Terry A. DiLorenzo

The Goldman Consensus statement on depression in multiple sclerosis

Background. In January 2002 the New York City Chapter of the National Multiple Sclerosis Society convened a panel of experts to review the issue of depressive affective disorders associated with multiple sclerosis (MS). This Consensus Conference was supported by a grant from the Goldman family of New York City. Results. The panel reviewed summaries of current epidemiologic, neurobiologic, and therapeutic studies having to do with depressive disorders among MS patient populations. Depressive disorders occur at high rates among patients with MS, and there is reason to believe that the immunopathology of the disease is involved in the clinical expression of affective disorders. The depressive syndromes of MS have a major, negative impact on quality of life for MS sufferers, but are treatable. At the present time, most MS patients with depression do not receive adequate recognition and treatment. Conclusions. The Goldman Consensus Conference Study Group provides recommendations for improved screening, diagnosis, and clinical management for depressive affective disorders among patients suffering from MS.

Family and friends with disease:: their impact on perceived risk

BACKGROUND For many common diseases, having a family history is the strongest predictor of lifetime risk. Perceptions of personal risk, important for appropriate prevention efforts, have been found to be exaggerated in healthy individuals with family histories. These findings highlight the contribution of objective and experiential factors to perceived risk. This study examined, across a variety of diseases, whether (1) family history of the disease contributes to perceived risk, (2) history of disease in a friend or nonblood relative, which would not increase ones objective risk, nonetheless increases perceived risk, and (3) these effects are similar across genders. METHODS Participants (N = 522; 38% male; 56% Caucasian; mean age = 40 years) completed a brief health survey. RESULTS Analyses revealed an effect of having a family history of the disease on perceived risk for breast and colon cancers, heart disease, and diabetes (P < 0.001). Interestingly, having a friend diagnosed with the disease also contributed to perceived risk for breast and colon cancers, as well as heart disease and diabetes among women (P < 0.05), but not among men. CONCLUSIONS Results suggest that interventions to alter perceived risk of cancer should account for gender, as women appear to be impacted by who they know.

The application of a shortened version of the profile of mood states in a sample of breast cancer chemotherapy patients

Objectives. The Profile of Mood States (POMS) is a 65-item mood measure with demonstrated reliability and validity; however, its length can be of concern to researchers. The present study investigated the utility of a 37-item shortened version of the POMS (SV-POMS) developed by Shacham (1983). Design. In samples of breast cancer chemotherapy patients (patient group 1) and healthy volunteers, correlations between the subscales of the measures and internal consistencies were examined; these samples were also used to compare mood ratings of healthy women and patients. In another sample of breast cancer chemotherapy patients (patient group 2), the sensitivity to changes in mood of the measures was investigated. Methods. Patient group 1 comprised 114 women; patient group 2 comprised 48 women. Healthy volunteers were 55 women recruited through newspaper advertisements. Results. The correspondence between the measures was demonstrated by significant correlations of the shortened with the full-length scales. Internal consistencies of the measures were comparable. Both measures demonstrated mood differences between patients and volunteers. The responsiveness of the measures to change were comparable as demonstrated by changes in distress scores across chemotherapy infusions. Conclusions. Results suggest that the SV-POMS can be used when participant burden is of concern.

A qualitative analysis of acute skin toxicity among breast cancer radiotherapy patients

Objectives: One of the most common acute side effects of breast cancer radiotherapy is treatment‐induced skin changes, referred to as skin toxicity. Yet no research to date has focused expressly on skin toxicity‐related quality of life (QOL) in breast cancer radiotherapy patients. Therefore, our aim was to use qualitative approaches to better understand the impact of skin toxicity on QOL.

A Model of Disease-Specific Worry in Heritable Disease: The Influence of Family History, Perceived Risk and Worry About Other Illnesses

Disease-related worry is associated with family history and perceived risk of that disease; however, the influences of general risk perceptions and tendencies to worry about diseases have been neglected in the literature. This study investigates a model of disease-specific worry which includes family history, disease-specific perceived risk, and perceived risk for and worry about other diseases. Participants completed a survey assessing these variables in relation to several heritable diseases. Structural equation modeling found that family history predicted disease-specific perceived risk but not perceived risk for other diseases. Disease-specific perceived risk predicted disease-specific worry and worry about other diseases. Perceived risk for other diseases predicted worry about other diseases and disease-specific perceived risk but not disease-specific worry. Disease-specific worry predicted worry about other diseases. This model was supported across several diseases and indicates that disease-specific and general considerations of risk influence worry about a disease and should be considered in interventions.

A qualitative investigation of adaptation in older individuals with multiple sclerosis

Purpose. This qualitative investigation was designed to identify themes that underlie adaptation in older individuals with multiple sclerosis (MS). Method. Thirteen individuals (age 60 and above) with MS were recruited from an MS Comprehensive Care Centre and local chapters of the National Multiple Sclerosis Society. Participants completed The Perceptions of Aging Interview by telephone. This open-ended interview was developed to explore two lines of inquiry: MS: Perceptions of Aging, which was based on the literature on adaptation in MS, and Life Strengths, which was adapted from Kivnicks Life Strengths Inventory. Results. The majority of participants reported having adapted to MS and aging. They described several themes and subthemes that seemed to influence their levels of adaptation: Social comparisons, mobility/independence, integration of MS into self-identity, acceptance, pacing and planning, finding meaning/cognitive reframing, social support, religion/spirituality and generativity. Conclusions. The themes identified in this investigation are generally supported by the literatures on adaptation to MS and adaptation to aging. However, this is the first study to examine these factors in an older MS sample. Moreover, many of these themes are potentially modifiable through clinical intervention, and should be examined in future research with this population.

Reliability and validity of the Multiple Sclerosis Quality of Life Inventory in older individuals

Purpose: Despite the increasing number of older individuals with multiple sclerosis (MS), there is a paucity of research on this subpopulation. Health-related quality of life (HRQOL) has received extensive attention in MS; however samples tend to be young. The present study assesses the internal consistency reliability and construct validity of the MS Quality of Life Inventory (MSQLI), a widely employed measure of HRQOL, in older individuals. Method: Select subscales of the MSQLI and other measures of mental health and physical functioning were administered by telephone to 30 randomly selected older ( ⩾̸ 60) individuals and a gender-matched sample of younger ( < 60) individuals. Reliability estimates were calculated separately for each group. Construct (convergent) validity was assessed by examining the pattern of correlations between MSQLI subscales and measures of related constructs in the two groups. Results: Reliability estimates were similar in the two groups. With few exceptions, the correlations measuring convergent validity were in the expected direction, and of considerable magnitude, in both groups Conclusions: Results provide preliminary evidence that the MSQLI is a reliable and valid instrument for use with older individuals. The slightly different pattern of results observed in the validity analysis might be explained by an adjustment hypothesis. Future research on HRQOL in this subpopulation is encouraged.

Perceived Risk and Worry About Prostate Cancer: A Proposed Conceptual Model

Prostate cancer is one of the most common forms of cancer among American men, and worry about the disease has psychological, behavioral, and biological consequences. To better understand prostate cancer-specific worry, the authors tested a model of the interrelationships among family history of prostate cancer, perceived risk of and worry about prostate cancer, and perceived risk of and worry about other diseases. Men who attended prostate cancer-screening appointments at a general urology practice (n = 209) were given a brief anonymous self-report measure. Structural equation modeling (LISREL) results indicated: (1) perceived risk of prostate cancer mediated the relationship between family history of prostate cancer and prostate cancer worry; (2) perceived risk of other diseases increased perceived risk of prostate cancer; and (3) prostate cancer worry and increased other disease worry.

Comparison of Older and Younger Individuals With Multiple Sclerosis: A Preliminary Investigation

Objective: To describe and contrast physical functioning, mental health, and quality of life of older individuals with multiple sclerosis (MS) with those of younger individuals with MS. Design/Participants: Thirty older (age 60 years) and 30 younger participants with MS (age 60 years) completed telephone interviews. Main Outcome Measures: Selected subtests of the Multiple Sclerosis Quality of Life Instrument, Patient-Determined Disease Steps, Profile of Mood States—Shortened Version, Beck Depression Inventory, and Activities of Daily Living Scale. Results: After accounting for duration of illness, older individuals reported greater physical impairment than younger individuals but did not report poorer quality of life or mental health. Conclusion: Older individuals may undergo a psychological adjustment process enabling them to cope with physical impairment. A greater number of older individuals with multiple sclerosis (MS) can be expected because of the aging of the general population overall and the fact that individuals with MS now have normal life expectancies (Weinshenker, 1994). However, there has been a paucity of research on this population. Although investigators have considered the influence of age in MS, samples have tended to be relatively young. Many studies have also considered the influence of duration of MS. Although duration and age are related, one is not a proxy for the other. No study, to our knowledge, has examined the independent effects of age and illness duration on physical functioning, mental health, or quality of life (QOL). A review of the natural history literature in MS found only one study that examined the association between age and disability (Provinciali, Ceravolo, Bartolini, Logullo, & Danni, 1999) and these were unrelated. However, the mean age of participants was only 43.6 years. Studies of duration of illness and disease course (e.g., Ebers et al., 2000) have indicated that MS tends to progress over time, but that course is unpredictable. These studies did not assess QOL or mental health. Mental health is often negatively affected by MS, with lifetime prevalence estimates of depression ranging from 36.7% (Schiffer, Caine, Bamford, & Levy, 1983) to 54% (Minden, Orav, & Reich, 1987). A few studies have found age and mental health to be unrelated (e.g., Singer, Hopman, & MacKenzie, 1999). However, because of the relatively young age of the samples, these studies provide little information about mental health in older individuals. QOL has been extensively investigated in MS. However, most studies have considered duration of disease rather than age. Duration tends to be negatively associated with physical domains but unrelated or positively associated with mental health (e.g., Hopman, Coo, Brunet, Edgar, & Singer, 2000). A few studies did look at age in relation to QOL (e.g., Koch, Rumrill, Roessler, & Fitzgerald, 2001); however, the mean ages were young (40s). One study (Roberts & Stuifbergen, 1998) found no differences between older (60‐75 years) and younger individuals. In view of the limited research in this area, we undertook the present study, a preliminary investigation of physical functioning, mental health, and QOL in older individuals with MS.

Quality of life in MS: does aging enhance perceptions of mental health?

Purpose. This study was designed to examine the relationship between age and quality of life in middle aged and older adults with MS. Method. Individuals with MS, recruited through a Comprehensive Care Centre and local registries of the National Multiple Sclerosis Society, completed a telephone interview which incorporated several scales of the MS Quality of Life Inventory. Participants were divided into three age groups reflective of developmental transitions in adulthood, from midlife transition to late adulthood. Results. Between group comparisons controlling for physical functioning and duration of MS revealed that the oldest age group (age 65 and above) reported significantly better mental health than the middle age group (age 50–64), but not the youngest age group (age 35–49). Differences between the middle and youngest age group were not significant. Conclusions. Results suggest that perhaps the process of getting older, or factors related to being older, enhance perceptions of mental health in individuals with MS. Results are discussed within the context of social comparison theory, which might be an adaptive strategy that could underlie response shift in older individuals with MS.