Steven C. Palmer

Marital quality, coping with conflict, marital complaints, and affection in couples with a depressed wife.

This study compared three groups of women--outpatient depressed, inpatient depressed, and community control--and their husbands on a range of variables including marital functioning and styles of coping with conflict. Outpatient depressed couples reported greater marital distress and more destructive and less constructive tactics for resolving conflict than did community control couples. They also were more likely to have been previously married and to express regrets about having married their current husbands. There were smaller and less consistent differences for couples with inpatient depressed spouses, although inpatient couples with younger wives were similar to outpatient depressed couples. Both groups of depressed women and their husbands reported fewer expressions of affection and more complaints about the marriage than did control couples. Results are discussed in terms of interpersonal perspectives on depression.

Experience of trauma, distress, and posttraumatic stress disorder among breast cancer patients.

Objectives Cancer would appear to be the paradigmatic example of an acute or chronic illness that can precipitate posttraumatic stress disorder (PTSD). Few studies, however, have examined the applicability of PTSD criteria to patients with cancer. We examined the relationships between the experience of trauma, psychological distress, and PTSD among a waiting room sample of patients with breast cancer. Methods We assessed 115 consecutive patients with breast cancer in the waiting room of a large comprehensive cancer center using measures of general distress, posttraumatic stress symptoms, and a semistructured diagnostic interview. Results A substantial minority (41%) reported responding to cancer with intense fear, helplessness, or horror (DSM-IV A2 criterion). However, cancer-related PTSD was uncommon (4%), and meeting the A2 criterion was a poor indicator of PTSD. Psychological distress was common (38%) and was strongly associated with A2, but was a poor predictor of PSTD. Conclusions Although an intense negative emotional reaction to breast cancer was common, PTSD had low prevalence. Results suggest that using a trauma framework to understand the experience of most patients with cancer may be inaccurate.

Survivorship care planning after the Institute of Medicine recommendations: how are we faring?

IntroductionThis study evaluates the concordance of treatment summaries (TSs) and survivorship care plans (SCPs) delivered to breast cancer survivors within the LIVESTRONG™ Network of Survivorship Centers of Excellence with Institute of Medicine (IOM) recommendations and describes additional structure/process variables.MethodSeven NCI-designated comprehensive cancer centers and six community-based centers participated. TS/SCPs for 65 patients were rated against IOM recommendations using a study-derived checklist, and surveys were administered to better understand the structure and process of delivering TSs/SCPs.ResultsOn average, fewer than half of IOM content recommendations were met for TSs (M = 46%) and less than two thirds for SCPs (M = 59%). No sites achieved ≥75% overall concordance with IOM recommendations for TSs and only two of 13 met this criterion for SCPs. Content domain scores across sites varied widely, as did the number of sites addressing domain content with ≥75% concordance. Nonetheless, resources required for document preparation and delivery were substantial.DiscussionGaps in concordance with IOM recommendations exist even in dedicated survivorship centers. A substantial time burden was also noted. Further research is needed to determine which informational elements are essential, to develop and test strategies for improving efficiency and reach, and to determine if outcomes of survivorship care planning warrant the resources required in their preparation and delivery.Implications for survivorsTSs and SCPs have been recommended for all cancer survivors. Essential elements must be determined, approaches made more efficient, outcome improvements demonstrated, and cost-benefit analyses determined before survivors should expect widespread implementation of this recommendation for survivorship care.

Psychotherapy and Survival in Cancer: The Conflict Between Hope and Evidence

Despite contradictory findings, the belief that psychotherapy promotes survival in people who have been diagnosed with cancer has persisted since the seminal study by D. Spiegel, J. R. Bloom, H. C. Kramer, and E. Gottheil (1989). The current authors provide a systematic critical review of the relevant literature. In doing so, they introduce some considerations in the design, interpretation of results, and reporting of clinical trials that have not been sufficiently appreciated in the behavioral sciences. They note endemic problems in this literature. No randomized clinical trial designed with survival as a primary endpoint and in which psychotherapy was not confounded with medical care has yielded a positive effect. Among the implications of the review is that an adequately powered study examining effects of psychotherapy on survival after a diagnosis of cancer would require resources that are not justified by the strength of the available evidence.

Screening for depression in medical care pitfalls, alternatives, and revised priorities

Depression is a disorder seen commonly in general and specialty medical settings. Screening has been advocated as a means of ensuring that depressed patients are identified and receive appropriate treatment. Yet, recommendations for routine screening are frequently made without reference to empirical data demonstrating that it will have its intended effect. We examine the literature regarding screening in medical settings and suggest that screening in itself is unlikely to improve patient outcomes. Further, we identify costs to screening that are not readily apparent and that may negatively affect both patient outcomes and health-care delivery systems. We offer suggestions for how screening instruments might be used to improve the outcomes of depressed persons while minimizing negative effects on health care.

Should we screen for depression? Caveats and potential pitfalls

Abstract The availability of brief screening instruments encourages their routine use in identifying individuals who are presumed to be at risk for clinical depression. In primary medical care where this idea has been most tested, however, there is little evidence that screening by itself improves the outcome of depression. Reasons why screening cannot serve as an efficient basis for the prevention of depression are reviewed. Moreover, a positive score on a screening instrument does not indicate a clear need for intervention or the form that any intervention should take. Routine screening should be undertaken only when the resources are available for interpreting the significance of positive screen scores, appropriate and acceptable interventions are available, and potential negative effects of screening can be avoided. Until these conditions can be met, alternatives to screening should be considered.

A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer

Objective: Peer‐to‐peer interactions are associated with enhanced psychosocial adjustment among women with breast cancer. Millions of women with cancer and others with various health conditions use the Internet to establish peer relationships, usually without professional moderation. This paper reports findings from the first randomized, controlled study of the benefits of these types of Internet‐based peer interactions.

Cardiovascular risk in long-term survivors of testicular cancer

Long‐term survivors of testicular cancer (TC) who received cisplatin‐based chemotherapy have an increased risk of cardiovascular disease. A cross‐sectional study was performed to objectively assess cardiovascular risk, subclinical atherosclerosis, and endothelial function in long‐term survivors of TC.

Unmet psychosocial needs of Pennsylvanians with cancer: 1986-2005.

The purpose of the current study was to identify unmet psychosocial needs of cancer survivors, understand the distribution of needs across subgroups, and compare unmet needs in 2005 with those identified by Houts et al. in 1986.

Special issue on depression and mental disorders and diabetes, renal disease and obesity and nutritional disordersScreening for depression in medical care: Pitfalls, alternatives, and revised priorities☆

Depression is a disorder seen commonly in general and specialty medical settings. Screening has been advocated as a means of ensuring that depressed patients are identified and receive appropriate treatment. Yet, recommendations for routine screening are frequently made without reference to empirical data demonstrating that it will have its intended effect. We examine the literature regarding screening in medical settings and suggest that screening in itself is unlikely to improve patient outcomes. Further, we identify costs to screening that are not readily apparent and that may negatively affect both patient outcomes and health-care delivery systems. We offer suggestions for how screening instruments might be used to improve the outcomes of depressed persons while minimizing negative effects on health care.