Miri Cohen

Quality of life, depressed mood, and self-esteem in adolescents with heart disease.

Objective: To assess health-related quality of life (HRQoL), depressed mood, and self-esteem in adolescents with heart disease and compare them with age-matched healthy adolescents (control group). Methods: Ninety adolescents (aged 12 to 18 years with congenital or acquired heart disease) and 87 controls completed the HRQoL (TAAQOL-CHD), Center for Epidemiologic Studies Depression scale, and Rosenberg self-esteem questionnaires. Relevant medical details were collected. The patients and their parents were asked to rate their perceived severity of heart disease. Results: Adolescents with severe heart disease reported higher levels of depressed mood and lower self-esteem than did adolescents with moderate and mild heart disease and age-matched healthy controls. Adolescents with severe heart disease also reported worse HRQoL than those with moderate and mild disease. According to the multiple regression analysis, 44% of variance of HRQoL was explained by the study variables. Disease severity alone explained 11% of the variance, but when entered with the other study variables, depressed mood, self-esteem, and adolescents’ perceived severity of disease were the only significant contributors to the explained variance of HRQoL. An exploratory mediation analysis, using the Sobel test, was therefore applied, and it showed that depressed mood and perceived disease severity, but not self-esteem, mediated the relationship between disease severity and HRQoL. Conclusions: Lower HRQoL was found in adolescents with severe heart disease. Psychosocial factors have a significant effect on the psychological state of adolescents, and they should be addressed and treated. HRQoL = health-related quality of life.

Comparing Relaxation Training and Cognitive-Behavioral Group Therapy for Women With Breast Cancer

Objective: To assess the effectiveness of cognitive-behavior (CB) group intervention versus relaxation and guided imagery (RGI) group training. Method: A total of 114 early-stage breast cancer patients were randomly assigned to CB, RGI, or control groups, and instruments were completed at pre- and postintervention and 4 months later. Results: Psychological distress was significantly reduced in both intervention groups compared to the control group. The RGI group was more effective in reducing levels of fatigue and sleep difficulties, whereas the CB group was more effective in reducing external health locus of control. Internal health locus of control did not significantly change. Adherence to self-practice at home was significantly associated with reduction in psychological and physical symptoms. Conclusions: The study supports the use of both CB and RGI models for reducing psychological distress in breast cancer patients. RGI showed advantages in reducing fatigue and improving sleep quality, whereas CB better reduced external health locus of control perceptions.

First-degree relatives of breast-cancer patients: cognitive perceptions, coping, and adherence to breast self-examination.

Abstract The author assessed patterns of breast self-examination (BSE) related to cognitive appraisal, coping, and emotional distress in 80 women with first-degree relatives who were breast-cancer patients and 47 matched controls. Participants with first-degree relatives adhered to BSE better than did women with no family history of breast cancer, and women whose relatives had recurrent or metastatic disease performed more BSE than those whose relatives were currently disease free. Greater adherence to BSE was associated with lower levels of depression, more problem-focused coping, older age, and more education. In the women with first-degree relatives, BSE was also associated with higher perceptions of (a) control over prevention, (b) risk for breast cancer, and (c) higher levels of state anxiety. Perception of control, problem-focused coping, depression, and anxiety predicted 35% of the variance in adherence to BSE. The findings suggest that cognitive appraisal, coping strategies, and levels of emotional distress should be considered in designing programs for enhancing adherence to early detection procedures.

Can Skill-Development Training Alleviate Burnout in Hospital Social Workers?

Abstract Staff development programs, which focus on imparting and improving intervention skills, are acknowledged as an efficient way to reduce burnout, but few studies have examined this effect. The aim of the present study was to detect any difference in the level of social workers burnout before and after attending two different skill-development groups, namely group-intervention skills for more experienced social workers and general hospital social-work skills for less experienced. Twenty-five hospital social workers participated in the study. The three dimensions of burnout, namely emotional exhaustion, depersonalization, and personal accomplishment, changed between the pre-training and post-training measures: personal accomplishment rose by 12.39% and depersonalization fell by 29.75%. The difference was significant for the two dimensions in both groups. Emotional exhaustion significantly declined in the hospital social-work skills group only, and revealed a group-time effect. The level of peer support rose in the hospital-skills group and was positively related to a lowering of emotional exhaustion. This was an exploratory study, with a rather small sample, and the results are preliminary, but they show a promising possibility of burnout reduction among professional workers. Further research on the effect of skill development training on reducing burnout is needed.

Coping and Emotional Distress in Primary and Recurrent Breast Cancer Patients

The purpose of this study was to explore the emotional distress and coping strategies among women with primary as against recurrent (local or metastatic) breast cancer. The study sample consisted of 80 women, all 1 year postdiagnosis of primary or recurrent breast cancer. All women completed a demographic questionnaire, the Emotional Symptoms Checklist (SCL-90R) and the Ways of Coping Questionnaire (WCQ). Patients with recurrence reported higher levels of depression and anxiety as well as a higher global severity index (GSI). This group used significantly fewer problem-solving and positive-focus strategies. Emotion-focused coping predicted depression and the GSI, but only positive attitude predicted the level of anxiety. The state of disease was a major predictor of emotional symptoms, and to a lesser extent of the coping strategies used. Although emotion-focused coping had a deleterious effect on emotional well-being, our study highlighted the importance and relevance of positive attitude for reducing emotional distress in general and level of anxiety in particular. Promotion of positive-focus coping strategies should thus be a key element in psychological interventions with cancer patients.

Increased emotional distress in daughters of breast cancer patients is associated with decreased natural cytotoxic activity, elevated levels of stress hormones and decreased secretion of Th1 cytokines

DBCP who are aware of their increased risk of developing breast cancer may suffer from high emotional distress. Chronic stress may interfere with NCA and low NCA is associated with increased cancer risk. We studied 80 DBCP and 47 age‐ and education‐matched healthy females (controls). Heparinized venous blood (30 ml) was drawn from all subjects between 8 and 9 A.M., and each participant answered a set of psychologic questionnaires. In addition, the first‐morning urine sample was collected. DBCP scored significantly higher in emotional distress compared to controls. Levels of stress hormones in DBCP were higher and in vitro secretion of IL‐2, IL‐12 and IFN‐γ lower compared to controls. NCA against NK‐resistant (MCF‐7, COLO‐205, U937) and NK‐sensitive (K562) cell lines was significantly lower in DBCP and much less augmented by in vitro preincubation with IL‐2 or IL‐12 compared to controls. NCA and in vitro Th1 cytokine secretion were inversely correlated with the degree of emotional distress and the level of stress hormones in blood or urine. High emotional distress and elevated levels of stress hormones are associated with impaired immune surveillance functions in DBCP. This may contribute to the increased risk of DBCP to develop breast cancer. An interventional trial to enhance coping and reduce stress levels may help to decrease the risk for breast cancer onset in DBCP.

Mothers with breast cancer and their adult daughters: The relationship between mothers' reaction to breast cancer and their daughters' emotional and neuroimmune status

Objectives: The objectives of this study were to assess the associations between psychologic distress of patients with breast cancer and of their adult daughters; and to assess the associations between mothers’ psychologic distress and daughters’ psychologic distress, stress hormone levels, natural cytotoxic activity (NCA), and Th1 cytokine secretion. Methods: Eighty mothers with breast cancer and 80 adult daughters participated in the study. They completed the Symptom Check List (SCL-90R) questionnaire. In addition, daughters completed a set of questions on their health status and habits and on the effects of their mothers’ disease on their own lives. Thirty milliliters of heparinized venous blood and a first early-morning urine sample were collected from daughters between 8:00 and 9:00am. Spontaneous and interleukin-2 (IL-2)-induced NCA, in vitro IL-2 and IL-12 secretion, and levels of plasma cortisol and urinary catecholamines were tested in daughters. Forty-seven healthy women, age- and education- matched to daughters, completed the psychologic, immunologic, and hormonal tests, and served as a control group. Results: Psychologic distress of mothers and daughters was highly correlated. However, mothers experienced a higher level of distress than daughters. Mothers with advanced disease and their daughters were more distressed than mothers with primary disease and their daughters. Daughters’ distress was also related to their subjective caregiving burden and the frequency of meetings with mothers. Higher distressed daughters had lower IL-2-induced NCA and decreased in vitro IL-2 and IL-12 secretion. Norepinephrine secretion level mediated the relationship between daughters’ level of distress and their immune functions. Cortisol mediated only the relationship between daughters’ distress and IL-2 secretion. Conclusions: This initial study shows that the psychologic distress of mothers with breast cancer and that of their adult daughters are similar. Stress hormone secretions and immune functions of daughters are related to both their own and their mothers’ psychologic distress. GSI= Global Severity Index; IL-2 = interleukin 2; IL-12 = interleukin 12; NCA = natural cytotoxic activity; SCL = symptom checklist; SD = standard deviation.

Factors associated with low screening for breast cancer in the Palestinian Authority: relations of availability, environmental barriers, and cancer-related fatalism.

The current study was conducted to assess screening behaviors in relation to cultural and environmental barriers among Palestinian women in the West Bank.

Increasing Breast Examinations Among Arab Women Using a Tailored Culture-Based Intervention

This study aimed to assess outcomes of a culture-specific intervention devised to reduce barriers to breast cancer screening among Arab women in Israel. Women in intervention (n = 42) and control (n = 24) groups answered breast examination performance and Arab culture–specific barriers and health beliefs questionnaires at pre- and postintervention. Women in the study group received tailored telephone intervention between the 2 interviews. Although the study and control groups did not differ in rate of attending clinical examinations and mammography at pre-intervention, at post-intervention, almost 48% of the intervention group and 12.5% of the control group scheduled or attended a clinical examination, and 38.5% of women in the intervention group and 21.4% of the control group attended or scheduled a mammography. Of the cultural barriers, a significant group x time effect was found for the cultural barriers of exposure, social barriers, and self-uneasiness with body, with a higher decrease in the intervention group. Of the health beliefs, a group x time effect was found for perceived vulnerability and perceived barriers to clinical examination and mammography, which significantly decreased in the intervention group, but not in the control group. The preliminary results showed that the culture-based intervention was effective in reducing barriers and increasing the rate of breast cancer examinations.

Posttraumatic growth in breast cancer survivors: a comparison of volunteers and non-volunteers

Background: The need to understand posttraumatic growth (PTG) in relation to actual changes in an individuals life has recently been raised. However, the relationship of volunteering, health, and PTG has not yet been assessed.