Roeline G. Kuijer

Psychological adjustment to chronic disease

This Review discusses physiological, emotional, behavioural, and cognitive aspects of psychological adjustment to chronic illness. Reviewing the reports of the past decade, we identify four innovative and promising themes that are relevant for understanding and explaining psychological adjustment. In particular, the emphasis on the reasons why people fail to achieve a healthy adjustment has shifted to the identification of factors that help patients make that adjustment. To promote psychological adjustment, patients should remain as active as is reasonably possible, acknowledge and express their emotions in a way that allows them to take control of their lives, engage in self-management, and try to focus on potential positive outcomes of their illness. Patients who can use these strategies have the best chance of successfully adjusting to the challenges posed by a chronic illness.

Couples dealing with cancer : Role and gender differences regarding psychological distress and quality of life

The goal of the present study was to further knowledge on gender and role (i.e. patient versus partner) differences in psychological distress and quality of life as a consequence of dealing with cancer. There is some evidence that being the patient or the caregiver makes more difference for men than for women. In total, 173 couples facing various forms of cancer (two samples) and a control group of 80 couples completed the CES‐D and Cantrils Ladder. Analyses of variance revealed that both female patients and female partners of patients perceived more psychological distress and a lower quality of life than women in healthy couples. In contrast, role did have an effect on men. Specifically, male patients scored as high on psychological distress and as low on quality of life as female patients and female partners, but psychological distress and quality of life did not differ between male partners of patients and their healthy controls. However, this effect was found in only one patient sample. The finding that female partners perceived more psychological distress and a lower quality of life than male partners could not be accounted for by differences in the physical condition of the patient or the partner.

Caregiver burnout among intimate partners of patients with a severe illness: an equity perspective

In the present study, caregiver burnout among the intimate partners of 106 cancer patients and 88 patients with multiple sclerosis was assessed. This study examined how burnout is related to marital quality and perceptions of inequity in the relationship. LISREL analyses showed that higher perceptions of inequity are strongly associated with higher emotional exhaustion and depersonalization, and lower feelings of personal accomplishment. Intimate partners of both cancer patients and patients with multiple sclerosis are relatively likely to experience burnout when they feel that they do not invest or benefit enough in the exchange with their ill partner. The relationship between inequity and burnout held when general marital quality, gender, the duration of the illness, the physical and psychological condition of the ill partner, and support from other persons were controlled for. This study shows that perceptions of equity or balance in the relationship between patients and their intimate partners are important for preventing caregiver burnout and for enhancing positive caregiver experiences.

Are equity concerns important in the intimate relationship when one partner of a couple has cancer

Guided by equity theory, the present study examined the balance of give-and-take in couples facing cancer. Healthy couples were included as a control group. Patients with cancer felt, as expected, more overbenefited in their relationship than did healthy people. Contrary to our expectation, their partners did not feel underbenefited; they felt as equitably treated as did healthy people. Moreover, perceived equity was related to quality of the relationship: all participants (patients, their partners, and healthy people) generally reported the lowest quality when they felt underbenefited in their relationship. Equity concerns were not equally important to all patients and partners, however. When the patient was seriously physically impaired, neither patients nor their partners were troubled any longer by feeling underbenefited.

Depression and Perceptions of Inequity among Couples Facing Cancer

In the present study, symptoms of nonclinical depression among 106 cancer patients and their intimate partners were assessed. From the perspective of equity theory, it was examined how depression was related to neuroticism, marital quality, and perceptions of inequity in the relationship. LISREL analyses showed that neuroticism and perceptions of inequity in the relationship were associated with higher depression, but differences were found between patients and partners in the way that inequity and depression were related. Cancer patients reported more symptoms of depression when they felt that they invested too little in the relationship, whereas their partners were higher in depression when they felt that they received too little benefits in the relationship. The findings are discussed in terms of structural differences in roles between patients and caregiving partners.

Is spousal support always helpful to patients with asthma or diabetes? A prospective study

The current study examined effects of three ways of providing spousal support (active engagement, protective buffering, and overprotection) on self-efficacy and physical and mental health in patients with diseases imposing a high demand on self-management routines (36 asthma patients and 21 diabetic patients). Employing a nine-month prospective design, we hypothesized that active engagement would be positively related to health and self-efficacy, that overprotection would have a negative impact, and that the impact of protective buffering would depend on symptom level at baseline. Results confirmed the latter hypothesis while either positive or negative effects of active engagement and overprotection were absent. These findings are discussed with respect to the role of spousal support in diseases requiring self-management behaviour.

The relation between perceived inequity, marital satisfaction and emotions among couples facing cancer.

The central aim of the present study was to examine if equity theory still applies to intimate relationships when couples are confronted with a serious illness. Equity concerns were examined among 68 cancer patients and their partners. Contrary to our expectations, only male patients on average felt overbenefited in their relationship, whereas female patients on average felt equitably treated. Moreover, it was found that the partners of these patients did not, as was expected, feel underbenefited in their relationship. The main focus of the present study was on the association between perceived equity on the one hand and relationship satisfaction and emotions on the other. It was found that in general patients seemed most sensitive to underbenefit (i.e. they felt least satisfied), and experienced on average least positive and most negative affect when they felt underbenefited. Particularly, patients who were physically impaired felt dissatisfied and angry when underbenefited. The partners of these patients were in general equally sensitive to inequity in both directions, regardless of their ill partners physical condition.

Anxiety and self-management behaviour in chronic obstructive pulmonary disease: what has been learned?

A considerable amount of literature has described the prevalence of anxiety in patients with the lung condition chronic obstructive pulmonary disease (COPD). Few, if any, papers have reviewed the inter-relationship between anxiety symptoms and self-management interventions in this population. This is the aim of the current review. First, the review examines the evidence suggesting that anxiety is more common in COPD than other populations. Secondly, the focus shifts to evaluating the evidence for and against the efficacy of COPD self-management programmes. Finally this paper examines the relationship between anxiety and COPD self-management with particular reference to the benefits and possible harm of some COPD self-management goals and anxious patients.

Dieting as a case of behavioural decision making. Does self-control matter?

To be a successful dieter, one has to be able to consistently resist immediate temptations in order to achieve the bigger, but delayed rewards of weight loss, increased attractiveness and better health. These long-term benefits are by no means guaranteed as the delayed rewards are more uncertain than the immediate rewards. Several researchers have suggested that the population of restrained eaters consists of two populations: unsuccessful dieters who score high on restraint and high on disinhibition, and successful dieters who score high on restraint but low on disinhibition. The present study examines to what extent restrained eating in combination with individual differences in self-control (akin to low disinhibition) is related to successful decision making on a task that mimics the uncertainty of dieting (measured with the Iowa Gambling Task). As expected, self-control moderated the association between restraint and decision making: restrained eating was related to worse decision making when self-control was low, but to better decision making when self-control was high. This suggest that those high in restraint and high in self-control may be more successful in their dieting attempts because they are generally better at inhibiting short-term rewards in order to gain better long-term outcomes.

A double-blind, randomized, placebo-controlled trial of Lactobacillus helveticus and Bifidobacterium longum for the symptoms of depression

Objectives: This trial investigated whether probiotics improved mood, stress and anxiety in a sample selected for low mood. We also tested whether the presence or severity of irritable bowel syndrome symptoms, and levels of proinflammatory cytokines, brain-derived neurotrophic factor and other blood markers, would predict or impact treatment response. Method: Seventy-nine participants (10 dropouts) not currently taking psychotropic medications with at least moderate scores on self-report mood measures were randomly allocated to receive either a probiotic preparation (containing Lactobacillus helveticus and Bifidobacterium longum) or a matched placebo, in a double-blind trial for 8 weeks. Data were analysed as intent-to-treat. Results: No significant difference was found between the probiotic and placebo groups on any psychological outcome measure (Cohen’s d range = 0.07–0.16) or any blood-based biomarker. At end-point, 9 (23%) of those in the probiotic group showed a ⩾60% change on the Montgomery–Åsberg Depression Rating Scale (responders), compared to 10 (26%) of those in the placebo group ( χ 1 2 = 0 . 107 , p = ns). Baseline vitamin D level was found to moderate treatment effect on several outcome measures. Dry mouth and sleep disruption were reported more frequently in the placebo group. Conclusions: This study found no evidence that the probiotic formulation is effective in treating low mood, or in moderating the levels of inflammatory and other biomarkers. The lack of observed effect on mood symptoms may be due to the severity, chronicity or treatment resistance of the sample; recruiting an antidepressant-naive sample experiencing mild, acute symptoms of low mood, may well yield a different result. Future studies taking a preventative approach or using probiotics as an adjuvant treatment may also be more effective. Vitamin D levels should be monitored in future studies in the area. The results of this trial are preliminary; future studies in the area should not be discouraged.