Rhonda F. Brown

Longitudinal assessment of anxiety, depression, and fatigue in people with multiple sclerosis.

OBJECTIVES No longitudinal studies have concurrently evaluated predictors of anxiety, depression, and fatigue in people with multiple sclerosis (PwMS). This study determined factors that best predicted anxiety, depression, and fatigue in MS patients from a large pool of disease, cognitive, life-event stressor (LES), psychosocial, life-style, and demographic factors. DESIGN A 2-year prospective longitudinal study evaluated predictors of psychological distress and fatigue in PwMS. METHODS One hundred and one consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. LES, anxiety, depression, and fatigue were assessed at baseline and at 3-monthly intervals for 2-years. Disease, cognitive, demographic, psychosocial, and life-style factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. RESULTS Depression strongly predicted anxiety and fatigue, and anxiety and fatigue strongly predicted later depression. Psychological distress (i.e. anxiety, depression) was also predicted by a combination of unhealthy behaviours (e.g. drug use, smoking, no exercise, or relaxation) and psychological factors (e.g. low optimism, avoidance coping), similar to the results of community-based studies. However, state-anxiety and fatigue were also predicted by immunotherapy status, and fatigue was also predicted by LES and demographics. CONCLUSIONS These results suggest that similar factors might underpin psychological distress and fatigue in MS patients and community-well samples, although MS treatment factors may also be important. These results might assist clinicians in determining which MS patients are at greatest risk of developing anxiety, depression, or fatigue.

The Impact of a Self-Efficacy Intervention on Short-Term Breast-Feeding Outcomes

Maternal self-efficacy for breast-feeding may contribute to success in breast-feeding. This study aimed to increase breast-feeding self-efficacy and actual breast-feeding through an intervention based on Banduras self-efficacy theory. A total of 90 pregnant women participated in the study. The women who were assigned to a breast-feeding self-efficacy intervention showed significantly greater increases in breast-feeding self-efficacy than did the women in the control group. Furthermore, at 4 weeks postpartum, women in the intervention group showed a trend toward breast-feeding their infants longer and more exclusively than did those in the control group. Greater increases in breast-feeding self-efficacy were associated with a significantly higher level of breast-feeding. Replicating previous research, breast-feeding self-efficacy was significantly related to concurrent breast-feeding behavior, and high antenatal breast-feeding self-efficacy predicted a higher level of later breast-feeding in control-group women. These findings have implications for breast-feeding support programs and for the potential general utility of self-efficacy-based interventions in health education.

Stress, Depression, Workplace and Social Supports and Burnout in Intellectual Disability Support Staff.

BACKGROUND Staff providing support to people with intellectual disabilities are exposed to stressful work environments which may put them at an increased risk of burnout. A small prior literature has examined predictors of burnout in disability support staff, but there is little consensus. In this study, we examined direct and indirect associations between work stressors (i.e. challenging client behaviour), staff emotional response to the behaviour (i.e. perceived stress, anxiety, depression), social and organisational support resources, and staff burnout. METHODS A short survey examined client behaviour, staff psychological stress, anxiety, depression, social support (number, satisfaction), organisational support and burnout in 80 disability support staff in a community setting. RESULTS Burnout levels were similar to or slightly lower than normed values for human services staff. Cross-sectional regression analyses indicated that depression symptoms and organisational support were related to worse emotional exhaustion and depersonalisation, whereas less social support was related to less personal accomplishment. Social support satisfaction (but not social support number or organisational support) moderated between high psychological stress to less emotional exhaustion. CONCLUSIONS Taken together, these results suggest that depression symptoms and low organisational support were frequently concurrent with burnout symptoms. Furthermore, workers personal and organisational supports may have helped bolster their sense of personal accomplishment, and buffered against the potential for emotional exhaustion.

Stress, psychological distress, psychosocial factors, menopause symptoms and physical health in women.

OBJECTIVES Relatively few studies have evaluated relationships between stress, psychological distress, psychosocial factors and menopause symptoms, and none have evaluated emotional intelligence (EI) in relation to menopause. In this study, direct and indirect relationships were evaluated between stress, psychological distress, psychosocial factors (e.g. social support, coping, EI), menopause symptom severity and physical health in middle-aged women. METHODS One hundred and sixteen women aged 45-55 years were recruited through womens health centres and community organizations. They completed a short questionnaire asking about stress, psychological distress (i.e. anxiety, depression), EI, attitude to menopause, menopause symptoms and physical health. RESULTS Low emotional intelligence was found to be related to worse menopause symptoms and physical health, and these associations were partly mediated by high stress, anxiety and depression, a negative attitude to menopause and low proactive coping. CONCLUSIONS Women with high EI appear to hold more positive attitudes to menopause and experience less severe stress, psychological distress and menopause symptoms and better physical health. These results suggest that women who expect menopause to be a negative experience or are highly stressed or distressed may be more likely to experience a more negative menopause.

Relationship between stress and relapse in multiple sclerosis: part I. Important features

Objective The aim of this two-year prospective study was to examine the relationship between multiple aspects of life-event stress and relapse in multiple sclerosis (MS) patients. Background Few studies have defined the critical features of this life-event stress; for example, stressor duration, frequency, severity, disease-dependency, valency, or stressor constructs, such as the propensity to cause emotional distress/threat or the frustration of life goals. Methods 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life events were assessed at study-entry and at three-monthly intervals for two years. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. Results Acute events, but not chronic difficulties (CDs), predicted relapse occurrence: acute stressor frequency counts predicted greater relapse risk, along with low disability score (EDSS) and being male. We also confirmed the bi-directional stress-illness hypothesis: stressors predicted relapse, and relapse separately predicted stressors. Conclusions Life-event stress impacts to a small degree on MS relapse. The number and not the severity of acute stressors are most important; chronic stressors do not predict later relapse. Males and those with early stage disease are also at greater risk of relapse. MS patients should be encouraged to reduce acute stressors during times of high stress, and feel reassured that disease-related chronic stressors do not increase their relapse risk.

The 'grass ceiling': limitations in the literature hinder our understanding of cannabis use and its consequences.

AIM To illustrate how limitations in the cannabis literature undermine our ability to understand cannabis-related harms and problems experienced by users and identify users at increased risk of experiencing adverse outcomes of use. METHOD AND RESULTS Limitations have been organized into three overarching themes. The first relates to the classification systems employed by researchers to categorize cannabis users, their cannabis use and the assumptions on which these systems are based. The second theme encompasses methodological and reporting issues, including differences between studies, inadequate statistical control of potential confounders, the under-reporting of effect sizes and the lack of consideration of clinical significance. The final theme covers differing approaches to studying cannabis use, including recruitment methods. Limitations related to the nature of the data collected by researchers are discussed throughout, with a focus on how they affect our understanding of cannabis use and users. CONCLUSIONS These limitations must be addressed to facilitate the development of effective and appropriately targeted evidence-based public health campaigns, treatment programmes and preventative, early intervention and harm minimization strategies, and to inform cannabis-related policy and legislation.

Argentine tango dance compared to mindfulness meditation and a waiting-list control: A randomised trial for treating depression

OBJECTIVES To determine whether tango dancing is as effective as mindfulness meditation in reducing symptoms of psychological stress, anxiety and depression, and in promoting well-being. DESIGN This study employed analysis of covariance (ANCOVA) and multiple regression analysis. PARTICIPANTS Ninety-seven people with self-declared depression were randomised into tango dance or mindfulness meditation classes, or to control/waiting-list. SETTING classes were conducted in a venue suitable for both activities in the metropolitan area of Sydney, Australia. INTERVENTIONS Participants completed six-week programmes (1½h/week of tango or meditation). The outcome measures were assessed at pre-test and post-test. MAIN OUTCOME MEASURES Depression, Anxiety and Stress Scale; The Self Esteem Scale; Satisfaction with Life Scale, and Mindful Attention Awareness Scale. RESULTS Sixty-six participants completed the program and were included in the statistical analysis. Depression levels were significantly reduced in the tango (effect size d=0.50, p=.010), and meditation groups (effect size d=0.54, p=.025), relative to waiting-list controls. Stress levels were significantly reduced only in the tango group (effect size d=0.45, p=.022). Attending tango classes was a significant predictor for the increased levels of mindfulness R(2)=.10, adjusted R(2)=.07, F (2,59)=3.42, p=.039. CONCLUSION Mindfulness-meditation and tango dance could be effective complementary adjuncts for the treatment of depression and/or inclusion in stress management programmes. Subsequent trials are called to explore the therapeutic mechanisms involved.

Relationship between stress and relapse in multiple sclerosis: Part II. Direct and indirect relationships.

Objective The aim of this two-year prospective study was to determine which factors were: (i) directly related and/or (ii) indirectly related to multiple sclerosis (MS) relapse. These factors included life-event stressors, disease, demographic, psychosocial and lifestyle factors. Background Relatively little attention has been paid to the role of non-clinical relapse predictors (other than stressful life-events) in MS, or factors that indirectly impact on the stress-relapse relationship. Methods A total of 101 consecutive participants with MS were recruited from two MS clinics in Sydney, Australia. Stressful life-events, depression, anxiety and fatigue were assessed at study-entry and at three-monthly intervals for two years. Disease, demographic, psychosocial and lifestyle factors were assessed at baseline. Patient-reported relapses were recorded and corroborated by neurologists or evaluated against accepted relapse criteria. Results MS relapse was predicted by acute stressor frequency counts, coping responses that utilized social support, and being born in Australia, but not by chronic stressors, disease, demographic, psychosocial or lifestyle factors. No factors were found to indirectly impact on the stress-relapse relationship. Conclusions The number rather than severity of stressors was most important in relation to MS relapse risk, along with coping responses that utilized social support, suggesting that MS patients should avoid situations that are likely to generate multiple stressors or which provide few avenues for social support.

A review of stress-relapse interactions in multiple sclerosis : important features and stress-mediating and -moderating variables

Studies do not provide a consensus opinion of the relationship between stress and relapse in relapsing=remitting multiple sclerosis (RRMS). Few studies have defined the critical features of these stressful situations, or examined the role of stress-mediating and -moderating variables. Available evidence indicates that the relationship between life stress and relapse is complex, and is likely to depend on factors such as stressor chronicity, frequency, severity and type, and individual patient characteristics such as depression, health locus of control and coping strategy use. Little is known about how these factors, individually or in combination, are related to MS disease activity. Viral infections are also likely to precipitate relapse in MS, and significant life-stress may further enhance this relationship. The nature and strength of these interrelationships have strong clinical implications. MS patients are particularly vulnerable to a deteriorating cycle of stressful life events, illness episodes and disability. Timely multidisciplinary care interventions aimed at both minimizing psychological distress and physical symptoms may halt this downward reciprocal cycle. Little is known of the pathogenesis of these putative stress-induced changes in disease activity, and almost all stressor studies suffer from some biases or limitations.

The Multiple Sclerosis Work Difficulties Questionnaire

Background: A better understanding of the workplace difficulties experienced by people with multiple sclerosis (PwMS) may be critical to developing appropriate vocational and rehabilitative programs. Objective: We aimed to assess the factor structure, internal consistency and validity of the new Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ). Methods: Work difficulty items were developed and reviewed by a panel of experts. Using the MSWDQ, cross-sectional self-report data of work difficulties were obtained in addition to employment status and MS disease information, in a community-based sample of 189 PwMS. Results: Exploratory Maximum Likelihood Factor Analysis on the draft questionnaire yielded 50 items measuring 12 factors. Subscale internal consistencies ranged from 0.74 to 0.92, indicating adequate to excellent internal consistency reliability. The MSWDQ explained 40% of the variance in reduced work hours since diagnosis, 40% of the variance in expectations about withdrawing from work, 34% of the variance in expectations about reducing work hours, and 39% of the variance in expectations about changing type of work due to MS. Conclusion: The MSWDQ is a valid and internally reliable measure of workplace difficulties in PwMS. Physical difficulties, as well as cognitive and psychological difficulties were important predictors of workplace outcomes and expectations about future employment.