Stacey L. Hart

Meta-Analysis of Efficacy of Interventions for Elevated Depressive Symptoms in Adults Diagnosed With Cancer

BACKGROUNDnCancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients.nnnMETHODSnEfficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided.nnnRESULTSnTen randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07).nnnCONCLUSIONSnOur findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.

Fear of recurrence, treatment satisfaction, and quality of life after radical prostatectomy for prostate cancer

Goals of workFear of cancer recurrence (FOR) is common in prostate cancer patients, but little research has examined the impact of FOR on quality of life (QOL) or the mechanism by which these fears become intensified. The objective of this study was to examine treatment satisfaction (TS) as a moderator of the relationship between FOR and QOL.Patients and methodsData were drawn from the CaPSURE™ database, a 12,000-man national observational prostate cancer registry. Three hundred and thirty-three patients who underwent radical prostatectomy (RP) to treat their prostate cancer completed self-report measures. TS was measured 0–6xa0months post-RP with a nine-item scale developed for this study, FOR was measured 6–12xa0months post-RP with a previously validated five-item scale, and QOL was measured 12–18xa0months post-RP with the Short Form 36.Main resultsAfter controlling for age, education, number of comorbid medical conditions, and cancer severity, lower FOR (Bu2009=u2009−0.12, pu2009<u20090.0001), higher TS (Bu2009=u20090.09, pu2009<u20090.001), and the interaction of TSu2009×u2009FOR (Bu2009=u20090.87, pu2009<u20090.05) significantly predicted higher mental health QOL scores. Furthermore, lower FOR (Bu2009=u2009−0.08, pu2009<u20090.01), and the interaction of TSu2009×u2009FOR (Bu2009=u2009−1.11, pu2009<u20090.01) significantly predicted higher physical health QOL scores.ConclusionsTS levels mitigated the impact of high FOR on lower levels of QOL. Specifically, patients who reported lower TS and greater FOR endorsed significantly lower levels of QOL compared to other patients in the sample.

The relationship of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms among Sri Lankan university students.

The relationships of posttraumatic growth to peritraumatic reactions and posttraumatic stress symptoms were examined in 93 Sri Lankan university students who had experienced a traumatic life event. Posttraumatic growth was associated with peritraumatic dissociation and posttraumatic stress symptoms, but was not associated with peritraumatic emotional distress. Results indicated a curvilinear relationship between peritraumatic dissociation and posttraumatic growth and between posttraumatic stress symptoms and posttraumatic growth. In a regression model predicting posttraumatic growth scores, each of the quadratic relationships of peritraumatic dissociation and posttraumatic stress symptoms to posttraumatic growth were statistically significant, and combined accounted for 22% of the variance. Results suggest that moderate levels of peritraumatic dissociation and symptoms are most associated with the greatest levels of growth.

Obstructive Defecation in Middle-aged Women

Obstructive defecation, a significant contributor to constipation, is frequently reported in middle-aged women, yet few population-based studies have established prevalence in this group. We analyzed data from the Reproductive Risks for Incontinence Study at Kaiser, a population-based cohort of racially diverse women, 40–69xa0years old, to describe the prevalence of obstructive defecation and identify associated risk factors. The Reproductive Risks for Incontinence Study at Kaiser is a randomly selected cohort of 2,109 women in the Kaiser Medical System. Obstructive defecation, determined by self-report, was defined as difficulty in passing stool, hard stool, straining for more than 15xa0min, or incomplete evacuation, occurring at least weekly. Age, race, income, education, drinking, health status, parity, pelvic organ prolapse, urinary incontinence, number of medications, hysterectomy, surgery for pelvic organ prolapse, colectomy, irritable bowel syndrome, and body mass index were assessed for both their univariate and multivariate association with obstructive defecation. Multivariate logistic regression was used to determine the independent association between associated factors and the primary outcome of obstructive defecation. Obstructive defecation that occurred at least weekly was reported by 12.3% of women. Significant independent risk factors included irritable bowel syndrome [odds ratio 1.78, (95% confidence interval 1.21–2.60)], vaginal or laparoscopic hysterectomy [2.01 (1.15–3.54)], unemployment [2.33 (1.39–3.92)], using three or more medications [1.81 (1.36–2.42)], symptomatic pelvic organ prolapse [2.34 (1.47–3.71)], urinary incontinence surgery [2.52 (1.29–4.90)], and other pelvic surgery [1.35 (1.03–1.78)]. We concluded that obstructive defecation is common in middle-aged women, especially those with a history of treatment for pelvic floor conditions. Women who had undergone laparoscopic/vaginal hysterectomies or surgery for pelvic organ prolapse or urinary incontinence had a nearly two times greater risk of weekly obstructive defecation. Demographic factors, with the exception of employment status, were not significant, indicating that obstructive defecation, although widespread, does not affect any particular group of women.

Family psychiatric history, peritraumatic reactivity, and posttraumatic stress symptoms: A prospective study of police

BACKGROUNDnFamily history of psychiatric and substance use disorders has been associated with posttraumatic stress disorder (PTSD) in cross-sectional studies.nnnMETHODnUsing a prospective design, we examined the relationships of family history of psychiatric and substance use disorders to posttraumatic stress symptoms in 278 healthy police recruits. During academy training, recruits were interviewed on family and personal psychopathology, prior cumulative civilian trauma exposure, and completed self-report questionnaires on nonspecific symptoms of distress and alcohol use. Twelve months after commencement of active duty, participants completed questionnaires on critical incident exposure over the previous year, peritraumatic distress to the worst critical incident during this time, and posttraumatic stress symptoms.nnnRESULTSnA path model indicated: (1) family loading for mood and anxiety disorders had an indirect effect on posttraumatic stress symptoms at 12 months that was mediated through peritraumatic distress to the officers self-identified worst critical incident, (2) family loading for substance use disorders also predicted posttraumatic stress symptoms at 12 months and this relationship was mediated through peritraumatic distress.nnnCONCLUSIONnThese findings support a model in which family histories of psychopathology and substance abuse are pre-existing vulnerability factors for experiencing greater peritraumatic distress to critical incident exposure which, in turn, increases the risk for development of symptoms of posttraumatic stress disorder. Replication in other first responders, military and civilians will be important to determine generalizability of these findings.

Sexual rehabilitation after localized prostate cancer: current interventions and future directions.

Many published articles have documented the impact of prostate-cancer treatment on sexual functioning in men treated for localized disease. Surprisingly, the literature on interventions to rehabilitate mens sexual functioning is much more limited. In this article, we review the sexual-rehabilitation interventions for prostate-cancer patients and identify a number of common themes across interventions. We also identify areas where further research is needed and propose a conceptual model based on psychologic and nursing theories and informed by the published research.

A randomized controlled trial of anorectal biofeedback for constipation

PurposeThe purposes of this study were: (1) to examine the efficacy of anorectal biofeedback (AB) for constipation compared to a biofeedback control (BC) treatment and (2) to examine the extent to which self-reported childhood sexual/physical abuse predicted biofeedback outcome.MethodsTwenty-one patients with pelvic floor dyssynergia were randomized to either (1) an AB arm, where patients learned to isolate the anal sphincter using an electromyography probe, or (2) a BC arm that controlled for the nonspecific effects of biofeedback, where patients learned to relax trapezius or temporalis muscles with EMG feedback. Both treatments were delivered by registered nurses for six sessions. Prior to randomization and post-treatment, patients completed the validated Constipation Severity Instrument and two measures of quality of life (QOL), the Irritable Bowel Syndrome-QOL, and the SF-36. Generalized estimating equations examined the within-group and between-group differences over time.ResultsPre- and post-treatment data were obtained for six AB and nine BC patients. AB patients overall constipation severity scores decreased by 35.5% (vs. 15.3%), and their obstructive defecation symptom scores decreased by 37.9% (vs. 19.7%) compared to BC. A similar pattern was shown on the IBS-QOL. On the SF-36 Mental Health Composite (MCS), AB scores improved 28.0% compared to BC scores, which worsened 12.7%. Those without (vs. with) a childhood sexual/physical abuse history showed improvement on the MCS post-biofeedback.ConclusionsWhile our sample was statistically underpowered, AB produced clinical improvements in constipation severity and QOL.

Improvements in Partner Support Predict Sexual Satisfaction Among Individuals With Multiple Sclerosis

PURPOSEnSexual dysfunction and low sexual satisfaction are common among individuals with multiple sclerosis (MS); however, little is known about factors that influence sexual satisfaction within this population. As such, the purpose of this study was to investigate the extent to which changes in negative and positive partner support predict sexual satisfaction levels over time in individuals with MS.nnnDESIGNnEighty-one individuals with MS completed measures of sexual dysfunction, sexual satisfaction, partner social support, and depression. Data from baseline and posttreatment follow-up were obtained from a larger randomized clinical trial of telephone-administered psychotherapy for depression in a population with MS. Multiple regression analyses were conducted with change in overall sexual satisfaction from baseline to posttreatment as the outcome variable.nnnRESULTSnAfter controlling for age, gender, sexual dysfunction, years diagnosed with MS, and depression severity, those with increased positive partner support reported significant improvement in sexual satisfaction over time (β = .50, p < .001), as did individuals with decreased negative partner support (β = .36, p < .01).nnnCONCLUSIONSnResults provide evidence that both positive and negative partner support have a distinctive role in the outcome of sexual satisfaction for individuals with MS. Understanding the unique role of positive and negative forms of partner support on sexual satisfaction will help lead to future interventions to improve sexual satisfaction among couples.

Cancer perceptions: implications from the 2007 Health Information National Trends Survey

IntroductionResearch has demonstrated associations between sociodemographic characteristics and illness perceptions; however, the impact of cancer exposure through personal or family diagnoses is not well-studied. The purposes of this study were to examine different cancer beliefs and disparities in cancer beliefs across groups of individuals with distinct cancer histories and to identify whether cancer history predicts a set of cancer beliefs.MethodsUsing Leventhal’s Common Sense Model and data from the 2007 Health Information National Trends Survey (Nu2009=u20097,172), we constructed multivariable logistic regression models to evaluate the effect of different stimuli, including cancer experience on cancer perceptions (e.g., prevention, causation, outcome, worry).ResultsFindings indicated significant associations between cancer history and cancer perceptions. Individuals with family and personal cancer histories were more likely than individuals without any cancer history to worry about getting cancer (ORu2009=u20093.55, 95xa0%CIu2009=u20092.53–4.99), agree they will develop cancer in the future (ORu2009=u20098.81, 95xa0%CIu2009=u20096.12–12.67) and disagree that cancer is most often caused by a person’s behavior or lifestyle (ORu2009=u20091.24, 95xa0%CIu2009=u20091.01–1.52).ConclusionsCancer history affects perceptions throughout the cancer continuum. Additionally, cancer history may influence coping behaviors and outcomes. Cancer education and survivorship programs should assess important variables such as cancer history to more effectively tailor services and monitor evolving needs throughout cancer care. IMPLICATIONS FOR CANCER SURVIVORS: Integrating cancer history information into patient education programs tailored to an individual’s needs may better empower survivors and their family members to effectively promote informed decision-making about screening and preventive health behaviors, manage cancer worry, and enhance quality of life.

Development and assessment of the constipation-related disability scale

Aliment Pharmacol Ther 2012; 35: 183–192