Stephen Holzapfel

Stress, social support, and emotional distress in a community sample of pregnant women

Emotional distress in women during pregnancy has been shown to increase the risk of adverse outcomes for women and newborns. Increasingly, assessment and management of mood and anxiety problems during pregnancy entail consideration of life stress and interpersonal relationships with partners, friends, and family members. This study describes cross-sectional relations between life stress, perceived social support, and symptoms of depression and anxiety as well as the mediating influence of social support on relations between stress and symptoms. A community sample of women (N = 2,052) provided self-report data during their second trimester of pregnancy. Empirical fit was found for a structural equation model that depicted the combined influences of sociodemographic factors (i.e., socioeconomic status, age, parity), stress (partner conflict and life events), and social support on symptoms of depression and anxiety, χ2 (df 51) = 310.65, p < .05; CFI = .91. Women who reported low levels of social support showed stronger relations between stress and symptoms than women who reported high levels of social support - indicative of a mediating effect of social support. Consistent with previous studies, results suggest that dyadic psychosocial assessment of pregnant women and their partners may facilitate interventions to augment support networks, thereby reducing the risk of emotional distress.

EVALUATING PATIENT'S KNOWLEDGE OF MATERNAL SERUM SCREENING

The objective was to describe the development, characteristics, and initial use of an instrument for assessing knowledge about maternal serum screening (MSS). Items for a knowledge scale were selected based on a review of educational materials, the literature, and expert opinion. Items were pre‐tested for comprehensibility and ambiguity in a convenience sample. After extensive pre‐testing and pilot testing a 14‐item scale, the Maternal Serum Screening Knowledge Questionnaire (MSSKQ) was developed. It was administered to 1084 women attending a maternal registration clinic. The overall knowledge score was compared across socio‐demographic groups, and by sources of information about MSS. Mean MSSKQ scores increased with age, education, and family income, and among those reporting having an opportunity to discuss MSS and receiving written material. The MSSKQ is a reliable instrument with good content and construct validity. This tool should be valuable in assessing knowledge and level of informed consent in women receiving MSS and in evaluating the implementation of MSS programmes.

Aphasia and Sexuality

Changes in sexuality following stroke have attracted the interest of clinical researchers, but studies seldom include aphasic individuals, who comprise almost one third of the stroke population. Studies excluded those with moderate or severe aphasia because they cannot participate in interviews or complete questionnaires used in sexuality research. This pilot study investigated how stroke changed sexuality for aphasic people and their spouses. We sought their input as to when these issues should be addressed during the process of stroke recovery, and by whom. Interviews included a structured verbal questionnaire supported by gesture, written, and pictographic materials. Responses were qualitatively analyzed. We found that aphasia affects sexuality differently than for other stroke patients. They believe that improved communication skills would help their sex life. Aphasic individuals and their spouses are open to discussing sexuality with a physician and have specific medical, physical, and psychological issues they wish to address.

Counseling and Psychotherapy Skills Training for Family Physicians

In many healthcare systems, family physicians are the primary source of direct care for patients with mental health problems in the community, yet family physicians are not often routinely or adequately trained to conduct counseling or psychotherapy. The current study conducted a 5-weekend yearlong, hands-on, interactive, intensive training of family physicians in the skills of officebased counseling/psychotherapy. Fifty-five family physicians took the course over 4 different years. Outcomes were analyzed with 3 major measures and collected at baseline, the end of the course, and 6 months later. Based on an ability to answer a skill-testing questionnaire called the Carkhuff Discrimination Skills Index, all the family physician participants significantly improved their counseling skills by the end of the course and about half continued to improve 6 months later. Participants showed significant improvement in their confidence counseling individuals, couples, and families. Participants also indicated they significantly increased the time they spent in counseling individual patients as a result of the course. Implications for future research on primary care training programs in psychological therapy are discussed.