Paul N. Duckro

Psychosocial— spiritual correlates of death distress in patients with life-threatening medical conditions

The purpose of this study was to identify demographic, disease, health care, and psychosocial spiritual factors associated with death distress (death-related depression and anxiety). Cross-sectional baseline data from a randomized controlled trial were used. Outpatients (n=70) were recruited from an urban academic medical centre and proprietary hospital. All patients had life-threatening medical conditions, including cancer; pulmonary, cardiac, liver, or kidney disease; HIV/AIDS; or geriatric frailty. Measures of death distress, physical symptom severity, depression and anxiety symptoms, spiritual well-being, social support, patient-perceived physician communication, and patient-perceived quality of health care experiences were administered. In a hierarchical multiple regression model, higher death distress was significantly associated with living alone, greater physical symptom severity, more severe depression symptoms, lower spiritual well-being, and less physician communication as perceived by the patient. Death distress as a unique experiential construct was discriminable among younger patients with specific, diagnosable life-threatening conditions, but less so among geriatric frailty patients. The findings suggest that the experience of death distress among patients with life-threatening medical conditions is associated with the psychosocial spiritual dimensions of the patients life. Attention to these dimensions may buffer the negative affects of death distress.

Post-traumatic Stress Disorder in Chronic Post-traumatic Headache Patients

SYNOPSIS

A review of studies evaluating biofeedback and relaxation training in the management of pediatric headache

SYNOPSIS

Promoting diabetes self-management and independence in the visually impaired: a model clinical program.

Program Structure and Content A program has been developed at the St Louis University School of Medicine aimed at encouraging independence and improved self-esteem for the visually impaired individual with diabetes. This clinical program employs an integrated multidisciplinary approach to include ( 1 ) diabetes education focusing on the teaching of skills and devices needed by the visually impaired for diabetes selfmanagement ; (2) a monitored exercise program, individually tailored to accommodate visual, cardiovascular, and neurologic limitations; (3) group support with individual counseling as indicated; and (4) a prospective evaluation of measures of glucose control, exercise tolerance, and psychological adjustment. The program was initiated by several St Louis University diabetologists, and was designed through collaboration with consultants in the areas

The Relationship of Anger, Depression, and Perceived Disability Among Headache Patients

SYNOPSIS

Anger, Depression, and Disability: A Path Analysis of Relationships in a Sample of Chronic Posttraumatic Headache Patients

Anger and depression are common affective concomitants of chronic headache. Previous research suggests that the affective component of headache may contribute to the patients perceptions of the degree to which the headache is disabling. The present study examined the relationship between anger expression, anger suppression, depression, and headache‐related disability (interference with function) in a sample of chronic posttraumatic headache patients. A path analytic model indicated a direct relationship between depression and perceived disability. Anger suppression and anger expression each had a direct influence on depression, but their effects on disability were mediated through depression. The results partially replicate a previous path analytic study of the relationships among these variables in a chronic headache sample.

Psychosocial Profiles in Patients With Visual Impairment Due to Diabetic Retinopathy

The psychological impact of vision loss due to diabetic retinopathy is compounded by the loss of diabetes self-management skills. The appropriate role and timing for rehabilitative intervention has not been determined. Twenty-nine individuals with diabetes mellitus, 16 with stable visual impairment and 13 with fluctuating and transitional visual impairment, underwent psychological assessment before and after entering into a specially designed rehabilitation program. Low levels of performance were demonstrated by the Rosenberg Self- Esteem Scale and the Diabetes Self-Reliance Test in both groups. The Minnesota Multiphasic Personality Inventory, the Zung Self-Rating Depression Scale, and the Rand Mental Health Index suggested that subjects with stable vision impairment were moderately compensated relative to the transitional group, although the former group may have been totally blind. Both groups demonstrated significant improvements in psychological profiles after the program. It is suggested that a rehabilitation program may be of clinical benefit early in the course of vision loss associated with diabetic retinopathy.

Identifying barriers to psychosocial spiritual care at the end of life: A physician group study

Objective. The recent literature addresses the need to improve care for dying patients. The purpose of this study was to identify barriers to the psychosocial spiritual care of these patients by their physicians. Psychosocial spiritual care is defined as aspects of care concerning patient emotional state, social support and relationships, and spiritual well-being. The study was an exploratory means for generating hypotheses and identifying directions for interventions, research, and training in care for the dying. Design and participants. The study used a qualitative group discussion format. Seventeen physicians at a university-based health sciences center representing 10 areas of medical specialty—including internal medicine, oncology, pediatrics, and geriatrics—met in two groups for 20 75-minute discussion sessions over the course of one year. Discussions were recorded, analyzed, and categorized. Results. Barriers to psychosocial spiritual care were grouped into three domains and seven themes. The cultural domain included the themes of training, selection, medical practice environment, and debt/delay. Participants believed that medical selection and training combine to marginalize psychosocial spiritual approaches to patient care, while the practice environment and debt/delay augment emotional isolation and dampen idealism. The organizational domain included the themes of dissatisfaction and time/busyness. Physicians indicated that the current reimbursement climate and time pressures contribute to dissatisfaction and the tendency to avoid patient psychosocial spiritual issues. The clinical domain included the theme of communication. Physicians were concerned about their ability to communicate nonmedical issues effectively and manage the patient’s reactions and needs in the psychosocial spiritual arena. Conclusions. This study suggests that research and educational approaches to improving the psychosocial spiritual care of the dying by physicians should address barriers at the cultural, organizational, and clinical levels. Suggestions for interventions at various levels are offered.

Prevalence of Temporomandibular Symptoms in a Large United States Metropolitan Area

The prevalence of five symptoms of temporomandibular disorder and associated symptoms of pain, headache, and stress was estimated in a random telephone survey of a large United States metropolitan area. The prevalences for nocturnal bruxing, joint noise with use, soreness on waking, soreness with use, and diurnal clenching were roughly equivalent (ranging from 8% to 12%) and were within the range of prevalences reported in previous studies. Overall, 149 of the 500 respondents reported one or more of the five symptoms. Symptoms were not more prevalent among women than men, but were more prevalent among younger respondents. Soreness on waking and daytime clenching were the only symptoms significantly associated with report of pain. Pain was more commonly reported by respondents with multiple (four or five) symptoms. The results are compared with those of previous random surveys, and limitations to generalization of the present findings are discussed.

Personal and family stress in individuals with diabetes and vision loss

The intrapersonal distress and the impact of diabetes and vision impairment on marital functioning were assessed. Significant degrees of intrapersonal distress were demonstrated by the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and Rand Mental Health Index. Family functioning as assessed by the Family Assessment Device was significantly compromised. Vision impairment was a major stressor in the spousal relationship. Of 18 subjects who had been involved in a committed relationship at the onset of vision impairment, 9 had separated. Separation occurred at a mean of 1.6 years after the vision impairment. Totally blind individuals were at greater risk for separation than those who were legally, but not totally, blind. Psychological intervention was a limited benefit. Studies are necessary to identify the appropriate timing for further interventions.