguese version of the Body Image Scale (BIS) – psychometric properties in a sample of breast cancer patients

PURPOSE The aim of this study was to analyse the psychometric properties of the Portuguese version of the body image scale (BIS; Hopwood, P., Fletcher, I., Lee, A., Al Ghazal, S., 2001. A body image scale for use with cancer patients. European Journal of Cancer, 37, 189-197). This is a brief and psychometric robust measure of body image for use with cancer patients, independently of age, cancer type, treatment or stage of the disease and it was developed in collaboration with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Study Group. METHOD The sample is comprised of 173 Portuguese postoperative breast cancer patients that completed a battery of measures that included the BIS and other scales of body image and quality of life, in order to explore its construct validity. RESULTS The Portuguese version of BIS confirmed the original unidimensional structure and demonstrated adequate internal consistency, both in the global sample (alpha=.93) as in surgical subgroups (mastectomy=.92 and breast-conserving surgery=.93). Evidence for the construct validity was provided through moderate to largely sized correlations between the BIS and other related measures. In further support of its discriminant validity, significant differences in BIS scores were found between women who underwent mastectomy and those who underwent breast-conserving surgery, with the former presenting higher scores. Age and time since diagnosis were not associated with BIS scores. CONCLUSIONS The Portuguese BIS proved to be a reliable and valid measure of body image concerns in a sample of breast cancer patients, allowing a brief and comprehensive assessment, both on clinical and research settings.

Development and psychometric properties of the World Health Organization Quality of Life Assessment Instrument (WHOQOL-100) in Portugal.

BackgroundAt the beginning of the 1990s, the World Health Organization (WHO) developed a project in order to create a cross-cultural instrument of quality of life assessment: the World Health Organization Quality of Life (WHOQOL).PurposeThis paper describes the development of the European Portuguese version of the WHOQOL-100, according to the methodology recommended by the WHO.MethodSpecial attention is given to the qualitative pilot study, which led to the development of the Portuguese Facet [Political P], and to the empirical pilot study and the psychometric studies, based on the application of the Portuguese version of the instrument to a sample of 315 subjects from the general population and 289 patients. The assessment protocol also included the Beck Depression Inventory and the Brief Symptom Inventory.ResultsThe Portuguese version of WHOQOL-100 showed acceptable internal consistency (α range 0.84–0.94) and test–retest reliability in all domains (r range 0.67–0.86). Discriminant validity was significant for all domains, except in Spirituality. Convergent validity with the Beck Depression Inventory and the Brief Symptom Inventory was satisfactory for most domains.ConclusionThe WHOQOL showed good psychometric characteristics, suggesting that the Portuguese version of WHOQOL is valid and reliable in the assessment of quality of life in Portugal.

Psychosocial adjustment during the transition to parenthood of Portuguese couples who conceived spontaneously or through assisted reproductive technologies.

We examined the psychosocial adjustment of 35 Portuguese couples who conceived through Assisted Reproductive Technologies (ART) and 31 couples with a spontaneous conception during their transition to parenthood (pregnancy and 4 months postpartum). Couples completed self-report questionnaires regarding their perceptions of pregnancy and parenthood, psychological distress, quality of life, marital relationship, and parenting stress. Compared with parents who conceived spontaneously, parents who conceived through ART perceived pregnancy as being more risky and demanding, reported a decrease in their psychological quality of life, and ART fathers only perceived themselves as being more competent than fathers who conceived spontaneously. Healthcare professionals should be aware of need of couples in their efforts to adapt to the individual and relational challenges associated with the transition to parenthood.